Duong-Quy Sy, Nguyen-Hoang Yen, Nguyen-Ngoc-Quynh Le, Nguyen-Thi-Phuong Mai, Nguyen-Thi-Bich Hanh, Le-Thi-Minh Huong, Nguyen-Thi-Dieu Thuy
Biomedical Research Centre, Lam Dong Medical College, Dalat, Vietnam.
Division of Immuno-Allergology, Penn State Medical College, Hershey Medical Center, Hershey, PA, United States.
Front Neurol. 2023 Jan 4;13:1065038. doi: 10.3389/fneur.2022.1065038. eCollection 2022.
Obstructive sleep apnea (OSA) is the most common form of respiratory disorders during sleep in children, especially those with severe asthma. However, optimal treatment of asthma might significantly improve OSA severity.
It was a cohort study including children aged >5 years old and diagnosed with asthma according to GINA (Global Initiative for Asthma). The data related to age, gender, height, weight, body mass index (BMI), clinical symptoms and medical history of asthma, spirometry (FEV: forced expiratory in 1 s), and exhaled nitric oxide (FNO) were recorded for analysis. Respiratory polygraphy (RPG) was done for each study subject to diagnose OSA and its severity.
Among 139 asthmatic children, 99 patients with OSA (71.2%) were included in the present study (9.3 ± 0.2 years): 58.6% with uncontrolled asthma and 32.3% with partial controlled asthma. The mean ACT (asthma control testing) score was 19.0 ± 3.4. The most frequent night-time symptoms were restless sleep (76.8%), snoring (61.6%), sweating (52.5%), and trouble breathing during sleep (48.5%). The common daytime symptoms were irritable status (46.5%) and abnormal behavior (30.3%). The mean AHI (apnea-hypopnea index) was 3.5 ± 4.0 events/h. There was a significant correlation between BMI and snoring index ( = 0.189 and = 0.027), bronchial and nasal FNO with AHI ( = 0.046 and < 0.001; = 0.037 and < 0.001; respectively). There was no significant correlation between asthma level, FEV and AHI. The severity of asthma and respiratory function were improved significantly after 3 months and 6 months of asthma treatment in combination with leukotriene receptor antagonist (LRA) treatment. The symptoms related to OSA were significantly improved after treatment with LRA. The severity of OSA was decreased significantly after 3 months and 6 months of treatment.
The treatment of asthmatic children with comorbid OSA by LRA in combination with standard therapy for asthma could improve the control of asthma and the symptoms and severity of OSA.
阻塞性睡眠呼吸暂停（OSA）是儿童睡眠期间最常见的呼吸障碍形式，尤其是重度哮喘患儿。然而，哮喘的最佳治疗可能会显著改善OSA的严重程度。
这是一项队列研究，纳入年龄大于5岁且根据全球哮喘防治创议（GINA）诊断为哮喘的儿童。记录年龄、性别、身高、体重、体重指数（BMI）、哮喘的临床症状和病史、肺功能测定（FEV：第1秒用力呼气量）以及呼出一氧化氮（FNO）的数据进行分析。对每个研究对象进行呼吸多导睡眠图（RPG）检查以诊断OSA及其严重程度。
在139名哮喘儿童中，本研究纳入了99例OSA患者（71.2%）（9.3±0.2岁）：58.6%为哮喘未控制，32.3%为部分控制哮喘。哮喘控制测试（ACT）平均得分为19.0±3.4。最常见的夜间症状为睡眠不安（76.8%）、打鼾（61.6%）、出汗（52.5%）以及睡眠期间呼吸困难（48.5%）。常见的日间症状为烦躁状态（46.5%）和行为异常（30.3%）。平均呼吸暂停低通气指数（AHI）为3.5±4.0次/小时。BMI与打鼾指数之间存在显著相关性（r = 0.189，P = 0.027），支气管和鼻腔FNO与AHI之间存在显著相关性（分别为r = 0.046，P < 0.001；r = 0.037，P < 0.001）。哮喘水平、FEV与AHI之间无显著相关性。在联合使用白三烯受体拮抗剂（LRA）治疗哮喘3个月和6个月后，哮喘严重程度和呼吸功能显著改善。使用LRA治疗后，与OSA相关的症状显著改善。治疗3个月和6个月后，OSA严重程度显著降低。
LRA联合哮喘标准治疗方案治疗合并OSA的哮喘儿童，可改善哮喘控制情况以及OSA的症状和严重程度。
