睡眠结构与综合征性颅缝早闭儿童的气道阻塞和颅内高压相关。

Sleep Architecture Linked to Airway Obstruction and Intracranial Hypertension in Children with Syndromic Craniosynostosis.

作者信息

Spruijt Bart, Mathijssen Irene M J, Bredero-Boelhouwer Hansje H, Cherian Perumpillichira J, Corel Linda J A, van Veelen Marie-Lise, Hayward Richard D, Tasker Robert C, Joosten Koen F M

机构信息

Rotterdam, The Netherlands; London, United Kingdom; and Boston, Mass.

From the Dutch Craniofacial Center; the Departments of Plastic and Reconstructive Surgery and Hand Surgery, Clinical Neurophysiology, and Neurosurgery, and the Pediatric Intensive Care Unit, Erasmus Medical Center-Sophia Children's Hospital, University Medical Center Rotterdam; the Department of Neurosurgery, Great Ormond Street Hospital for Children; and the Departments of Neurology and Anaesthesia (Pediatrics), Harvard Medical School and Boston Children's Hospital.

出版信息

Plast Reconstr Surg. 2016 Dec;138(6):1019e-1029e. doi: 10.1097/PRS.0000000000002741.

DOI:10.1097/PRS.0000000000002741

PMID:27879596

Abstract

BACKGROUND

Children with syndromic craniosynostosis often have obstructive sleep apnea and intracranial hypertension. The authors aimed to evaluate (1) sleep architecture, and determine whether this is influenced by the presence of obstructive sleep apnea and/or intracranial hypertension; and (2) the effect of treatment on sleep architecture.

METHODS

This study included patients with syndromic craniosynostosis treated at a national referral center, undergoing screening for obstructive sleep apnea and intracranial hypertension. Obstructive sleep apnea was identified by polysomnography, and categorized into no, mild, moderate, or severe. Intracranial hypertension was identified by the presence of papilledema on funduscopy, supplemented by optical coherence tomography and/or intracranial pressure monitoring. Regarding sleep architecture, sleep was divided into rapid eye movement or non-rapid eye movement sleep; respiratory effort-related arousals and sleep efficiency were scored.

RESULTS

The authors included 39 patients (median age, 5.9 years): 19 with neither obstructive sleep apnea nor intracranial hypertension, 11 with obstructive sleep apnea (four moderate/severe), six with intracranial hypertension, and three with obstructive sleep apnea and intracranial hypertension. Patients with syndromic craniosynostosis, independent of the presence of mild obstructive sleep apnea and/or intracranial hypertension, have normal sleep architecture compared with age-matched controls. Patients with moderate/severe obstructive sleep apnea have a higher respiratory effort-related arousal index (p < 0.01), lower sleep efficiency (p = 0.01), and less rapid eye movement sleep (p = 0.04). An improvement in sleep architecture was observed following monobloc surgery (n = 5; rapid eye movement sleep, 5.3 percent; p = 0.04).

CONCLUSIONS

Children with syndromic craniosynostosis have in principle normal sleep architecture. However, moderate/severe obstructive sleep apnea does lead to disturbed sleep architecture, which fits within a framework of a unifying theory for obstructive sleep apnea, intracranial hypertension, and sleep.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

摘要

背景

综合征性颅缝早闭患儿常伴有阻塞性睡眠呼吸暂停和颅内高压。作者旨在评估：（1）睡眠结构，并确定其是否受阻塞性睡眠呼吸暂停和/或颅内高压的影响；（2）治疗对睡眠结构的影响。

方法

本研究纳入了在一家国家转诊中心接受治疗的综合征性颅缝早闭患者，这些患者均接受了阻塞性睡眠呼吸暂停和颅内高压筛查。通过多导睡眠图确定阻塞性睡眠呼吸暂停，并将其分为无、轻度、中度或重度。通过眼底镜检查发现视乳头水肿，并辅以光学相干断层扫描和/或颅内压监测来确定颅内高压。关于睡眠结构，睡眠被分为快速眼动睡眠或非快速眼动睡眠；对呼吸努力相关觉醒和睡眠效率进行评分。

结果

作者纳入了39例患者（中位年龄5.9岁）：19例既无阻塞性睡眠呼吸暂停也无颅内高压，11例有阻塞性睡眠呼吸暂停（4例为中度/重度），6例有颅内高压，3例既有阻塞性睡眠呼吸暂停又有颅内高压。与年龄匹配的对照组相比，综合征性颅缝早闭患者无论是否存在轻度阻塞性睡眠呼吸暂停和/或颅内高压，其睡眠结构均正常。中度/重度阻塞性睡眠呼吸暂停患者的呼吸努力相关觉醒指数较高（p < 0.01），睡眠效率较低（p = 0.01），快速眼动睡眠较少（p = 0.04）。在接受整块手术（n = 5）后，观察到睡眠结构有所改善（快速眼动睡眠占5.3%；p = 0.04）。