Meira E Cruz Miguel, Salles Cristina, Seixas Luana, D Elia Claudio, Rocha Isabel, Gozal David
Sleep Unit, Centro Cardiovascular da Universidade de Lisboa, Lisbon School of Medicine, Lisbon, Portugal.
International Center on Clinical Sleep Medicine and Research, Bahiana School of Medicine and Public Health, Salvador, Brazil.
J Sleep Res. 2023 Feb;32(1):e13705. doi: 10.1111/jsr.13705. Epub 2022 Aug 26.
Insomnia and sleep-disordered breathing (SDB) are prevalent sleep disorders. These disorders can therefore be concurrently present - comorbid insomnia and sleep apnea (COMISA). The prevalence of COMISA in the paediatric age range is unclear. As such, phenotypic constructs should help better define this comorbid condition if it exists in children and improve both diagnostic sensitivity and ultimately clinical care outcomes. We aimed to evaluate the frequency of insomnia in children and adolescents referred for evaluation of sleep symptoms suggestive of SDB in one initial (Cohort#1) and verify such findings in an independent cohort (Cohort#2) using a retrospective cross-sectional approach in patients aged 9-19 years presenting at a sleep centre to be evaluated for symptoms of SDB. Cohort #1 comprised 50 consecutive children (58% males; mean [SD] age 13.6 [3.3] years; median [interquartile range, IQR] Epworth Sleepiness Scale score 10 [6-12]) who were evaluated using validated SDB and insomnia questionnaires. Cohort#2 was extracted from electronic medical records and included 384 polysomnographically evaluated children (mean [SD] age 12.9 [3.6] years; mean [SD] body mass index z score 1.27 [0.28]; median Epworth Sleepiness Scale score 9.7 [4-17]). In Cohort #1, 56% were at high risk of SDB, 36% had insomnia alone, and 18% were at high risk of COMISA. The prevalence of COMISA in Cohort #2 was 16%, 72% had SDB alone, and 12% had insomnia alone. In both cohorts, COMISA manifested as increased propensity for sleepiness and fatigue during both waking and daytime. Thus, the presence of COMISA is frequent in the paediatric age range and accompanied by a more prominent symptomatic phenotype.
失眠和睡眠呼吸障碍（SDB）是常见的睡眠障碍。因此，这些障碍可能同时存在——即共病性失眠和睡眠呼吸暂停（COMISA）。儿童期COMISA的患病率尚不清楚。因此，如果儿童存在这种共病情况，表型结构应有助于更好地定义它，并提高诊断敏感性以及最终改善临床护理结果。我们旨在评估因睡眠症状提示SDB而前来评估的儿童和青少年中失眠的发生率，在一个初始队列（队列1）中进行评估，并使用回顾性横断面方法，在一个独立队列（队列2）中对年龄在9至19岁、因SDB症状在睡眠中心接受评估的患者进行验证。队列1包括50名连续的儿童（58%为男性；平均[标准差]年龄13.6[3.3]岁；爱泼华嗜睡量表评分中位数[四分位间距，IQR]为10[6 - 12]），他们使用经过验证的SDB和失眠问卷进行评估。队列2从电子病历中提取，包括384名经多导睡眠图评估的儿童（平均[标准差]年龄12.9[3.6]岁；平均[标准差]体重指数z评分1.27[0.28]；爱泼华嗜睡量表评分中位数9.7[4 - 17]）。在队列1中，56%有SDB高风险，36%仅有失眠，18%有COMISA高风险。队列2中COMISA的患病率为16%，72%仅有SDB，12%仅有失眠。在两个队列中，COMISA均表现为清醒和白天时嗜睡和疲劳倾向增加。因此，COMISA在儿童期很常见，并伴有更突出的症状表型。
