Carroll J L, McColley S A, Marcus C L, Curtis S, Loughlin G M
Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Children's Center, Baltimore, MD 21287-2533, USA.
Chest. 1995 Sep;108(3):610-8. doi: 10.1378/chest.108.3.610.
To determine whether primary snoring (PS) could be distinguished from childhood obstructive sleep apnea syndrome (OSAS) by clinical history.
Retrospective study of clinical history of 83 children with snoring and/or sleep disordered breathing who were referred for polysomnography.
Tertiary referral center; pediatric pulmonary sleep apnea clinic.
We evaluated the ability of a clinical obstructive sleep apnea (OSA) score and other questions about sleep, breathing, and daytime symptoms to distinguish PS from OSAS in children. Parents were asked about the child's snoring, difficulty breathing, observed apnea, cyanosis, struggling to breathe, shaking the child to "make him or her breathe," watching the child sleep, afraid of apnea, the frequency and loudness of snoring, and daytime symptoms such as excessive daytime sleepiness (EDS).
Based on polysomnography results, 48 patients were classified as PS and 35 as OSAS. Peak endtidal CO2 (49 +/- 3.2 vs 55 +/- 8.2 [SD] mm Hg); lowest arterial oxygen saturation measured by pulse oximetry (95 +/- 1.9 vs 82 +/- 14%); and apnea/hypopnea index (0.27 +/- .3 vs 8.4 +/- 6 events/h) indicated that the diagnostic criteria for PS versus OSA were reasonable. There were no differences between PS and OSA patients with respect to age, sex, race, failure to thrive, obesity, history of EDS, snoring history, history of cyanosis during sleep, or daytime symptoms except for mouth breathing. There were no significant differences in sleep variables between PS patients and those with any severity of OSAS. The OSA score misclassified about one of four patients. Comparing PS and OSA patients, significant findings were daytime mouth breathing (61 vs 85%; p = 0.024); observed apnea (46 vs 74%; p = 0.013); shaking the child (31 vs. 60%; p = 0.01); struggling to breathe (58 vs 89%; p = 0.003); and afraid of apnea (71 vs 91%; p = 0.028). However, none of these were sufficiently discriminatory to predict OSAS.
We conclude that PS in children cannot be reliably distinguished from OSAS by clinical history alone.
通过临床病史判断原发性打鼾（PS）是否可与儿童阻塞性睡眠呼吸暂停综合征（OSAS）相区分。
对83名因打鼾和/或睡眠呼吸障碍而接受多导睡眠监测的儿童的临床病史进行回顾性研究。
三级转诊中心；儿科肺部睡眠呼吸暂停诊所。
我们评估了临床阻塞性睡眠呼吸暂停（OSA）评分以及其他关于睡眠、呼吸和日间症状的问题在区分儿童PS和OSAS方面的能力。向家长询问孩子的打鼾情况、呼吸困难、观察到的呼吸暂停、发绀、呼吸挣扎、摇晃孩子以“使其呼吸”、观察孩子睡眠、对呼吸暂停的恐惧、打鼾的频率和响度，以及日间症状如日间过度嗜睡（EDS）。
根据多导睡眠监测结果，48例患者被分类为PS，35例为OSAS。呼气末二氧化碳峰值（49±3.2对比55±8.2[标准差]mmHg）；通过脉搏血氧饱和度测定法测得的最低动脉血氧饱和度（95±1.9对比82±14%）；以及呼吸暂停/低通气指数（0.27±0.3对比8.4±6次/小时）表明PS与OSA的诊断标准是合理的。PS患者和OSA患者在年龄、性别、种族、生长发育迟缓、肥胖、EDS病史、打鼾病史、睡眠期间发绀病史或日间症状方面（除口呼吸外）无差异。PS患者与任何严重程度的OSAS患者在睡眠变量方面无显著差异。OSA评分将约四分之一的患者误诊。比较PS患者和OSA患者，显著的发现有日间口呼吸（61%对比85%；p = 0.024）；观察到的呼吸暂停（46%对比74%；p = 0.013）；摇晃孩子（31%对比60%；p = 0.01）；呼吸挣扎（58%对比89%；p = 0.003）；以及对呼吸暂停的恐惧（71%对比91%；p = 0.028）。然而，这些均不足以可靠地区分OSAS。
我们得出结论，仅通过临床病史无法可靠地区分儿童PS和OSAS。
