Dhandayuthapani R, McDougall C M, Gahleitner F, Cunningham S, Urquhart D S
Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, United Kingdom; Department of Child Life and Health, University of Edinburgh, United Kingdom; Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom.
Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, United Kingdom; Department of Child Life and Health, University of Edinburgh, United Kingdom.
Paediatr Respir Rev. 2025 Apr 22. doi: 10.1016/j.prrv.2025.04.007.
Cerebral palsy refers to a group of disorders affecting movement and posture, caused by an impact to the developing brain. Children and young people (CYP) with cerebral palsy (CP) may have multiple associated co-morbidities, including sleep disorders. Sleep disorders, including sleep disordered breathing, are more prevalent among CYP with CP compared to typically developing children due to several contributory factors. Sleep-disordered breathing (SDB) collectively represents several different pathologies, namely obstructive sleep apnoea (OSA), central sleep apnoea (CSA), and hypoventilation. Multiple intrinsic and extrinsic factors contribute to each of these pathologies. Sleep studies (either as polysomnography or cardiorespiratory polygraphy) allow the detection of effort and apnoea, with contemporaneous measurement of oxygen saturations (SpO) and transcutaneous carbon dioxide (tcpCO). Together these enable the diagnosis of SDB, and the delineation of OSA, CSA and/or hypoventilation. The multifactorial component of SDB among CYP with CP may require intervention ranging from conservative measures (e.g. nasopharyngeal airway, soft collar), surgical options (e.g. adenotonsillectomy), or the initiation of respiratory support. Respiratory support, delivered as Continuous Positive Airway Pressure (CPAP) or Non-Invasive Ventilation (NIV), has a key role in the management of SDB in children with CP though the journey can often be turbulent with a high failure rate. Nonetheless, CYP with CP are being increasingly commenced on respiratory support, often for reasons others than SDB, for example aiding airway clearance in order to reduce the frequency of lower respiratory tract infections. Open discussions between the parents and healthcare professionals are important in setting shared goals for CYP with CP, guided by the primary aim of improving quality of life.
脑瘫是指因发育中的大脑受到影响而导致的一组影响运动和姿势的疾病。患有脑瘫（CP）的儿童和年轻人（CYP）可能有多种相关的合并症，包括睡眠障碍。由于多种促成因素，与发育正常的儿童相比，患有CP的CYP中睡眠障碍（包括睡眠呼吸紊乱）更为普遍。睡眠呼吸紊乱（SDB）总体上代表几种不同的病理情况，即阻塞性睡眠呼吸暂停（OSA）、中枢性睡眠呼吸暂停（CSA）和通气不足。多种内在和外在因素导致了这些病理情况中的每一种。睡眠研究（无论是多导睡眠图还是心肺多导睡眠图）可以检测用力情况和呼吸暂停，并同时测量血氧饱和度（SpO）和经皮二氧化碳（tcpCO）。这些共同作用有助于诊断SDB，并区分OSA、CSA和/或通气不足。患有CP的CYP中SDB的多因素成分可能需要从保守措施（如鼻咽气道、软颈圈）、手术选择（如腺样体扁桃体切除术）或开始呼吸支持等方面进行干预。以持续气道正压通气（CPAP）或无创通气（NIV）形式提供的呼吸支持在CP患儿SDB的管理中起着关键作用，尽管这个过程往往充满波折且失败率很高。尽管如此，患有CP的CYP越来越多地开始接受呼吸支持，通常是出于SDB以外的其他原因，例如帮助气道清理以减少下呼吸道感染的频率。在以提高生活质量为主要目标的指导下，家长和医疗保健专业人员之间的公开讨论对于为患有CP的CYP设定共同目标很重要。
