超越打鼾、嗜睡与手术：儿童阻塞性睡眠呼吸暂停各年龄段常见症状及治疗效果的最新进展。
Beyond Snoring, Sleepiness and Surgery: Update on the Prevalent Symptoms of and Treatment Effects in all Age Groups With Pediatric Obstructive Sleep Apnea.
文献信息
| PMID | 42829879 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Amanda B Hassinger |
| 作者单位 | Department of Pediatrics, Division of Pulmonology and Sleep Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Attending Physician, Golisano Children's Hospital of Buffalo, Buffalo, New York, USA. |
| 期刊 | Pediatric pulmonology |
| SCI 分区 | Q2 |
| IF | 2.5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
引言： 儿童阻塞性睡眠呼吸暂停（pOSA）的筛查和治疗常采用成人症状和传统手术方法。本研究检验了OSA的症状和治疗疗效在不同年龄组之间存在差异的假设。
方法： 单中心队列研究，纳入2020年至2024年在一家儿科专用睡眠医学中心接受管理并接受多导睡眠监测（PSG）的0至18岁儿童。
结果： 491名儿童中，489名患有pOSA，57.7%为男性，中位年龄为6岁（IQR1-3，4-9），41%在PSG前已接受腺样体或腺样体扁桃体切除术。仅15.6%肥胖，13.2%的Epworth嗜睡评分超过10。打鼾并非最普遍的夜间症状：不安（91.6%）、慢性失眠（86.1%）、踢腿（82.0%）和频繁觉醒（78.4%）均更为常见。神经认知问题存在于93.7%的患儿中，最常见的是情绪波动（86.5%）和ADHD（51.9%）。在PSG前未手术的270名患儿中，72.2%（n=195）被转诊，173名接受了手术。240名（49.1%）患者被处方气道正压通气（PAP），其中176名（73%）有足够的CPAP使用量以提供机器估算的呼吸暂停低通气指数（AHI）。腺样体扁桃体切除术后，27.0%的术后AHI低于每小时5次事件，73.1%的神经认知问题得到改善，而使用PAP者分别为94.9%和87.2%。在调整年龄和AHI后，PAP改善神经认知问题的几率是手术的三倍（aOR 3.85，95%CI 1.39-10.67），p=0.010。
结论： 大多数pOSA儿童并不疲倦或肥胖。失眠和不安睡眠比打鼾更常见。日间神经认知问题影响几乎所有pOSA儿童，并随治疗改善，尤其是PAP。
英文摘要
INTRODUCTION: Screening and treatments for pediatric obstructive sleep apnea (pOSA) often use adult symptoms and conventional surgical approaches. This study tested the hypothesis that symptoms and treatment efficacy for OSA differ across age groups.
METHODS: Single-center cohort study of 0 to 18-year-olds who were managed and underwent polysomnography (PSG) in a pediatric-dedicated sleep medicine center from 2020 to 2024.
RESULTS: Of 491 children, 489 had pOSA, 57.7% were male, the median age was 6 years old (IQR1-3, 4-9), and 41% already had an adeno- or adenotonsillectomy prior to the PSG. Only 15.6% were obese, and 13.2% had an Epworth Sleepiness Score over 10. Snoring was not the most prevalent nocturnal symptom: restlessness (91.6%), chronic insomnia (86.1%), kicking legs (82.0%), and frequent awakening (78.4%) were all more common. Neurocognitive issues, present in 93.7%, were most commonly mood swings (86.5%) and ADHD (51.9%). Of the 270 without surgery before the PSG, 72.2% (n = 195) were referred, and 173 had surgery. Positive airway pressure (PAP) was prescribed for 240 (49.1%) patients, 176 (73%) of whom had enough CPAP usage to provide machine-estimated apnea-hypopnea index (AHI). After adenotonsillectomy, 27.0% had a post-operative AHI under 5 events per hour, and 73.1% had improvement in neurocognitive issues while that was 94.9% and 87.2% in those using PAP, respectively. After adjusting for age and AHI, PAP had threefold (aOR 3.85, 95%CI 1.39-10.67) higher odds of improving neurocognitive issues than surgery, p = 0.010.
CONCLUSIONS: The majority of children with pOSA are not tired or obese. Insomnia and restless sleep are more common than snoring. Daytime neurocognitive issues affect almost all children with pOSA and improve with treatment, especially PAP.