Al-Saleh Suhail, Kantor Paul F, Chadha Neil K, Tirado Yamilet, James Adrian L, Narang Indra
1 Division of Respiratory Medicine and.
Ann Am Thorac Soc. 2014 Jun;11(5):770-6. doi: 10.1513/AnnalsATS.201309-325OC.
Cardiomyopathy is a rare condition in children that is associated with high mortality. Although sleep-disordered breathing is prevalent, its frequency and patterns in children with cardiomyopathy are unknown.
To evaluate the frequency and patterns of sleep-disordered breathing and their relationship to cardiac function in children with primary cardiomyopathy.
This study comprised a prospective, uncontrolled case series. Children with cardiomyopathy completed a sleep questionnaire, overnight polysomnography, blood pressure monitoring, otolaryngological assessment, and transthoracic echocardiography at the Hospital for Sick Children in Toronto, Canada.
Twenty-one patients (17 males) were recruited. The median age of the patients was 10.7 years, and the median body mass index z score was 0.8. Sleep-disordered breathing was observed in 10 (48%) of 21 patients. Significant central sleep apnea was the main finding in 5 (24%) of 21 of the cohort and in 50% of the sleep-disordered breathing population. The left ventricular end diastolic volume index was greater in children with central sleep apnea than in children without sleep-disordered breathing (P = 0.03). There were significant correlations between the central apnea-hypopnea index and both left ventricular end diastolic and end systolic volume indexes (Spearman's r = 0.55, P = 0.01; Spearman's r = 0.47, P = 0.03, respectively). Snoring, sleep architecture, blood pressure, and otolaryngological findings were not significantly different between children with sleep-disordered breathing versus those without sleep-disordered breathing.
Sleep-disordered breathing is common in children with cardiomyopathy. In our present study, 24% of participants exhibited primarily central sleep apnea. The severity of cardiac dysfunction, as measured by left ventricular end diastolic volume index and left ventricular end systolic volume index, is associated with central sleep apnea. Longitudinal research is necessary to better characterize sleep disorders and their impact on cardiac function in a large pediatric cardiomyopathy population.
心肌病在儿童中是一种罕见疾病，死亡率很高。虽然睡眠呼吸障碍很常见，但心肌病患儿中其发生频率和模式尚不清楚。
评估原发性心肌病患儿睡眠呼吸障碍的频率和模式及其与心功能的关系。
本研究为前瞻性、非对照病例系列研究。加拿大多伦多病童医院的心肌病患儿完成了一份睡眠问卷、整夜多导睡眠图监测、血压监测、耳鼻喉科评估及经胸超声心动图检查。
共纳入21例患者（17例男性）。患者的中位年龄为10.7岁，中位体重指数z评分为0.8。21例患者中有10例（48%）存在睡眠呼吸障碍。显著中枢性睡眠呼吸暂停是该队列21例中的5例（24%）以及睡眠呼吸障碍人群中的50%的主要表现。中枢性睡眠呼吸暂停患儿的左心室舒张末期容积指数高于无睡眠呼吸障碍患儿（P = 0.03）。中枢性呼吸暂停低通气指数与左心室舒张末期和收缩末期容积指数均存在显著相关性（斯皮尔曼相关系数r分别为0.55，P = 0.01；r = 0.47，P = 0.03）。有睡眠呼吸障碍的患儿与无睡眠呼吸障碍的患儿在打鼾、睡眠结构、血压及耳鼻喉科检查结果方面无显著差异。
睡眠呼吸障碍在心肌病患儿中很常见。在我们目前的研究中，24%的参与者主要表现为中枢性睡眠呼吸暂停。通过左心室舒张末期容积指数和左心室收缩末期容积指数衡量的心脏功能障碍严重程度与中枢性睡眠呼吸暂停有关。有必要进行纵向研究，以更好地描述大型儿科心肌病群体中的睡眠障碍及其对心功能的影响。
