睡眠临床记录在阻塞性睡眠呼吸暂停（OSA）患儿治疗后随访中的应用。
Use of the sleep clinical record in the follow-up of children with obstructive sleep apnea (OSA) after treatment.
作者信息
Villa Maria Pia, Sujanska Anna, Vitelli Ottavio, Evangelisti Melania, Rabasco Jole, Pietropaoli Nicoletta, Banovcin Peter, Kheirandish-Gozal Leila, Gozal David
机构信息
Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy.
Department of Pediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia.
出版信息
Sleep Breath. 2016 Mar;20(1):321-9. doi: 10.1007/s11325-015-1287-7. Epub 2015 Nov 13.
PURPOSE
The aim of our study was to evaluate the utility of the sleep clinical record (SCR) in the follow-up of children with obstructive sleep apnea (OSA) after treatment.
METHODS
SCR was completed and overnight polysomnography (PSG) was performed in all enrolled children (T0), with SCR considered positive for scores ≥6.5, as previously validated. Patients underwent adenotonsillectomy (T&A), rapid maxillary expansion (RME), and medical therapy according to severity of OSA and clinical features. Six months after completing therapy, the second overnight PSG and SCR (T1) were performed.
RESULTS
For all subjects, both Apnea-Hypopnea Index (AHI) and total SCR score decreased significantly (<0.005) from T0 to T1. For SCR items, clinical examination (item 1) and reported sleep respiratory symptoms (item 2) ameliorated significantly (<0.005). However, hyperactivity or inattention (item 3) decreased significantly (<0.005) after treatment only in T&A group, while no differences in AHI and SCR scores occurred in the medically treated group. At T1, SCR was positive in 95.6 % of children with AHI ≥1, with a concordance of 100 % in the T&A and RME groups, resulting in a positive predictive value of 100 %. A poor concordance (38.3 % in T&A group and 53.4 % in RME group) was found when SCR < 6.5. Children with SCR ≥ 6.5 at T1 showed higher AHI compared to patients with SCR < 6.5 (5.7 ± 5.9 ev/h vs 1.78 ± 1.76 ev/h; p < 0.005).
CONCLUSIONS
SCR emerges as a potentially useful instrument for follow-up of children with OSA after treatment.
目的
本研究旨在评估睡眠临床记录（SCR）在阻塞性睡眠呼吸暂停（OSA）患儿治疗后随访中的作用。
方法
所有入选儿童（T0）均完成SCR并进行整夜多导睡眠图（PSG）检查，如先前验证的那样，SCR评分≥6.5被视为阳性。根据OSA的严重程度和临床特征，患者接受腺样体扁桃体切除术（T&A）、快速上颌扩弓（RME）和药物治疗。治疗完成6个月后，进行第二次整夜PSG和SCR（T1）检查。
结果
对于所有受试者，从T0到T1，呼吸暂停低通气指数（AHI）和SCR总分均显著降低（<0.005）。对于SCR项目，临床检查（项目1）和报告的睡眠呼吸症状（项目2）有显著改善（<0.005）。然而，多动或注意力不集中（项目3）仅在T&A组治疗后显著降低（<0.005），而药物治疗组的AHI和SCR评分没有差异。在T1时，AHI≥1的儿童中95.6%的SCR为阳性，T&A组和RME组的一致性为100%，阳性预测值为100%。当SCR<6.5时，一致性较差（T&A组为38.3%，RME组为53.4%）。T1时SCR≥6.5的儿童与SCR<6.5的患者相比，AHI更高（5.7±5.9次/小时比1.78±1.76次/小时；p<0.005）。
结论
SCR成为OSA患儿治疗后随访的一种潜在有用工具。
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