Kahn A, Groswasser J, Sottiaux M, Rebuffat E, Franco P
Pediatric Sleep Unit, University Children's Hospital, Brussels, Belgium.
Biol Neonate. 1994;65(3-4):235-9. doi: 10.1159/000244058.
During sleep, infants with obstructive sleep apneas are characterised by snoring, laborious breathing, and profuse sweating. During wakefulness, they may have breath-holding spells, and during feeding, difficult breathing and swallowing coordination. Abnormal weight, difficult growth, and recurring ear infections may also develop. During sleep apneas, cinefluoroscopy shows approximation of tongue and hypopharyngeal tissues, with an obliteration of the air space. The obstructed breaths occur mainly in REM, and light NREM sleep, associated with total short sleep time, and frequent arousals. Preterm infants, and term neonates are more prone to obstructive apneas than older healthy infants. Apneas are more frequently seen in boys and in case of excess in body weight. Obstructive apneas are frequently associated with upper airway anatomic abnormalities: malformations, soft tissue infiltration, and neurologic lesions impairing muscle contractions. Alterations of the autonomic nervous control may induce airways obstructions. Contributing factors include mucopolysaccharide storage disease, hypothyroidism, or Down's syndrome. Superimposed factors may occur, such as nasal obstruction, secretions in the airways, or tissue edema. Pressure- and chemo-sensitive reflexes may also favor obstruction. Environmental factors also contribute to the development of sleep apneas: body position, neck flexion, sleep deprivation, or the effects of sedative drugs.
睡眠期间，阻塞性睡眠呼吸暂停婴儿的特征为打鼾、呼吸费力和大量出汗。清醒时，他们可能会出现屏气发作，进食时则存在呼吸与吞咽协调困难。还可能出现体重异常、生长困难和反复耳部感染。睡眠呼吸暂停期间，电影荧光透视检查显示舌头与下咽组织靠近，气道间隙消失。阻塞性呼吸主要发生在快速眼动睡眠期和浅非快速眼动睡眠期，伴有总睡眠时间短和频繁觉醒。与健康的大龄婴儿相比，早产儿和足月儿更容易发生阻塞性呼吸暂停。呼吸暂停在男孩中更为常见，且与体重超重有关。阻塞性呼吸暂停常与上呼吸道解剖异常有关：畸形、软组织浸润以及损害肌肉收缩的神经病变。自主神经控制的改变可能导致气道阻塞。促成因素包括黏多糖贮积病、甲状腺功能减退或唐氏综合征。可能会出现叠加因素，如鼻塞、气道分泌物或组织水肿。压力和化学敏感反射也可能导致阻塞。环境因素也会促使睡眠呼吸暂停的发生：体位、颈部弯曲、睡眠剥夺或镇静药物的影响。
