AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique - Centre Pédiatrique des Pathologies du Sommeil, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM, UMR1141, France.
AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique - Centre Pédiatrique des Pathologies du Sommeil, Paris, France.
Sleep Med. 2019 Jun;58:75-81. doi: 10.1016/j.sleep.2019.03.003. Epub 2019 Mar 18.
Our objective was to evaluate the usefulness of acoustic pharyngometry and rhinometry in assessing obstructive sleep apnea (OSA) syndrome in children.
PATIENTS/METHODS: Patients who were hospitalized for polysomnography underwent acoustic pharyngometry and rhinometry in sitting and supine positions to measure anatomical (pharyngeal and nasopharyngeal) volumes and collapsibility characteristics (reduction of pharyngeal volume, estimated pharyngeal compliance, and reduction of nasopharyngeal volume).
In this study, we prospectively enrolled 103 children (median age, 10.4 years; 47 girls). Measures obtained from rhinometry correlated with height and were further height-normalized whereas measures obtained from pharyngometry did not correlate with height. Sleep apnea was ruled out in 51 subjects, while 52 children fulfilled OSA criteria (35 with obstructive apnea-hypopnea index ≥ 2 and < 5.h [mild] and 17 with an index ≥ 5). The three groups differed on the z-score of BMI, the reduction of pharyngeal volume when supine, the estimated pharyngeal compliance and the supine normalized nasopharyngeal volume. These four factors linearly correlated with the apnea index even though children without OSA and mild OSA were found to be similar overall. A multivariate analysis with apnea index as the dependent variable and BMI z-score, neck circumference, mean pharyngeal area in supine position, estimated pharyngeal compliance and normalized nasopharyngeal volume as independent variables, showed that only BMI z-score and estimated compliance remained independent predictors of obstructive apnea (r value = 0.25, p < 0.0001).
An increase in pharyngeal compliance is an independent risk factor of OSA syndrome in children; it can be measured using acoustic pharyngometry while awake.
评估声学咽腔测量和鼻阻力测量在儿童阻塞性睡眠呼吸暂停（OSA）综合征评估中的作用。
患者/方法：因多导睡眠图检查而住院的患者在坐位和仰卧位时进行声学咽腔测量和鼻阻力测量，以测量解剖学（咽和鼻咽）容积和塌陷特征（咽腔容积减少、估计咽顺应性和鼻咽容积减少）。
本研究前瞻性纳入了 103 例儿童（中位数年龄为 10.4 岁；47 例女孩）。鼻阻力测量得到的指标与身高相关，并进一步进行身高归一化，而咽腔测量得到的指标与身高无关。51 例患者排除睡眠呼吸暂停，52 例儿童符合 OSA 标准（35 例阻塞性呼吸暂停低通气指数≥2 且<5.h [轻度]，17 例指数≥5）。三组儿童的 BMI z 评分、仰卧位时咽腔容积减少、估计咽顺应性和仰卧位时鼻咽容积归一化值存在差异。这四个因素与呼吸暂停指数呈线性相关，尽管无 OSA 和轻度 OSA 的儿童总体上相似。以呼吸暂停指数为因变量，BMI z 评分、颈围、仰卧位时平均咽腔面积、估计咽顺应性和鼻咽容积归一化值为自变量的多元分析显示，仅 BMI z 评分和估计顺应性仍然是阻塞性呼吸暂停的独立预测因素（r 值=0.25，p<0.0001）。
咽顺应性增加是儿童 OSA 综合征的独立危险因素；可以通过清醒时的声学咽腔测量来测量。
