儿童阻塞性睡眠呼吸暂停综合征的危险因素。
Risk factors of obstructive sleep apnea syndrome in children.
机构信息
Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Beijing Key Laboratory of Pediatric Otolaryngology, Head & Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
出版信息
J Otolaryngol Head Neck Surg. 2020 Mar 4;49(1):11. doi: 10.1186/s40463-020-0404-1.
BACKGROUND
The known risk factors of childhood OSAS include tonsillar and adenoidhypertrophy, obesity, craniofacial anomalies, neuromuscular disorders and African-American (AA) ancestry. Whether other factors such as allergic rhinitis (AR), premature, environmental tobacco smoking (ETS) are associated with OSAS are inconsistent in different studies. Our study enrolled children of a broad age range and included potential risk factors of OSAS derived from previous studies and our own experience. Our objective is to identify risk factors of OSAS in children in a clinical setting.
METHODS
Children between 2 and 15 years of age exhibiting snoring symptoms who visited the sleep center for polysomnography (PSG) were enrolled. All children completed a questionnaire, physical examination and PSG. The questionnaire included demographic data and information related to potential risk factors for sleep disorders. A physical examination included measurements of height, weight, neck circumference, waist and hip ratio, visual evaluation of the tonsils and the degree of adenoid obstruction. Children with obstructive apnea-hypopnea index (OAHI) ≥ 1 were defined as OSAS.
RESULTS
A total of 1578 children were enrolled and1009 children exhibited OSAS. Univariate analyses showed that snoring occurring for ≥ 3 months, male gender, preterm birth, breastfeeding, obesity, neck circumference ≥ 30 cm, waist/hip ratio ≥ 0.95, tonsillar hypertrophy, and adenoid hypertrophy were associated with OSAS. The proportion of low educational level was higher in parents who breastfed their babies than those who didn't. Multivariate analysis showed that snoring for ≥ 3 months, male gender, obesity, breastfeeding, tonsillar hypertrophy, and adenoid hypertrophy were associated with OSAS. Confounders such as socioeconomic status, parental occupation, and health-related behaviors should be explored further to investigate the relationship between breastfeeding and OSAS.
CONCLUSION
The independent risk factors for OSAS in children included snoring ≥ 3 months, male gender, obesity, breastfeeding, tonsillar and adenoid hypertrophy. The study was registered on Clinical Trials government (NCT02447614). The name of the trial is "Follow-up Studies of Primary Snoring (PS) and Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) in Chinese Children" and the URL is https://clinicaltrials.gov/.
背景
儿童阻塞性睡眠呼吸暂停低通气综合征（OSAS）的已知危险因素包括扁桃体和腺样体肥大、肥胖、颅面畸形、神经肌肉疾病和非裔美国人（AA）血统。其他因素，如变应性鼻炎（AR）、早产、环境烟草烟雾（ETS）是否与 OSAS 相关，在不同的研究中并不一致。我们的研究纳入了年龄范围广泛的儿童，并包括了来自先前研究和我们自身经验的 OSAS 潜在危险因素。我们的目的是确定临床环境中儿童 OSAS 的危险因素。
方法
研究纳入了因打鼾症状而到睡眠中心进行多导睡眠图（PSG）检查的 2-15 岁儿童。所有儿童均完成了一份问卷、体格检查和 PSG。问卷包括人口统计学数据和与睡眠障碍相关的潜在危险因素信息。体格检查包括身高、体重、颈围、腰围和臀围比、扁桃体和腺样体阻塞程度的视觉评估。阻塞性呼吸暂停低通气指数（OAHI）≥1 的儿童被定义为 OSAS。
结果
共纳入 1578 例儿童，其中 1009 例患有 OSAS。单因素分析显示，打鼾时间≥3 个月、男性、早产、母乳喂养、肥胖、颈围≥30cm、腰围/臀围比≥0.95、扁桃体肥大和腺样体肥大与 OSAS 相关。母乳喂养婴儿的父母中，低教育水平的比例高于不母乳喂养婴儿的父母。多因素分析显示，打鼾时间≥3 个月、男性、肥胖、母乳喂养、扁桃体肥大和腺样体肥大与 OSAS 相关。应进一步探讨社会经济地位、父母职业和与健康相关的行为等混杂因素，以研究母乳喂养与 OSAS 之间的关系。
结论
儿童 OSAS 的独立危险因素包括打鼾时间≥3 个月、男性、肥胖、母乳喂养、扁桃体和腺样体肥大。该研究已在临床试验政府（NCT02447614）注册。试验名称为“中国儿童原发性打鼾（PS）和阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的随访研究”，网址为 https://clinicaltrials.gov/。
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