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目的通过对临床怀疑为阻塞性睡眠呼吸暂停低通气综合征(obatructive sleep apneahppopnea syndrome,OSAHS)儿童的多道睡眠图分析,探讨阻塞性呼吸暂停指数(obstructive apneaindex,OAI)、呼吸暂停低通气指数(apnea-hypopnea index,AHI)、脑电醒觉反应指数的特点。方法对61例临床怀疑为 OSAHS 的儿童行多道睡眠监测,按照广州市儿童医院耳鼻咽喉科实验室标准[简称科室标准,将口鼻气流停止、胸腹呼吸运动存在的持续任何时间长度的阻塞性呼吸暂停事件均定义为阻塞性呼吸暂停,睡眠过程中呼吸气流强度(幅度)较基础水平降低50%以上并伴有动脉血氧饱和度较基础水平下降≥0.04定义为低通气]分析其 OAI、AHI、脑电醒觉反应指数。再以乌鲁木齐草案的标准[对阻塞性呼吸暂停的时间长度定义为大于或等于2个呼吸周期,低通气为口鼻气流信号峰值降低50%,并伴有0.03以上的血氧饱和度下降和(或)觉醒]重新分析这组结果。结果①67.2%(41例)的疑似 OSAHS 儿童发生了共206次阻塞性呼吸暂停事件,88.5%(54例)的儿童发生了共2249次阻塞性低通气事件,呼吸事件主要发生在快动眼睡眠期(rapid eye movement sleep,REMsleep);②采用科室标准61例疑似 OSAHS 儿童中有68.9%(42例)的儿童 OAI<1次/h,有34.4%(21例)的儿童 AHI<5次/h;采用乌鲁木齐草案标准61例儿童中有75.4%(46例)的疑似 OSAHS 儿童 OAI<1次/h,有24.6%(15例)的儿童 AHI<5次/h;③与呼吸有关的脑电醒觉反应指数与自发性脑电醒觉反应指数之间的差异有统计学意义(z=-5.787,P=0.000),自发性脑电醒觉反应指数大于与呼吸有关的脑电醒觉反应指数。结论在儿童 OSAHS 诊断标准的制订中应考虑到低通气事件的重要性,呼吸事件判断依据的确定应建立在大规模调查的基础上,应慎重考虑脑电醒觉反应在诊断中的地位。
Objective To investigate the relationship between obstructive apnea index (OAI), apnea-hypopnea index (OSAHS) and sleep apnea-hypopnea syndrome (OSAHS) in children with suspected obstructive sleep apnea-hypopnea syndrome apnea-hypopnea index, AHI), the characteristics of the arousal reaction index. Methods Sixty-one children with suspected OSAHS were undergoing multi-channel sleep monitoring. According to the department of Otorhinolaryngology Laboratory of Guangzhou Children’s Hospital [referred to as departmental standard, stop the nasal and respiratory flow for a long time and block the breathing of chest and abdomen for any length of time Sexual apnea events were defined as obstructive apnea, respiratory airflow intensity (amplitude) during sleep more than 50% lower than the basic level and accompanied by arterial oxygen saturation than the basic level of decline ≥ 0.04 defined as low airway] analysis of its OAI , AHI, EOG arousal reaction index. Then the Urumqi draft standard [for obstructive apnea length of time defined as greater than or equal to 2 respiratory cycles, hypopnea for the nose and mouth airflow signal peak reduction of 50%, accompanied by a decrease of more than 0.03 oxygen saturation and ( Or) awakening] to reanalyze the group of results. Results ① A total of 206 episodes of obstructive apnea occurred in 67.2% (41 cases) of suspected OSAHS children, and a total of 2249 obstructive hypoventilations occurred in 88.5% (54 cases) of children. The respiratory events mainly occurred in fast moving Children with OAI <1 / h in 68.9% (42 cases) of 61 suspected OSAHS children, and 34.4% (21 cases) of children with AHI <5 Times / h; children with suspected OSAHS of 75.4% (61 cases) in Urumchih draft standard had OAI <1 / h, children with AHI <5 times / h in 24.6% (P <0.05). The index of spontaneous arousal reaction was significantly higher than that of spontaneous EEG (P <0.05) Awake reaction index. Conclusion The importance of hypoventilation should be considered in the development of diagnostic criteria for OSAHS in children. The determination of basis for determining respiratory events should be based on large-scale surveys. The status of EOG arousal reaction should be carefully considered.