唐氏综合征儿童常规夜间多导睡眠图检查结果：一项回顾性队列研究。
Findings of routine nocturnal polysomnography in children with Down syndrome: a retrospective cohort study.
机构信息
Rady Children's Hospital San Diego, University of California, San Diego, USA.
Rady Children's Hospital San Diego, University of California, San Diego, USA.
出版信息
Sleep Med. 2020 Dec;76:58-64. doi: 10.1016/j.sleep.2020.10.003. Epub 2020 Oct 8.
STUDY OBJECTIVE
Children with Down syndrome (DS) are at risk for sleep disorders including; obstructive sleep apnea (OSA). Although OSA is diagnosed by polysomnography (PSG), the practicality of PSG in DS is questionable. Further, OSA treatment efficacy in DS is largely unknown given the challenges of PSG. Our aims were to review (i) the feasibility of PSG, and (ii) the efficacy (improvement in obstructive apnea hypopnea index (OAHI)) of OSA treatment using follow-up PSG in DS.
METHODS
Retrospective review of patients aged <21 years with DS who underwent PSG from October 2016 to June 2019. Successful PSG was determined using total sleep time (TST). PSG following treatment with adenotonsillectomy (AT) or positive airway pressure (PAP) was evaluated and compared to pre-treatment.
RESULTS
Among 248 patients with DS, only 11(4.4%) had unsuccessful PSG (TST<1h). Of the 237 successful studies (age: 7.9 ± 0.3y), average TST and sleep efficiency was 5.6 ± 0.1h and 79.5 ± 1.3%. 41 had post-AT PSG and 11(27%) achieved OSA cure (OAHI<2) with all demonstrating improved SE (p = 0.01) and OAHI (p = 0.0003). Multivariate analysis revealed only age was predictive (p = 0.003) of residual OSA post-AT. Of 24 children who underwent PAP titration, 20(83%) tolerated titration with improved OAHI (p = 0.01), however, no significant improvements in SE were observed.
CONCLUSIONS
In a large cohort of DS children, PSG was well tolerated. Following AT or PAP therapy, post treatment PSG confirmed efficacy, although residual OSA was identified. PSG is thus both feasible and useful in identifying OSA, OSA treatment response and should guide in decision making in children with DS.
研究目的
唐氏综合征（Down syndrome，DS）患儿存在睡眠障碍，包括阻塞性睡眠呼吸暂停（obstructive sleep apnea，OSA）。虽然多导睡眠图（polysomnography，PSG）可诊断 OSA，但 PSG 在 DS 中的实用性尚存在疑问。鉴于 PSG 存在的诸多挑战，DS 患儿 OSA 治疗的疗效在很大程度上尚不清楚。我们的目的是回顾：（i）PSG 的可行性；（ii）使用 DS 患儿 PSG 随访评估，腺扁桃体切除术（adenotonsillectomy，AT）或气道正压通气（positive airway pressure，PAP）治疗后，阻塞性呼吸暂停低通气指数（obstructive apnea hypopnea index，OAHI）的改善情况。
方法
对 2016 年 10 月至 2019 年 6 月间年龄＜21 岁、接受 PSG 的 DS 患儿进行回顾性研究。PSG 采用总睡眠时间（total sleep time，TST）来判断是否成功。评估并比较治疗前后的 AT 或 PAP 治疗后的 PSG 结果。
结果
248 例 DS 患儿中，仅 11 例（4.4%）PSG 不成功（TST＜1 小时）。237 例成功研究（年龄：7.9±0.3 岁）中，平均 TST 和睡眠效率分别为 5.6±0.1 小时和 79.5±1.3%。41 例患儿行 AT 后 PSG，11 例（27%）治愈（OAHI＜2），且所有患儿睡眠效率（p=0.01）和 OAHI（p=0.0003）均改善。多变量分析显示，仅年龄是 AT 后残余 OSA 的预测因素（p=0.003）。24 例行 PAP 滴定的患儿中，20 例（83%）耐受滴定并改善 OAHI（p=0.01），但睡眠效率无显著改善。
结论
在大型 DS 患儿队列中，PSG 可较好耐受。行 AT 或 PAP 治疗后，PSG 可证实治疗效果，尽管仍存在残余 OSA。因此，PSG 可用于识别 OSA、评估 OSA 治疗反应，在 DS 患儿中应指导决策。
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