Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI.
Department of Oral & Maxillofacial Surgery, University of Michigan, Ann Arbor, MI.
J Clin Sleep Med. 2015 Jan 15;11(1):37-43. doi: 10.5664/jcsm.4360.
Obstructive sleep symptoms are common in children with craniofacial malformations (CFM). However objective data about obstructive sleep apnea (OSA) is still limited. The aims of this study were to investigate the frequency of OSA in symptomatic children with CFM and to determine improvement in severity of OSA after treatment.
Symptomatic children with CFM referred for a diagnostic polysomnogram (PSG) were identified. Obstructive sleep apnea was defined as an apnea/hypopnea index (AHI) ≥ 1, with moderate/severe OSA as an AHI ≥ 5.
Overall, 151 symptomatic children were identified; 87% were diagnosed with OSA, of whom 24% had moderate-to-severe OSA. Children with syndromic CFM, compared to non-syndromic CFM, were more likely to have an AHI ≥ 5 (syndromic 33% vs. non-syndromic 15%, p = 0.02). Of the 131 children with OSA, 64 were treated and 32 returned for a posttreatment PSG, with 22 treated with either positive airway pressure (PAP) or adenotonsillectomy (AT). Children treated with PAP demonstrated a decrease in AHI from 6.2 to 3.5 (p = 0.057) and an increase in SpO2 from 89.1% to 91.1% (p = 0.091). There were no significant improvements for those in the AT group for either AHI (2.5 to 1.8, p = 0.19) or SpO2 (90.4% to 91.3%, p = 0.46). Normalization of the AHI (AHI < 1) occurred in only one child in each group (7% and 14% of the PAP and AT groups, respectively).
The vast majority of children with CFM referred for OSA evaluation are found to have objective evidence of OSA and a quarter of children have moderate-to-severe OSA. It is likely that many children with underlying OSA are not identified and referred for evaluation. Residual OSA after treatment is common in children with CFM.
颅面畸形（CFM）儿童常存在阻塞性睡眠症状。然而，阻塞性睡眠呼吸暂停（OSA）的客观数据仍然有限。本研究旨在调查有症状的 CFM 儿童中 OSA 的频率，并确定治疗后 OSA 严重程度的改善。
确定因诊断性多导睡眠图（PSG）而被转诊的有症状的 CFM 儿童。阻塞性睡眠呼吸暂停定义为呼吸暂停/低通气指数（AHI）≥1，中度/重度 OSA 定义为 AHI≥5。
总体而言，确定了 151 名有症状的儿童；87%被诊断为 OSA，其中 24%患有中重度 OSA。与非综合征性 CFM 相比，综合征性 CFM 儿童更有可能 AHI≥5（综合征性 33%比非综合征性 15%，p=0.02）。在 131 名患有 OSA 的儿童中，有 64 名接受了治疗，32 名返回进行了治疗后 PSG，其中 22 名接受了正压通气（PAP）或腺样体扁桃体切除术（AT）治疗。接受 PAP 治疗的儿童 AHI 从 6.2 降至 3.5（p=0.057），SpO2 从 89.1%增加至 91.1%（p=0.091）。AT 组的 AHI（2.5 至 1.8，p=0.19）和 SpO2（90.4%至 91.3%，p=0.46）均无显著改善。两组中仅有一名儿童 AHI 正常（PAP 和 AT 组分别为 7%和 14%）。
大多数因 OSA 评估而被转诊的 CFM 儿童均存在 OSA 的客观证据，其中四分之一的儿童患有中度至重度 OSA。很可能有许多患有潜在 OSA 的儿童未被识别并转介进行评估。CFM 儿童治疗后仍存在 OSA 很常见。
