The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.
Department of Paediatrics, Monash University, Melbourne, VIC, Australia.
Respirology. 2020 Nov;25(11):1174-1182. doi: 10.1111/resp.13809. Epub 2020 Apr 2.
The contribution of non-anatomical factors, such as ventilatory control instability (i.e. LG), to the pathogenesis of obstructive SDB in children is unclear. Therefore, we aimed to identify the relationship between LG and severity of SDB, demographic, anthropometric and anatomical characteristics in a clinically representative cohort of children.
Children (aged 3-18 years) with various severities of SDB (n = 110) and non-snoring controls (n = 36) were studied. Children were grouped according to their OAHI. Anthropometric and upper airway anatomical characteristics were measured. Spontaneous sighs were identified on polysomnography and LG, a measure of the sensitivity of the negative feedback loop that controls ventilation, was estimated by fitting a mathematical model of ventilatory control to the post-sigh ventilatory pattern.
There was no difference in LG between controls and any of the SDB severity groups. However, LG was significantly lower in children with larger tonsils (tonsil grade 4) compared with children with smaller tonsils (tonsil grade 1) (median LG (range): 0.25 (0.20-0.42) vs 0.32 (0.25-0.44); P = 0.009) and in children with a modified Mallampati score of class III/IV compared with class I (0.28 (0.24-0.33) vs 0.37 (0.27-0.44); P = 0.009).
A direct relationship was not found between the severity of paediatric SDB and LG. However, an altered ventilatory control sensitivity may contribute to SDB in a subgroup of children depending on their degree of anatomical compromise of the airway.
通气控制不稳定（即 LG）等非解剖因素对儿童阻塞性睡眠呼吸暂停低通气综合征（SDB）发病机制的影响尚不清楚。因此，我们旨在确定 LG 与儿童不同严重程度 SDB 之间的关系，并确定在具有代表性的临床儿童队列中，LG 与 SDB 严重程度、人口统计学、人体测量学和解剖学特征之间的关系。
研究了患有各种严重程度 SDB（n = 110）和不打鼾对照组（n = 36）的儿童。根据 OAHI 将儿童分为组。测量人体测量学和上气道解剖特征。在多导睡眠图上识别自发性叹息，并通过拟合通气控制的数学模型来估计 LG，LG 是衡量控制通气的负反馈回路敏感性的指标。
对照组和任何 SDB 严重程度组之间的 LG 没有差异。然而，与扁桃体较小的儿童（扁桃体分级 1）相比，扁桃体较大（扁桃体分级 4）的儿童的 LG 明显较低（中位数 LG（范围）：0.25（0.20-0.42）vs 0.32（0.25-0.44）；P = 0.009），改良 Mallampati 评分 III/IV 级的儿童与 I 级相比，LG 也较低（0.28（0.24-0.33）vs 0.37（0.27-0.44）；P = 0.009）。
在儿童中，SDB 的严重程度与 LG 之间没有直接关系。然而，根据气道解剖学的严重程度，通气控制敏感性的改变可能会导致 SDB 发生在一部分儿童中。
