儿童神经肌肉疾病患者的睡眠呼吸障碍特征分析

Clinical features of sleep-disordered breathing in children with neuromuscular disease

摘要:

目的 分析神经肌肉疾病（NMD）患儿的睡眠呼吸障碍（SDB）特征，提高对儿童NMD合并SDB的诊治认识。方法 回顾性分析既往确诊NMD且行多导睡眠监测（PSG）的18例患儿（NMD组）的病例资料，选取同期睡眠习惯异常、无神经肌肉疾病且PSG显示睡眠结构正常的11例儿童作为对照组。比较两组患儿的SDB日夜间症状、阻塞性睡眠呼吸暂停（OSA）发生率、肺功能及呼气末二氧化碳分压数值、睡眠结构特征、睡眠呼吸事件等。结果 NMD组中16例（89%）存在SDB相关日、夜间临床症状，发生症状最小年龄为1岁。与对照组相比，NMD组总睡眠时间减少、睡眠效率降低（P < 0.05），快速动眼（REM）期睡眠比例下降（P < 0.05），OSA和低通气事件增加（P < 0.05），REM期氧减事件增多，该期血氧饱和度降低（P < 0.05）。NMD组中确诊OSA 17例（94%）；所有患儿肺功能及呼气末二氧化碳分压均正常。结论 NMD儿童发生SDB比例高，病程早期即可出现SDB，其睡眠结构受损，睡眠效率降低，呼吸事件以阻塞型为主，氧减多发生REM期。

Abstract:

Objective To study the clinical features of sleep-disordered breathing(SDB)in children with neuromuscular disease(NMD).Methods A retrospective analysis was performed on the medical data of 18 children who were diagnosed with NMD and underwent polysomnography(PSG)(NMD group).Eleven children without NMD who had abnormal sleeping habit and normal sleep structure on PSG were enrolled as the control group.The two groups were compared in terms of the daily and nocturnal symptoms of SDB,incidence rate of obstructive sleep apnea(OSA),pulmonary function,end-tidal partial pressure of carbon dioxide(PetCO2),features of sleep structure,and sleep respiratory events.Results In the NMD group,16 children(89%)had related daily and nocturnal symptoms of SDB,and the youngest age was 1 year at the onset of such symptoms.Compared with the control group,the NMD group had significant reductions in total sleep time and sleep efficiency(P<0.05),a significant reduction in the proportion of rapid eye movement(REM)sleep(P<0.05),significant increases in obstructive apnea and hypopnea events(P<0.05)and oxygen reduction events during REM sleep(P<0.05),and a significant reduction in blood oxygen saturation during REM sleep(P<0.05).In the NMD group,17 children(94%)were diagnosed with OSA,and all children had normal lung function and PetCO2.Conclusions There is a high proportion of children with SDB among the children with NMD,and SDB can be observed in the early stage of NMD,which results in the damage of sleep structure and the reduction in sleep efficiency.Respiratory events are mainly obstructive events,and oxygen reduction events are mainly observed during REM sleep.