Guilleminault C, Pelayo R
Stanford Sleep Disorders Center, CA 94305, USA.
Ann Med. 1998 Aug;30(4):350-6. doi: 10.3109/07853899809029934.
The first series of children with obstructive sleep apnoea syndrome was reported in 1976. Later it became apparent that children may have breathing disorders during sleep without frank apnoea or 'hypopnoeas'. This pattern could be detected by measuring the oesophageal pressure. This led to the concept of sleep-disordered breathing as a spectrum that combines obstructive sleep apnoea syndrome and the upper airway resistance syndrome. Studies that do not take into account this spectrum may misclassify symptomatic patients as 'primary snorers'. The exact prevalence of sleep-disordered breathing in children is unknown but may be as high as 11%. There is a familial predisposition to sleep-disordered breathing. Nasal obstruction and mouth breathing influence facial growth, which may further lead to difficulty in breathing while asleep. Symptoms include an increase in total sleep time, nonspecific behavioural difficulties, hyperactivity, irritability, bed-wetting and morning headaches. Clinical signs include failure to thrive, increased respiratory effort with nasal flaring and suprasternal or intercostal retractions. Also, abnormal paradoxical inward motion of the chest may occur during sleep. Excessive daytime sleepiness and obesity are not always present. Untreated children may develop cardiovascular complications. The condition is treatable with continuous or bilevel positive airway pressure, and may be cured with surgery.
1976年报道了首批患有阻塞性睡眠呼吸暂停综合征的儿童。后来发现，儿童在睡眠中可能存在呼吸障碍，但没有明显的呼吸暂停或“呼吸浅慢”。这种情况可以通过测量食管压力来检测。这就引出了睡眠呼吸障碍这一概念，它是一种涵盖阻塞性睡眠呼吸暂停综合征和上气道阻力综合征的谱系。未考虑这一谱系的研究可能会将有症状的患者错误分类为“原发性打鼾者”。儿童睡眠呼吸障碍的确切患病率尚不清楚，但可能高达11%。睡眠呼吸障碍存在家族易感性。鼻塞和口呼吸会影响面部发育，这可能进一步导致睡眠时呼吸困难。症状包括总睡眠时间增加、非特异性行为问题、多动、易怒、尿床和晨起头痛。临床体征包括生长发育迟缓、鼻翼扇动及胸骨上窝或肋间凹陷导致的呼吸费力增加。此外，睡眠期间胸部可能会出现异常的矛盾性向内运动。白天过度嗜睡和肥胖并不总是存在。未经治疗的儿童可能会出现心血管并发症。这种疾病可以通过持续气道正压通气或双水平气道正压通气进行治疗，也可能通过手术治愈。
