分析变应性鼻炎对睡眠呼吸障碍儿童的影响。
Analysis of the impact of allergic rhinitis on the children with sleep disordered breathing.
机构信息
Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, People's Republic of China.
Beijing Key Laboratory of Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, People's Republic of China.
出版信息
Int J Pediatr Otorhinolaryngol. 2020 Nov;138:110380. doi: 10.1016/j.ijporl.2020.110380. Epub 2020 Sep 12.
OBJECTIVES
We assessed the influence of allergic rhinitis (AR) on sleep disordered breathing (SDB) in children with adenotonsillar hypertrophy (ATH), and compared sleep quality and polysomnographic data in habitually snoring children with or without AR.
METHODS
Children with snoring resulting from adenoid/tonsils hypertrophy were recruited between Jan 1st, 2018 and Jun 30th, 2018. The exclusion criteria were congenital disorders, metabolic disorders, neurological disorders and pulmonary diseases, such as, asthma etc. Overnight polysomnography (PSG) and Sleep Questionnaire (SQ) were assessed on each participant to identify children with obstructive sleep apnea (OSA). Cross-sectional study design was used to examine PSG and SQ data. The diagnosis of AR was based upon history of allergies and positive clinical examinations, then confirmed by allergen test. Participants were categorized into four groups (AR and Non-OSA group; AR and OSA group; Non-AR and Non-OSA group; Non-AR and OSA group). Non-parametric rank sum test was used for statistical analysis.
RESULTS
Six hundred and sixty children (age between 3yrs and 14yrs) with SDB were enrolled in the study (mean age 6.7 ± 2.1yrs, 67.4% male). The number of children diagnosed with OSA was 495 (74.3%). The prevalence of AR among all participating SDB children was 25.8%, and AR with OSA was19.4%. The behavioral problems scores in SQ showed significant difference among SDB children with AR (P<.0001). No difference was observed in the OAHI (obstructive apnea-hypopnea index) and AHI (apnea-hypopnea index) between the groups of children with and without AR regardless whether OSA was coexisting. The percentage of time spent in the rapid eye movement (REM) sleep stage was shortened among children with AR without OSA (P = 0.031), however, the percentage of time spent in the REM sleep stage was not different among children with OSA (P = 0.98). The total sleep time was shorter among children with AR (OSA P = 0.02; without OSA P = 0.03).
CONCLUSIONS
Despite the high prevalence of AR in patients with SDB, AR is not an aggravating factor for the severity of AHI. High risk behavioral problems link to SDB with AR. AR is associated with shortened REM sleep stage in children with SDB without sleep apnea, and shortened total sleep time in children with SDB.
目的
我们评估了变应性鼻炎（AR）对腺样体扁桃体肥大（ATH）儿童睡眠呼吸障碍（SDB）的影响，并比较了伴有或不伴有 AR 的习惯性打鼾儿童的睡眠质量和多导睡眠图数据。
方法
2018 年 1 月 1 日至 2018 年 6 月 30 日期间，我们招募了因腺样体/扁桃体肥大而打鼾的儿童。排除标准为先天性疾病、代谢性疾病、神经疾病和肺部疾病，如哮喘等。对每位参与者进行整夜多导睡眠图（PSG）和睡眠问卷（SQ）评估，以确定阻塞性睡眠呼吸暂停（OSA）患儿。采用横断面研究设计检查 PSG 和 SQ 数据。AR 的诊断基于过敏史和阳性临床检查，然后通过过敏原测试确认。参与者分为四组（AR 和非 OSA 组；AR 和 OSA 组；非 AR 和非 OSA 组；非 AR 和 OSA 组）。采用非参数秩和检验进行统计学分析。
结果
共有 660 名 SDB 儿童（年龄 3 至 14 岁，平均年龄 6.7±2.1 岁，67.4%为男性）入组。诊断为 OSA 的儿童有 495 名（74.3%）。所有 SDB 儿童中 AR 的患病率为 25.8%，伴有 OSA 的 AR 患病率为 19.4%。在 SDB 儿童中，SQ 的行为问题评分存在显著差异（P<.0001）。无论是否伴有 OSA，有和无 AR 的儿童在 OAHI（阻塞性呼吸暂停低通气指数）和 AHI（呼吸暂停低通气指数）方面均无差异。无 OSA 的 AR 儿童的快速眼动（REM）睡眠阶段时间百分比缩短（P=0.031），但 OSA 儿童的 REM 睡眠阶段时间百分比无差异（P=0.98）。AR 儿童的总睡眠时间更短（伴有 OSA 的 P=0.02；无 OSA 的 P=0.03）。
结论
尽管 SDB 患者的 AR 患病率较高，但 AR 并不是 AHI 严重程度的加重因素。高风险行为问题与伴有 AR 的 SDB 有关。AR 与无睡眠呼吸暂停的 SDB 儿童的 REM 睡眠阶段缩短以及 SDB 儿童的总睡眠时间缩短有关。
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