Machado Rodrigo Strehl, Woodley Frederick W, Skaggs Beth, Di Lorenzo Carlo, Eneli Ihuoma, Splaingard Mark, Mousa Hayat
Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
Division of Pediatric Gastroenterology, Ohio State University, Columbus, OH, USA.
Pediatr Gastroenterol Hepatol Nutr. 2016 Mar;19(1):12-9. doi: 10.5223/pghn.2016.19.1.12. Epub 2016 Mar 22.
This study was performed to evaluate the quality of sleep in snoring obese children without obstructive sleep apnea (OSA); and to study the possible relationship between sleep interruption and gastroesophageal reflux (GER) in snoring obese children.
Study subjects included 13 snoring obese children who were referred to our sleep lab for possible sleep-disordered breathing. Patients underwent multichannel intraluminal impedance and esophageal pH monitoring with simultaneous polysomnography. Exclusion criteria included history of fundoplication, cystic fibrosis, and infants under the age of 2 years. Significant association between arousals and awakenings with previous reflux were defined by symptom-association probability using 2-minute intervals.
Sleep efficiency ranged from 67-97% (median 81%). A total of 111 reflux episodes (90% acidic) were detected during sleep, but there were more episodes per hour during awake periods after sleep onset than during sleep (median 2.3 vs. 0.6, p=0.04). There were 279 total awakenings during the sleep study; 56 (20.1%) of them in 9 patients (69.2%) were preceded by reflux episodes (55 acid, 1 non-acid). In 5 patients (38.5%), awakenings were significantly associated with reflux.
The data suggest that acid GER causes sleep interruptions in obese children who have symptoms of snoring or restless sleep and without evidence of OSA.
本研究旨在评估无阻塞性睡眠呼吸暂停（OSA）的打鼾肥胖儿童的睡眠质量；并研究打鼾肥胖儿童睡眠中断与胃食管反流（GER）之间的可能关系。
研究对象包括13名因可能存在睡眠呼吸障碍而被转诊至我们睡眠实验室的打鼾肥胖儿童。患者接受多通道腔内阻抗和食管pH监测，同时进行多导睡眠图检查。排除标准包括胃底折叠术史、囊性纤维化病史以及2岁以下婴儿。使用2分钟间隔的症状关联概率来定义觉醒与既往反流之间的显著关联。
睡眠效率范围为67%-97%（中位数81%）。睡眠期间共检测到111次反流事件（90%为酸性），但睡眠开始后清醒期每小时的反流事件比睡眠期间更多（中位数2.3对0.6，p=0.04）。睡眠研究期间共有279次觉醒；其中9名患者（69.2%）的56次（20.1%）觉醒之前有反流事件（55次酸性，1次非酸性）。在5名患者（38.5%）中，觉醒与反流显著相关。
数据表明，酸性GER会导致有打鼾或睡眠不安症状且无OSA证据的肥胖儿童出现睡眠中断。
