Nagao Asuka, Komori Masahiro, Kajiyama Taihei, Shimasaki Mutsumi, Hirakawa Daigo, Kobayashi Taisuke, Hyodo Masamitsu
Department of Otolaryngology and Clinical Laboratory, Kochi Medical School, Kochi University, Nankoku, Japan.
Department of Otolaryngology and Clinical Laboratory, Kochi Medical School, Kochi University, Nankoku, Japan.
Int J Pediatr Otorhinolaryngol. 2019 Apr;119:32-37. doi: 10.1016/j.ijporl.2019.01.013. Epub 2019 Jan 12.
In pediatric obstructive sleep apnea (OSA), the relationship between rapid eye movement sleep and upper airway collapse, and between sleep position and airway dimensions are well known. However, the interrelations between these factors and the obstructive apnea hypopnea index (O-AHI) have not been thoroughly investigated.
A retrospective study including 100 children who underwent adenotonsillectomy between March 2010 and July 2017. Total O-AHI was divided into four subcategories by sleep stage and position.
Preoperatively 14 of 47 mild cases of OSA (1 ≤ total O-AHI) and 17 of 18 moderate (5 ≤ total O-AHI) had time showing severe apnea (10 ≤ subcategorized O-AHI). Twenty-two of 24 severe cases (10 ≤ total O-AHI) exhibited very severe apnea (30 ≤ subcategorized O-AHI). All 11 very severe cases (30 ≤ total O-AHI) experienced more than 50 apnea events per hour in at least one of the O-AHI subcategories. After surgery, 23 of 70 cases classified as completely resolved (total O-AHI < 1) still had mild apnea in the O-AHI subcategories, and six of 13 cases who continued to experience apnea events had moderate-to-severe apnea. Seventeen cases worsened in the O-AHI subcategories, and total O-AHI deteriorated in two cases of the 17. The amount of REM sleep and use of the supine position increased significantly postoperatively in the quartile groups with the lowest baseline values (p < 0.0001).
When an unexpected AHI value is encountered, the O-AHI subcategories may be informative regarding the indications for surgery and evaluating the efficacy thereof.
在小儿阻塞性睡眠呼吸暂停（OSA）中，快速眼动睡眠与上气道塌陷之间的关系以及睡眠姿势与气道尺寸之间的关系已为人熟知。然而，这些因素与阻塞性呼吸暂停低通气指数（O-AHI）之间的相互关系尚未得到充分研究。
一项回顾性研究，纳入了2010年3月至2017年7月间接受腺样体扁桃体切除术的100名儿童。总O-AHI按睡眠阶段和姿势分为四个亚类。
术前，47例轻度OSA（1≤总O-AHI）中的14例和18例中度（5≤总O-AHI）中的17例有出现严重呼吸暂停（10≤亚类O-AHI）的时段。24例重度病例（10≤总O-AHI）中的22例表现出极重度呼吸暂停（30≤亚类O-AHI）。所有11例极重度病例（30≤总O-AHI）在至少一个O-AHI亚类中每小时经历超过50次呼吸暂停事件。术后，70例分类为完全缓解（总O-AHI<1）的病例中有23例在O-AHI亚类中仍有轻度呼吸暂停，13例继续经历呼吸暂停事件的病例中有6例有中度至重度呼吸暂停。17例在O-AHI亚类中病情恶化，17例中有2例总O-AHI恶化。在基线值最低的四分位组中，术后快速眼动睡眠量和仰卧位使用显著增加（p<0.0001）。
当遇到意外的AHI值时，O-AHI亚类可能有助于了解手术指征并评估其疗效。
