Scott Brian, Johnson Romaine F, Mitchell Md Ron B
University of Texas Southwestern Medical Center, Dallas, Texas, USA.
University of Texas Southwestern Medical Center, Dallas, Texas, USA Children's Health, Children's Medical Center Dallas, Dallas, Texas, USA.
Otolaryngol Head Neck Surg. 2016 May;154(5):936-43. doi: 10.1177/0194599816636626. Epub 2016 Mar 15.
The severity of obstructive sleep apnea in children determines perioperative management and is an indication for postoperative polysomnography. The relationship between increasing weight and sleep apnea severity in children remains unclear.
To compare demographic, clinical, and polysomnography parameters in normal-weight, overweight, obese, and morbidly obese children, as well as identify demographic factors that predict sleep apnea severity.
Case series with chart review.
Academic children's hospital.
A retrospective chart review of 290 children aged 2 to 18 years who underwent polysomnography at an academic children's hospital was performed. Demographics, clinical findings, and polysomnographic parameters were recorded. Children were categorized as normal weight, overweight, obese, or morbidly obese. Differences were assessed using linear and logistical regression models. Significance was set at P < .05.
Morbidly obese were older than normal-weight children (mean, 8.0 ± 0.5 years vs 5.8 ± 0.3 years; P < .001) and less likely to have a normal polysomnogram (16% vs 48%; P = .02). There were no differences in sex, ethnicity, birth status (term or preterm), or tonsil size between normal-weight, overweight, obese, and morbidly obese children. Sleep efficiency and percentage of time in rapid eye movement were decreased in morbidly obese compared with other children (P < .05). The apnea-hypopnea index was positively correlated with increasing body mass index z score only as a function of increasing age (P < .001).
Obstructive sleep apnea severity is correlated with a combination of increasing age and weight but not with either variable independently. This study suggests that obese and morbidly obese older children are most likely to have severe obstructive sleep apnea.
儿童阻塞性睡眠呼吸暂停的严重程度决定围手术期管理，也是术后多导睡眠图检查的一项指征。儿童体重增加与睡眠呼吸暂停严重程度之间的关系仍不明确。
比较正常体重、超重、肥胖和病态肥胖儿童的人口统计学、临床及多导睡眠图参数，并确定预测睡眠呼吸暂停严重程度的人口统计学因素。
病例系列研究并进行图表回顾。
学术性儿童医院。
对一家学术性儿童医院290例年龄在2至18岁接受多导睡眠图检查的儿童进行回顾性图表分析。记录人口统计学、临床发现及多导睡眠图参数。将儿童分为正常体重、超重、肥胖或病态肥胖。使用线性和逻辑回归模型评估差异。显著性设定为P <.05。
病态肥胖儿童比正常体重儿童年龄大（平均年龄，8.0±0.5岁对5.8±0.3岁；P <.001），且多导睡眠图正常的可能性较小（16%对48%；P =.02）。正常体重、超重、肥胖和病态肥胖儿童在性别、种族、出生状况（足月或早产）或扁桃体大小方面无差异。与其他儿童相比，病态肥胖儿童的睡眠效率和快速眼动时间百分比降低（P <.05）。呼吸暂停低通气指数仅作为年龄增长的函数与体重指数z评分增加呈正相关（P <.001）。
阻塞性睡眠呼吸暂停严重程度与年龄增长和体重增加的综合因素相关，而非单独与任何一个变量相关。本研究表明，肥胖和病态肥胖的大龄儿童最有可能患有严重的阻塞性睡眠呼吸暂停。
