Mims Mark, Thottam Prasad John, Kitsko Dennis, Shaffer Amber, Choi Sukgi
Otolaryngology, UPMC.
Michigan Pediatric Ear, Nose and Throat Associates, Children's Hospital of Michigan, Detroit Medical Center.
Cureus. 2017 Jan 17;9(1):e983. doi: 10.7759/cureus.983.
To define obstructive sleep architecture patterns in Down syndrome (DS) children as well as changes to sleep architecture patterns postoperatively.
The study was a retrospective review.
Forty-five pediatric DS patients who underwent airway surgery between 2003 and 2014 at a tertiary children's hospital for obstructive sleep apnea (OSA) were investigated. Postoperative changes in respiratory parameters and sleep architecture (SA) were assessed and compared to general pediatric normative data using paired t-tests and Wilcoxon signed-rank test.
Twenty-two out of 45 of the participants were male. Thirty participants underwent tonsillectomy and adenoidectomy, four adenoidectomy, 10 tonsillectomy, and one base of tongue reduction. The patients were divided into two groups based on age (<6 years & >6 years) and compared to previously published age matched normative SA data. DS children in both age groups spent significantly less time than controls in rapid eye movement (REM) and N1 (p<0.02). Children younger than six spent significantly less time in N2 than previously published healthy controls (p<0.0001). Children six years of age or older spent more time than controls in N3 (p=0.003). Airway surgery did not significantly alter SA except for an increase in time spent in N1 (p=0.007). Surgery did significantly reduce median apnea hypopnea index (AHI) (p=0.004), obstructive apnea-hypopnea index (OAHI) (p=0.006), hypopneas (p=0.005), total apneas (p<0.001), and central apneas (p=0.02), and increased the lowest oxygen saturation (p=0.028).
DS children are a unique population with different SA patterns than the general pediatric population. Airway intervention assists in normalizing both central and obstructive events as well as sleep architecture stages.
确定唐氏综合征（DS）患儿的阻塞性睡眠结构模式以及术后睡眠结构模式的变化。
本研究为回顾性研究。
对2003年至2014年间在一家三级儿童医院因阻塞性睡眠呼吸暂停（OSA）接受气道手术的45例儿科DS患者进行调查。使用配对t检验和Wilcoxon符号秩检验评估呼吸参数和睡眠结构（SA）的术后变化，并与一般儿科标准数据进行比较。
45名参与者中有22名男性。30名参与者接受了扁桃体切除术和腺样体切除术，4名接受了腺样体切除术，10名接受了扁桃体切除术，1名接受了舌根缩小术。根据年龄（<6岁和>6岁）将患者分为两组，并与之前发表的年龄匹配的标准SA数据进行比较。两个年龄组的DS患儿在快速眼动（REM）和N1期的时间均显著少于对照组（p<0.02）。6岁以下儿童在N2期的时间显著少于之前发表的健康对照组（p<0.0001）。6岁及以上儿童在N3期的时间比对照组更长（p=0.003）。气道手术除了使N1期时间增加外（p=0.007），并未显著改变SA。手术确实显著降低了中位呼吸暂停低通气指数（AHI）（p=0.004）、阻塞性呼吸暂停低通气指数（OAHI）（p=0.006）、低通气（p=0.005）、总呼吸暂停（p<0.001）和中枢性呼吸暂停（p=0.02），并提高了最低血氧饱和度（p=0.028）。
DS患儿是一个独特的群体，其SA模式与一般儿科人群不同。气道干预有助于使中枢性和阻塞性事件以及睡眠结构阶段正常化。
