加拿大肥胖合并中重度睡眠呼吸障碍儿童接受气道正压通气治疗后的行为和情绪特征：纵向变化及其与依从性的关系。
Behavioral and emotional characteristics of Canadian children with obesity and moderate-severe sleep-disordered breathing treated with positive airway pressure: longitudinal changes and associations with adherence.
机构信息
Montreal Children's Hospital/McGill University Health Centre, Montreal, Quebec, Canada.
Stollery Children's Hospital/University of Alberta, Edmonton, Alberta, Canada.
出版信息
J Clin Sleep Med. 2023 Mar 1;19(3):555-562. doi: 10.5664/jcsm.10386.
STUDY OBJECTIVES
Behavioral characteristics and outcomes of positive airway pressure (PAP) therapy in children with obesity and moderate-severe sleep-disordered breathing (SDB) have not been reported. Our aims were to 1) determine baseline behavioral/emotional symptoms of this population and characterize changes over time with PAP, and 2) examine associations between baseline behavioral/emotional symptoms and PAP adherence.
METHODS
This multicenter prospective cohort study of children with obesity prescribed PAP for moderate-severe SDB assessed PAP adherence (≥ 4 h/night, >50% of nights, usage diaries, downloads) and compared behavioral/emotional characteristics with parent- and child-reported Conners Rating Scale (Conners) and the Child Behavior Checklist (CBCL) at baseline and 1 year after PAP prescription between adherent and nonadherent participants; scores at baseline were compared retrospectively between adherence groups.
RESULTS
Twenty-four children were included (median 14.1 years [IQR:12.4,16.0]; 87.5% males). Baseline Conners and CBCL scores were elevated (parent- and child-reported Conners inattention and hyperactivity subscales and CBCL subscales [total, internalizing, externalizing]). Baseline parent-reported Conners scores were significantly more elevated in the nonadherent than adherent group (inattention: 73.3 ± 8.5 vs 60.5 ± 14.6, = .01; hyperactivity: 70.9 ± 11.1 vs 59.1 ± 16.0, = .05). This difference was present 1 year later for inattention ( = .01) but not for hyperactivity ( = .09). Parent-reported CBCL scores improved over 1 year in adherent but not nonadherent participants.
CONCLUSIONS
We found that children with obesity and moderate-severe SDB have elevated symptoms of behavioral/emotional concerns on standardized testing. Parent-reported emotional characteristics improved in the adherent but not in the nonadherent group. Children with greater inattention/hyperactivity at baseline were less adherent to PAP, suggesting this may contribute to PAP nonadherence.
CITATION
Constantin E, MacLean JE, Barrowman N, et al. Behavioral and emotional characteristics of Canadian children with obesity and moderate-severe sleep-disordered breathing treated with positive airway pressure: longitudinal changes and associations with adherence. . 2023;19(3):555-562.
研究目的
尚未有研究报道肥胖合并中重度睡眠呼吸障碍（SDB）儿童使用气道正压通气（PAP）治疗的行为特征和结局。我们的目的是：1）确定该人群的基线行为/情绪症状，并描述 PAP 治疗过程中的变化；2）研究基线行为/情绪症状与 PAP 依从性之间的关系。
方法
这项多中心前瞻性队列研究纳入了肥胖合并中重度 SDB 而接受 PAP 治疗的儿童，评估了 PAP 依从性（≥4 小时/夜，＞50%的夜晚，使用日记，下载），并比较了基线时和 PAP 处方后 1 年时依从组和非依从组儿童的父母和儿童报告的康纳氏评分量表（Conners）和儿童行为检查表（CBCL）的行为/情绪特征；回顾性比较了依从组之间的基线评分。
结果
共纳入 24 名儿童（中位数年龄 14.1 岁[IQR：12.4，16.0]；87.5%为男性）。基线时 Conners 和 CBCL 评分升高（父母和儿童报告的注意力不集中和多动障碍子量表以及 CBCL 子量表[总分、内化、外化]）。基线时，非依从组的父母报告的 Conners 评分明显高于依从组（注意力不集中：73.3±8.5 比 60.5±14.6， =.01；多动：70.9±11.1 比 59.1±16.0， =.05）。1 年后，注意力不集中仍存在差异（ =.01），但多动障碍无差异（ =.09）。在依从组中，父母报告的 CBCL 评分在 1 年内有所改善，但在非依从组中没有改善。
结论
我们发现肥胖合并中重度 SDB 的儿童在标准化测试中表现出行为/情绪问题的症状加重。在依从组中，父母报告的情绪特征有所改善，但在非依从组中没有改善。基线时注意力不集中/多动障碍更严重的儿童对 PAP 的依从性较差，提示这可能导致 PAP 依从性差。
参考文献
Constantin E, MacLean JE, Barrowman N, et al. Behavioral and emotional characteristics of Canadian children with obesity and moderate-severe sleep-disordered breathing treated with positive airway pressure: longitudinal changes and associations with adherence.. 2023;19(3):555-562.
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