Sawatari Hiroyuki, Chishaki Akiko, Nishizaka Mari, Matsuoka Fumio, Yoshimura Chikara, Kuroda Hiromi, Rahmawati Anita, Hashiguchi Nobuko, Miyazono Mami, Ono Junji, Ohkusa Tomoko, Ando Shin-Ichi
Department of Health Sciences, Kyushu University Graduate School of Medical Sciences, 2) Research Fellow of the Japan Society for the Promotion of Science, Japan.
Intern Med. 2015;54(9):1003-8. doi: 10.2169/internalmedicine.54.3989. Epub 2015 May 1.
It is well known that people with Down's syndrome (DS) frequently complicate with congenital heart diseases (CHDs). Patients with heart diseases often have sleep-disordered breathing as a co-morbidity (SDB) which worsens the heart diseases. However, the relationship between SDB and CHDs in DS people has not yet been fully elucidated. The aim of this study was to establish the association between SDB and CHDs in DS people using data from a large nationwide questionnaire survey in Japan.
We conducted a cross-sectional questionnaire survey of a randomly selected sample of 2,000 DS people and their caregivers throughout Japan to examine the associations between observed signs of SDB and CHDs in DS people. The questionnaire included the presence of SDB symptoms (snoring, apnea, arousal, nocturia, and napping) and CHDs (the presence and types of CHDs).
Of the 1,222 replies received from the caregivers, 650 reported complications of some type of CHDs. The observed apnea tended to be higher among DS people with CHDs than those without CHDs (OR=1.28, 95% CI=0.97-1.70, p=0.09). DS people with tetralogy of Fallot reported significantly more frequent apnea than those without CHDs (OR=3.10, 95% CI=1.36-7.05, p<0.01).
SDB prevailed among DS people with severe CHDs, such as tetralogy of Fallot. Careful attention to the signs of SDB in such patients may lead to earlier clinical intervention removing the vicious cycle between SDB and CHDs.
众所周知，唐氏综合征（DS）患者常并发先天性心脏病（CHD）。患有心脏病的患者经常合并睡眠呼吸障碍（SDB），这会使心脏病恶化。然而，DS患者中SDB与CHD之间的关系尚未完全阐明。本研究的目的是利用日本全国范围内一项大型问卷调查的数据，确定DS患者中SDB与CHD之间的关联。
我们对日本全国随机抽取的2000名DS患者及其照料者进行了横断面问卷调查，以研究DS患者中观察到的SDB体征与CHD之间的关联。问卷包括SDB症状（打鼾、呼吸暂停、觉醒、夜尿和小睡）的存在情况以及CHD（CHD的存在情况和类型）。
在照料者收到的1222份回复中，650份报告了某种类型CHD的并发症。观察到患有CHD的DS患者呼吸暂停的发生率往往高于未患CHD的患者（OR=1.28，95%CI=0.97-1.70，p=0.09）。法洛四联症的DS患者报告的呼吸暂停明显比未患CHD的患者更频繁（OR=3.10，95%CI=1.36-7.05，p<0.01）。
SDB在患有严重CHD（如法洛四联症）的DS患者中普遍存在。对此类患者的SDB体征予以密切关注可能会促使更早进行临床干预，消除SDB与CHD之间的恶性循环。
