儿科轻度睡眠呼吸紊乱和阻塞性睡眠呼吸暂停的神经行为发病率。
Neurobehavioral morbidity of pediatric mild sleep-disordered breathing and obstructive sleep apnea.
机构信息
Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Boston, MA, USA.
Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Boston, MA, USA.
出版信息
Sleep. 2022 May 12;45(5). doi: 10.1093/sleep/zsac035. Epub 2022 Feb 12.
STUDY OBJECTIVES
Obstructive sleep apnea is associated with neurobehavioral dysfunction, but the relationship between disease severity as measured by the apnea-hypopnea index and neurobehavioral morbidity is unclear. The objective of our study is to compare the neurobehavioral morbidity of mild sleep-disordered breathing versus obstructive sleep apnea.
METHODS
Children 3-12 years old recruited for mild sleep-disordered breathing (snoring with obstructive apnea-hypopnea index < 3) into the Pediatric Adenotonsillectomy Trial for Snoring were compared to children 5-9 years old recruited for obstructive sleep apnea (obstructive apnea-hypopnea 2-30) into the Childhood Adenotonsillectomy Trial. Baseline demographic, polysomnographic, and neurobehavioral outcomes were compared using univariable and multivariable analysis.
RESULTS
The sample included 453 participants with obstructive sleep apnea (median obstructive apnea-hypopnea index 5.7) and 459 participants with mild sleep-disordered breathing (median obstructive apnea-hypopnea index 0.5). By polysomnography, participants with obstructive sleep apnea had poorer sleep efficiency and more arousals. Children with mild sleep-disordered breathing had more abnormal executive function scores (adjusted odds ratio 1.96, 95% CI 1.30-2.94) compared to children with obstructive sleep apnea. There were also elevated Conners scores for inattention (adjusted odds ratio 3.16, CI 1.98-5.02) and hyperactivity (adjusted odds ratio 2.82, CI 1.83-4.34) in children recruited for mild sleep-disordered breathing.
CONCLUSIONS
Abnormal executive function, inattention, and hyperactivity were more common in symptomatic children recruited into a trial for mild sleep-disordered breathing compared to children recruited into a trial for obstructive sleep apnea. Young, snoring children with only minimally elevated apnea-hypopnea levels may still be at risk for deficits in executive function and attention.
TRIAL REGISTRATION
Pediatric Adenotonsillectomy for Snoring (PATS), NCT02562040; Childhood Adenotonsillectomy Trial (CHAT), NCT00560859.
研究目的
阻塞性睡眠呼吸暂停与神经行为功能障碍有关，但疾病严重程度与神经行为发病率之间的关系尚不清楚。我们的研究目的是比较轻度睡眠呼吸障碍与阻塞性睡眠呼吸暂停的神经行为发病率。
方法
入选儿童鼾症的小儿腺样体扁桃体切除术试验的轻度睡眠呼吸障碍（阻塞性呼吸暂停低通气指数＜3）儿童与入选阻塞性睡眠呼吸暂停的儿童青少年腺样体扁桃体切除术试验（阻塞性呼吸暂停低通气 2-30）的 5-9 岁儿童比较。使用单变量和多变量分析比较基线人口统计学、多导睡眠图和神经行为结果。
结果
样本包括 453 例阻塞性睡眠呼吸暂停（中位阻塞性呼吸暂停低通气指数 5.7）和 459 例轻度睡眠呼吸障碍（中位阻塞性呼吸暂停低通气指数 0.5）患者。多导睡眠图显示，阻塞性睡眠呼吸暂停患者的睡眠效率较差，觉醒次数较多。与阻塞性睡眠呼吸暂停患者相比，轻度睡眠呼吸障碍患者的执行功能评分更异常（调整后的优势比 1.96，95%CI 1.30-2.94）。轻度睡眠呼吸障碍组的儿童还存在注意力不集中（调整后的优势比 3.16，95%CI 1.98-5.02）和多动（调整后的优势比 2.82，95%CI 1.83-4.34）的 Conners 评分升高。
结论
与入选阻塞性睡眠呼吸暂停试验的儿童相比，入选轻度睡眠呼吸障碍试验的有症状儿童中，异常执行功能、注意力不集中和多动更为常见。仅轻度升高呼吸暂停低通气指数的年轻、打鼾儿童仍可能存在执行功能和注意力缺陷的风险。
试验注册
小儿鼾症的腺样体扁桃体切除术试验（PATS），NCT02562040；儿童青少年腺样体扁桃体切除术试验（CHAT），NCT00560859。
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