仰卧还是不仰卧：仰卧位对小儿阻塞性睡眠呼吸暂停的影响：阻塞性睡眠呼吸暂停患儿的睡眠姿势

Back to sleep or not: the effect of the supine position on pediatric OSA: Sleeping position in children with OSA.

作者信息

Walter Lisa M, Dassanayake Daranagama U N, Weichard Aidan J, Davey Margot J, Nixon Gillian M, Horne Rosemary S C

机构信息

The Ritchie Centre, Hudson Institute of Medical Research and the Department of Paediatrics, Monash University, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Medical Centre, Melbourne, Australia.

出版信息

Sleep Med. 2017 Sep;37:151-159. doi: 10.1016/j.sleep.2017.06.014. Epub 2017 Jul 3.

DOI:10.1016/j.sleep.2017.06.014

PMID:28899528

Abstract

BACKGROUND

In both adults and children, obstructive sleep apnea (OSA) has significant adverse cardiovascular consequences. In adults, sleeping position has a marked effect on the severity of OSA; however, the limited number of studies conducted in children have reported conflicting findings. We aimed to evaluate the effect of sleeping position on OSA severity and the cardiovascular consequences in preschool-aged children.

METHODS

This was a retrospective analysis of children (3-5 years of age) diagnosed with OSA (n = 75) and nonsnoring controls (n = 25). Sleeping position was classified as supine, semi-supine, left lateral, right lateral, prone, and semi-prone by using video recordings during one night of attended polysomnography. OSA severity and cardiovascular parameters were compared between the positions.

RESULTS

All children spent significantly more sleep time in the supine position than in any other position. The obstructive apnea-hypopnea index was higher in the supine position than in the other sleeping positions during NREM (p < 0.05), higher in the moderate/severe OSA group when sleeping in the supine position than when sleeping in the left and right lateral positions (p < 0.05 for both) and prone position (p = 0.007) during REM. Sympathovagal balance was decreased in children with OSA in the supine and lateral positions (p < 0.05).

CONCLUSIONS

This study identified that preschool-aged children, whether nonsnoring controls or children with OSA, predominately sleep in the supine position, and OSA was more severe in the supine position. We suggest that to avoid the supine sleep position, positional therapy has the potential to ameliorate OSA severity, and the known cardiovascular consequences.

摘要

背景

在成人和儿童中，阻塞性睡眠呼吸暂停（OSA）都会产生严重的不良心血管后果。在成人中，睡眠姿势对OSA的严重程度有显著影响；然而，针对儿童的研究数量有限，且结果相互矛盾。我们旨在评估睡眠姿势对学龄前儿童OSA严重程度及心血管后果的影响。

方法

这是一项对诊断为OSA的儿童（3至5岁，n = 75）和无打鼾对照组（n = 25）的回顾性分析。通过整夜的多导睡眠监测视频记录，将睡眠姿势分为仰卧位、半仰卧位、左侧卧位、右侧卧位、俯卧位和半俯卧位。比较不同姿势下的OSA严重程度和心血管参数。

结果

所有儿童仰卧位的睡眠时间显著多于其他任何姿势。在非快速眼动期（NREM），仰卧位的阻塞性呼吸暂停低通气指数高于其他睡眠姿势（p < 0.05）；在快速眼动期（REM），中度/重度OSA组儿童仰卧位时的该指数高于左侧卧位、右侧卧位（两者p < 0.05）和俯卧位（p = 0.007）。仰卧位和侧卧位的OSA儿童交感迷走神经平衡降低（p < 0.05）。