缺氧负荷是非肥胖睡眠呼吸障碍儿童身高的重要决定因素

文献信息

中文摘要

背景： 线性生长与阻塞性睡眠呼吸障碍（SDB）之间的关系尚未得到广泛研究。缺氧负荷（HB）是一种新指标，与传统呼吸暂停低通气指数（AHI）相比，可能更好地反映儿童SDB的终末器官损害。方法：这项观察性横断面研究考察了3-9岁非肥胖SDB儿童中HB与线性生长之间的关联。HB通过外周血氧饱和度下降曲线下面积评估，同时结合标准多导睡眠监测指标。结果：对164名除哮喘外无合并症的疑似SDB儿童进行了评估，并收集了人口学和人体测量学数据。身高z评分的均值±标准差为-0.05±1.09，HB的中位数[第25百分位数；第75百分位数]为1.4[0.4；3.5]%min/h。40名儿童（24%）的阻塞性AHI大于5/h。HB和频繁打鼾（≥3晚/周）与身高z评分显著负相关（标准化β=-0.21，p=0.036和-0.37，p=0.043），而AHI不能预测线性生长结局。在多变量分析中，HB仍与较低的身高z评分独立相关，并解释其7.5%的方差，相比之下，种族解释12.7%，体重指数z评分解释6.4%。氧减指数也是一个显著预测因子，但其解释身高z评分方差的能力低于HB。结论：这些发现提示，间歇性缺氧可能促成SDB儿童线性生长受损，尽管其贡献不大，其他生长决定因素仍然重要。

英文摘要

The relationship between linear growth and obstructive sleep-disordered breathing (SDB) has not been extensively studied. Hypoxic burden (HB) is a new metric that may better capture end-organ damage in paediatric SDB compared to the traditional apnea-hypopnea index (AHI). This observational cross-sectional study examined the association between HB and linear growth in nonobese children aged 3-9 years with SDB. HB was assessed as the area under the peripheral oxygen desaturation curve, alongside standard polysomnography indices. A cohort of 164 children without comorbidities except for asthma was evaluated for suspected SDB, with demographic and anthropometric data collected. The mean ± standard deviation height z score was -0.05 ± 1.09, and the median [25th; 75th percentile] HB was 1.4 [0.4; 3.5] %min/h. Forty children (24%) had an obstructive AHI greater than 5/h. HB and frequent snoring (≥ 3 nights/week) were significantly and negatively associated with height z score (standardized β = -0.21, p = 0.036 and -0.37, p = 0.043, respectively), whereas AHI did not predict linear growth outcomes. In multivariate analyses, HB remained independently associated with lower height z score and accounted for 7.5% of its variance, compared with 12.7% for ethnicity and 6.4% for body mass index z score. The oxygen desaturation index was also a significant predictor, but it explained less variance in height z score than HB. These findings suggest that intermittent hypoxia may contribute to impaired linear growth in children with SDB, although its contribution is modest and other determinants of growth remain important.