明显的危及生命事件可能是睡眠呼吸障碍的一个警钟。

Apparent life-threatening events could be a wake-up call for sleep disordered breathing.

作者信息

Rabasco Jole, Vigo Alessandro, Vitelli Ottavio, Noce Silvia, Pietropaoli Nicoletta, Evangelisti Melania, Pia Villa Maria

机构信息

Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs, Pediatric Sleep Disorder Centre, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy.

Center for Pediatric Sleep Medicine and SIDS, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Department of Pediatrics, University of Turin, Turin, Italy.

出版信息

Pediatr Pulmonol. 2016 Dec;51(12):1403-1408. doi: 10.1002/ppul.23468. Epub 2016 May 10.

DOI:10.1002/ppul.23468

PMID:27163733

Abstract

INTRODUCTION

Polysomnographic recordings of children with an apparent life-threatening event (ALTE) have often displayed signs of partial or complete obstruction during sleep. Various studies have focused on facial dysmorphia in infants with ALTE and tried to establish a correlation between ALTE and obstructive sleep apnoea. Our study evaluates the phenotypic characteristics and the presence of sleep disorders in pre-school children who had at least one ALTE in the first year of life.

MATERIALS AND METHODS

We analyzed a group of pre-school children (mean age 5.21 ± 0.90 years) who were referred for an ALTE between 2008 and 2010. Children with no history of ALTEs were recruited as a control group. A detailed personal and family history was obtained for all the participants. Moreover, all the children underwent a general clinical examination and an ear, nose, and throat and orthodontic assessment. A clinical score was calculated according to the previously validated Sleep Clinical Record (SCR).

RESULTS

In the ALTE group (n = 107), snoring (25.2% vs. 6.1%), apnoeas (19.6% vs. 4.3%), restless sleep (31.7% vs. 6.1%), and habitual mouth breathing (35.5% vs. 12.2%, P < 0.05) were significantly more common (P < 0.05) than in the control group (n = 115). The ALTE group also displayed a higher frequency of Angle class II (27.1% vs. 15.7%, P < 0.05), narrow palate (72.9% vs. 51.3%, P < 0.05), and Friedman palate position (grades III-IV) (31.7% vs. 16.6%, P < 0.05) than the control group. Moreover, 38/107 (35.5%) children in the ALTE group had a positive SCR score compared with 14/115 controls (12.2%) (P < 0.05).

CONCLUSIONS

Pre-school age children with previous ALTE had a higher frequency of sleep disordered breathing and malocclusion phenotypes. The occurrence of ALTEs may be predictive of the development of sleep disordered breathing and highlight the importance of a long-term follow-up. Pediatr Pulmonol. 2016;51:1403-1408. © 2016 Wiley Periodicals, Inc.

摘要

引言

有明显危及生命事件（ALTE）的儿童多导睡眠图记录常常显示睡眠期间存在部分或完全性梗阻迹象。多项研究聚焦于患有ALTE的婴儿的面部畸形，并试图确立ALTE与阻塞性睡眠呼吸暂停之间的关联。我们的研究评估了在生命第一年至少经历过一次ALTE的学龄前儿童的表型特征和睡眠障碍情况。

材料与方法

我们分析了一组在2008年至2010年间因ALTE前来就诊的学龄前儿童（平均年龄5.21±0.90岁）。招募无ALTE病史的儿童作为对照组。为所有参与者获取了详细的个人和家族病史。此外，所有儿童都接受了全面的临床检查以及耳鼻喉和正畸评估。根据先前验证的睡眠临床记录（SCR）计算临床评分。

结果

在ALTE组（n = 107）中，打鼾（25.2%对6.1%）、呼吸暂停（19.6%对4.3%）、睡眠不安（31.7%对6.1%）和习惯性口呼吸（35.5%对12.2%，P < 0.05）明显比对照组（n = 115）更常见（P < 0.05）。ALTE组在安氏II类错颌（27.1%对15.7%，P < 0.05）、腭狭窄（72.9%对51.3%，P < 0.05）和弗里德曼腭位置（III - IV级）（31.7%对16.6%，P < 0.05）方面的发生率也高于对照组。此外，ALTE组中有38/107（35.5%）的儿童SCR评分为阳性，而对照组为14/115（12.2%）（P < 0.05）。