Lai Chi-Chih, Lin Pei-Wen, Lin Hsin-Ching, Friedman Michael, Chang Hsueh-Wen, Salapatas Anna M, Lin Meng-Chih, Wang Pa-Chun
1 Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung Chang Gung Children Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
2 Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Ann Otol Rhinol Laryngol. 2018 Sep;127(9):608-613. doi: 10.1177/0003489418781961. Epub 2018 Jun 21.
To develop an adequate model using reliable clinical and physical factors to predict pediatric obstructive sleep apnea/hypopnea syndrome (OSAS).
Complete anthropometric measurements including BMI z score, tonsil size grading, and updated Friedman tongue position (uFTP) were evaluated. Subjective assessments of clinical symptoms/signs, including snoring visual analog scale (VAS), nasal obstruction, and mouth breathing, were recorded.
Eighty-eight children (57 boys and 31 girls, mean age = 9.0 years) were confirmed to have OSAS by comprehensive polysomnography (PSG). When the aforementioned variables were analyzed individually, the results indicated that snoring VAS, nasal obstruction, mouth breathing, and BMI z score were reliable predictors of apnea/hypopnea index (AHI/h) values (correlation coefficient r = 0.386, P < .001; r = 0.416, P < .001; r = 0.255, P = .02; and r = 0.243, P = .02, respectively). When all significant factors were included in the stepwise multiple linear regression analysis, the final predictive model is: Pediatric AHI = 0.108 + 0.103 snoring VAS + 0.894 nasal obstruction + 0.207 BMI z score ( F = 4.06, P = .01).
The proposed noninvasive, simple, inexpensive, and easy to perform screening tool could be used to predict pediatric OSAS. An abnormal calculated AHI may prompt clinical physicians to conduct further PSG diagnostics and treatment.
利用可靠的临床和体格检查因素建立一个合适的模型，以预测小儿阻塞性睡眠呼吸暂停/低通气综合征（OSAS）。
评估了完整的人体测量指标，包括BMI z评分、扁桃体大小分级和更新的弗里德曼舌位（uFTP）。记录了对临床症状/体征的主观评估，包括打鼾视觉模拟量表（VAS）、鼻塞和口呼吸情况。
通过全面多导睡眠图（PSG）确诊88名儿童（57名男孩和31名女孩，平均年龄=9.0岁）患有OSAS。对上述变量进行单独分析时，结果表明打鼾VAS、鼻塞、口呼吸和BMI z评分是呼吸暂停/低通气指数（AHI/h）值的可靠预测指标（相关系数r分别为0.386，P <.001；r = 0.416，P <.001；r = 0.255，P =.02；r = 0.243，P =.02）。当所有显著因素纳入逐步多元线性回归分析时，最终预测模型为：小儿AHI = 0.108 + 0.103打鼾VAS + 0.894鼻塞 + 0.207 BMI z评分（F = 4.06，P =.01）。
所提出的无创、简单、廉价且易于实施的筛查工具可用于预测小儿OSAS。计算得出的异常AHI可能促使临床医生进行进一步的PSG诊断和治疗。
