阻塞性睡眠呼吸暂停患儿的周期性交替模式及其与腺样体扁桃体切除术、行为、认知和生活质量的关系。
Cyclic alternating pattern in children with obstructive sleep apnea and its relationship with adenotonsillectomy, behavior, cognition, and quality of life.
机构信息
School of Electrical and Electronic Engineering, University of Adelaide, Adelaide, Australia.
Department of Social and Developmental Psychology, Sapienza University, Rome, Italy.
出版信息
Sleep. 2021 Jan 21;44(1). doi: 10.1093/sleep/zsaa145.
STUDY OBJECTIVES
To determine in children with obstructive sleep apnea (OSA) the effect of adenotonsillectomy (AT) on the cyclic alternating pattern (CAP) and the relationship between CAP and behavioral, cognitive, and quality-of-life measures.
METHODS
CAP parameters were analyzed in 365 overnight polysomnographic recordings of children with mild-to-moderate OSA enrolled in the Childhood Adenotonsillectomy Trial (CHAT), randomized to either early AT (eAT) or watchful waiting with supportive care (WWSC). We also analyzed CAP in a subgroup of 72 children with moderate OSA (apnea-hypopnea index > 10) that were part of the CHAT sample. Causal mediation analysis was performed to determine the independent effect of changes in CAP on selected outcome measures.
RESULTS
At baseline, a higher number of A1 phases per hour of sleep was significantly associated with worse behavioral functioning (caregiver Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite (GEC): ρ = 0.24, p = 0.042; caregiver Conners' Rating Scale Global Index: ρ = 0.25, p = 0.036) and lower quality of life (OSA-18: ρ = 0.27, p = 0.022; PedsQL: ρ = -0.29, p = 0.015) in the subgroup of children with moderate OSA, but not across the entire sample. At 7-months follow-up, changes in CAP parameters were comparable between the eAT and WWSC arms. CAP changes did not account for significant proportions of variations in behavioral, cognitive, and quality-of-life performance measures at follow-up.
CONCLUSIONS
We show a significant association between the frequency of slow, high-amplitude waves with behavioral functioning, as well as the quality of life in children with moderate OSA. Early AT in children with mild-to-moderate OSA does not alter the microstructure of nonrapid eye movement sleep compared with watchful waiting after an approximately 7-month period of follow-up.
CLINICAL TRIAL
The study "A Randomized Controlled Study of Adenotonsillectomy for Children With Obstructive Sleep Apnea Syndrome" was registered at Clinicaltrials.gov (#NCT00560859).
研究目的
确定阻塞性睡眠呼吸暂停（OSA）患儿腺样体扁桃体切除术（AT）对周期性交替模式（CAP）的影响，以及 CAP 与行为、认知和生活质量测量之间的关系。
方法
对 365 例轻度至中度 OSA 患儿进行过夜多导睡眠图记录，并将其纳入儿童腺样体扁桃体切除术试验（CHAT），随机分为早期 AT（eAT）或观察等待伴支持性护理（WWSC）。我们还分析了 CHAT 样本中 72 例中度 OSA（呼吸暂停低通气指数＞10）患儿的 CAP 亚组。进行因果中介分析以确定 CAP 变化对选定结果测量的独立影响。
结果
在基线时，每小时睡眠中 A1 阶段的数量与行为功能较差显著相关（照料者行为评定量表执行功能成分（BRIEF）总体执行综合评分（GEC）：ρ=0.24，p=0.042；照料者康纳氏评定量表总体指数：ρ=0.25，p=0.036）和生活质量较低（OSA-18：ρ=0.27，p=0.022；PedsQL：ρ=-0.29，p=0.015）在中度 OSA 患儿亚组中，但在整个样本中并非如此。在 7 个月的随访中，eAT 和 WWSC 组之间的 CAP 参数变化相当。CAP 变化并不能解释随访时行为、认知和生活质量表现测量的显著变化比例。
结论
我们在中度 OSA 患儿中显示出慢波、高振幅波的频率与行为功能以及生活质量之间存在显著关联。与观察等待相比，轻度至中度 OSA 儿童接受早期 AT 治疗在大约 7 个月的随访后并不会改变非快速眼动睡眠的微结构。
临床试验
该研究“腺样体扁桃体切除术治疗阻塞性睡眠呼吸暂停综合征儿童的随机对照研究”在 Clinicaltrials.gov 上注册（#NCT00560859）。
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