足月非综合征型婴儿睡眠呼吸障碍的表型与多导睡眠图表现之间的相关性：一项病例系列研究

文献信息

中文摘要

背景： 睡眠呼吸障碍（SBD）在非综合征型足月婴儿中研究不足，因为大多数研究集中于高危人群，如早产儿或存在基础疾病的婴儿。对于使该人群易发生SDB的表型，我们的认识仍存在空白。诊断阈值仍缺乏标准化，关于有效治疗策略的数据有限。
目的： 描述因疑似睡眠呼吸障碍（SDB）转诊评估的足月、非综合征型婴儿的临床表现和多导睡眠图特征。
方法： 这是一项单中心病例系列研究，回顾性分析来自一家三级医疗中心的0-12月龄非综合征型足月婴儿的多导睡眠图（PSG）数据。
结果： 15名婴儿符合纳入标准。平均胎龄为38.4 ± 0.6周；80%为男性。首次PSG时的平均年龄为7.5 ± 3.6个月。33%存在打鼾，47%被诊断为胃食管反流（GER）。平均呼吸暂停低通气指数（AHI）为23.1次/小时。平均阻塞性AHI（OAHI）为20次/小时，平均中枢性呼吸暂停指数（CAI）为3.1次/小时。平均血氧饱和度为97.5 ± 1.5%，最低值为81.0 ± 9.9%。6名患者符合睡眠相关低氧血症标准（SpO2 < 90%持续≥5分钟）。平均和峰值CO2水平分别为35 mmHg和48.6 mmHg。没有患者符合睡眠相关低通气标准（CO2 > 50 mmHg持续超过总睡眠时间的25%）。71%的婴儿接受了上气道评估，其中7例有异常发现。10名婴儿在平均13.4个月时获得随访PSG，显示4名婴儿SDB缓解。1名患者经CPAP治疗后SDB缓解，但失访。5名婴儿SDB持续但有所改善。AHI与年龄呈弱负相关（ρ = -0.31，p = 0.26）。
结论： 在非综合征型足月婴儿中，中重度阻塞性睡眠呼吸暂停（OSA）的发生频率较高。其临床意义仍不明确。然而，AHI似乎确实随年龄增长而下降，许多婴儿能够在没有任何干预的情况下随生长而缓解OSA。仍需进一步研究以完善该特殊人群SDB的诊断阈值，并标准化诊断评估和干预措施。

英文摘要

UNLABELLED: Sleep-disordered breathing (SBD) is understudied in non-syndromic term infants since most of the research focuses on high-risk groups such as premature infants or those with underlying medical conditions. There is a gap in our understanding of phenotypes that predispose this population to experience SDB. Threshold for diagnosis remain poorly standardized, and there is limited data on effective treatment strategies.
OBJECTIVE: To characterize the clinical presentation and polysomnographic features of term, non-syndromic, infants referred for evaluation of suspected sleep-disordered breathing (SDB).
METHODS: This was a single-center case series of review of polysomnographic (PSG) data in non-syndromic term infants from 0-12 months of age from a tertiary care center.
RESULTS: Fifteen infants met inclusion criteria. The mean gestational age was 38.4 ± 0.6 weeks; 80% were male. The mean age at initial PSG was 7.5 ± 3.6 months. Snoring was present in 33% and 47% carried a diagnosis of gastroesophageal reflux (GER). The average apnea-hypopnea index (AHI) was 23.1/h. The mean obstructive AHI (OAHI) was 20/h and the mean central apnea index (CAI) was 3.1/h. Mean oxygen saturation was 97.5 ± 1.5%, with a nadir of 81.0 ± 9.9%. Six patients met criteria for sleep-related hypoxemia (SpO2 < 90% for ≥ 5 min). Mean and peak CO2 levels were 35 mmHg and 48.6 mmHg, respectively. None of the patients met criteria for sleep-related hypoventilation (CO2 > 50 mmHg for > 25% of total sleep time). 71% of the infants underwent an evaluation of their upper airway, and 7 had abnormal findings. Follow-up PSG obtained around 13.4 months, on average, in 10 of the infants showed resolution of SDB in 4 infants. One patient showed resolution of the SDB with CPAP, but was lost to follow-up. SDB was persistent but improved in 5 infants. AHI showed a weak negative correlation with age (ρ = -0.31, p = 0.26).
CONCLUSION: Frequency of moderate-severe obstructive sleep apnea (OSA) is high among non-syndromic term infants. The clinical implication of this is still unclear. However, AHI does appear to decrease with age, and many infants are able to outgrow their OSA without any intervention. Further research is warranted to refine diagnostic thresholds and standardize the diagnostic evaluation and interventions for SDB in this unique population.