儿童阻塞性睡眠呼吸暂停中夜间呼吸紊乱和低氧血症与线性生长受损相关

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中文摘要

目的： 尽管阻塞性睡眠呼吸暂停（OSA）相关低氧血症与多种并发症的关联比呼吸紊乱更强，但其对线性生长（儿科主要关注问题）的影响仍不清楚。本研究探讨低氧血症和呼吸紊乱对OSA儿童身高的独立影响。
方法： 这项回顾性横断面研究对2013年1月至2025年6月期间临床评估的可疑OSA儿童进行了研究。排除患有其他睡眠障碍、严重神经精神疾病和躯体疾病的个体。受试者接受夜间多导睡眠监测（PSG）和身高测量。OSA定义为呼吸暂停低通气指数（AHI）≥1次/小时，AHI<1次/小时者作为非OSA参考组。AHI和血氧饱和度<90%的总睡眠时间百分比（T90%）分别用于评估呼吸紊乱严重程度（轻度，1≤AHI<5次/小时；中度，5≤AHI<10次/小时；重度，AHI≥10次/小时）和低氧血症（T90%四分位数）。身高z评分≤-1 SD定义为亚临床生长受损。线性和逻辑回归模型分析AHI和T90%与身高及亚临床生长受损之间的独立关联。本研究未收集和调整营养、内分泌疾病、慢性疾病和父母身高。
结果： 共纳入2443名儿童（348名无OSA，2095名有OSA）。在线性回归模型中，较高的T90%与全样本（B=-0.005，95% CI：-0.010至-0.000，P=0.033）和OSA儿童（B=-0.005，95% CI：-0.010至-0.000，P=0.034）较低的身高z评分相关，而AHI则无此关联（全样本：B=-0.003，95% CI：-0.006至0.001，P=0.111；OSA儿童：B=-0.002，95% CI：-0.005至0.002，P=0.330）。逻辑模型显示，与无OSA儿童相比，中度（OR=1.73，95% CI：1.05-2.84）或重度OSA（OR=1.96，95% CI：1.19-3.21）儿童以及T90%最高四分位数儿童（OR=2.17，95% CI：1.30-3.60）亚临床生长受损的比值更高。这些关联在女性和2-9岁儿童中保持稳定。
结论： 据我们所知，这是首项表明更严重的呼吸紊乱和夜间低氧血症与OSA儿童身材矮小风险增加相关的研究。这些发现支持在儿科OSA临床管理中常规进行身高评估。

英文摘要

OBJECTIVES: Although obstructive sleep apnea (OSA) related hypoxia shows stronger associations with multiple complications than respiratory disturbance, its impact on linear growth, a major pediatric concern, remains unclear. This study investigates independent effects of hypoxia and respiratory disturbance on the height of children with OSA.
METHODS: This retrospective, cross-sectional study clinically evaluated children with suspicious OSA from January 2013 to June 2025. Individuals with other sleep disorders, severe neuropsychiatric disorders and physical disorders were excluded. Subjects underwent overnight polysomnography (PSG) and height measurement. OSA was defined as apnea-hypopnea index (AHI) ≥1 event/hour, and those with AHI <1 event/hour served as the non-OSA reference group. AHI and percentage of total sleep time with oxygen saturation < 90% (T90%), were separately used to evaluate the severity of respiratory disturbance (mild, 1≤AHI < 5 events/h; moderate, 5≤AHI < 10 events/h; severe, AHI ≥10 events/h) and hypoxia (T90% quartiles). Height z-scores ≤-1 SD defined subclinical growth impairment. Linear and logistic regression models analyzed the independent associations between AHI and T90% and height and subclinical growth impairment. Nutrition, endocrine disorders, chronic illnesses, and parental height were not collected and adjusted in this study.
RESULTS: A total of 2443 children were included (348 children without OSA, 2095 children with OSA). In linear regression models, higher T90% was associated with a lower height z-score in the full sample (B = -0.005, 95% CI: -0.010 to -0.000, P = 0.033) and children with OSA (B = -0.005, 95% CI: -0.010 to -0.000, P = 0.034), whereas AHI was not (full sample: B = -0.003, 95% CI: -0.006 to 0.001, P = 0.111; children with OSA: B = -0.002, 95% CI: -0.005 to 0.002, P = 0.330).Logistic models showed higher odds of subclinical growth impairment in children with moderate (OR = 1.73, 95% CI: 1.05-2.84) or severe OSA (OR = 1.96, 95% CI: 1.19-3.21) and in those in the highest T90% quartile (OR = 2.17, 95% CI: 1.30-3.60), compared with children without OSA. These associations remained stable in females and children aged 2-9 years.
CONCLUSIONS: To our knowledge, this is the first study to show that greater respiratory disturbance and nocturnal hypoxemia are associated with a higher risk of short stature in children with OSA. These findings support routine height assessment in the clinical management of pediatric OSA.