抗炎治疗改善轻度阻塞性睡眠呼吸暂停综合征患儿的症状和注意力被引量：11

Effect of anti-inflammatory therapy of mild OSAS on improving clinical symptoms and attention deficiency in children

下载PDF

导出

摘要目的探讨非手术抗炎治疗对轻度阻塞性睡眠呼吸暂停综合征（OSAS）患儿临床症状、生命质量及注意力损害的疗效。方法以2013年1月至2015年3月在上海交通大学医学院附属儿童医学中心门诊就诊并行多导睡眠图（PSG）监测的5~7岁、体重正常、呼吸暂停低通气指数（AHI）在1~5·h-1的OSAS患儿为研究对象。予鼻部糖皮质激素和白三烯受体调节剂（孟鲁司特钠）治疗16周。治疗前和治疗后均行扁桃体、腺样体体积评分,PSG监测睡眠结构和觉醒参数,整合视听持续测试评估综合注意力商数及反应控制商数,检测尿液半胱氨酰白三烯（Cys LTs）水平,行生命质量评分（OSA-18）,分析治疗前后上述指标的差异。结果 66例轻度OSAS患儿进入分析,年龄（5.5±0.8）岁,男36例（54.5%）。1抗炎治疗后扁桃体、腺样体体积评分较治疗前显著降低[扁桃体：（2.0±0.5）vs（2.4±0.6）,腺样体：（1.5±0.7）vs（2.2±0.6）;P均〈0.05]。2 PSG参数快速眼动睡眠期百分比、AHI、总觉醒指数、呼吸相关觉醒指数、睡眠压力指数、最低Sp O2治疗后较治疗前差异均有统计学意义（P均〈0.05）;27例（41%）治疗后PSG监测正常（AHI〈1·h-1）。3治疗后综合注意力商数、综合反应控制商数和OSA-18总分较治疗前明显改善[综合注意力商数：（111.5±4.8）vs（106.0±9.5）,综合反应控制商数：（103.1±7.1）vs（98.7±7.0）;OSA-18：（33.2±5.7）vs（44.7±8.1）;P均〈0.05]。4治疗后尿液Cys-LTs（pg·m L-1）/尿肌酐（mg·d L-1）比值较治疗前显著下降（P=0.039）。结论鼻部糖皮质激素联合白三烯受体调节剂治疗可改善轻度OSAS患儿的临床症状、间歇性缺氧和睡眠片段化,且可改善轻度OSAS患儿的注意力损害。 Objective To investigate nonsurgical alternatives for mild obstructive sleep apnea syndrome（ OSAS） primarily consisting of anti-inflammatory therapy effect on the clinical symptoms,quality of life and attention deficiency. Methods Consecutive snoring children aged 5- 7 years with normal weight were recruited from Shanghai Children＇ s Medical Center,who fulfilled mild OSAS criteria [apnea hypopnea index（ AHI） 1- 5 No· h- 1] and received 16 weeks nasal steroid spray and leukotriene receptor modifiers（ montelukast） therapy. The outcomes were compared including tonsil and adnoid scoring,sleep structure and arousal parameters by polysomnography（ PSG）,full attention quotient and full response control quotient by IVA-CPT test,urine cysteine leukotriene（ Cys LTs） concentration,and quality of life before and after the therapy. Results A total of 66 children with mild OSAS including 36 boys（ 54. 5%） were recruited,aged（ 5. 5 ± 0. 8） years. 1 Tonsil and adnoid scoring decreased after the antiinflammatory therapy [Tonsil：（ 2. 0 ± 0. 5） vs（ 2. 4 ± 0. 6）,Adnoid：（ 1. 5 ± 0. 7） vs（ 2. 2 ± 0. 6）; P〈0. 05]. 2 After the antiinflammatory therapy,there was significant difference in the PSG parameters including REM（ %）,AHI,total arousal index,respiratory related arousal index,sleep pressure score（ SPS） and nadir Sp O2（ P〈0. 05）. Of them,27 cases（ 41%） had normal PSG result after the therapy. 3The full attention quotient,full response control quotient and OSA-18 were improved [full attention quotient：（ 111. 5 ± 4. 8） vs（ 106. 0 ± 9. 5）,full response control quotient：（ 103. 1 ± 7. 1） vs（ 98. 7 ± 7. 0）; OSA-18：（ 33. 2 ± 5. 7）vs（ 44. 7 ± 8. 1）; P〈0. 05]; 4The urine Cys LTs（ pg·m L- 1） /Cr（ mg·d L- 1） ratio was decreased after the treatment（ P = 0.039）. Conclusion Nasal steroid spray and leukotriene receptor modifiers can improve the clinical symptoms,intermittent hypoxia,sleep fragmentation and the attention deficiency in children with mild OSAS.

作者张静张清清江帆殷勇陈洁

机构地区上海交通大学医学院附属上海儿童医学中心呼吸科上海交通大学医学院附属上海儿童医学中心睡眠障碍诊治中心上海交通大学医学院附属上海儿童医学中心发育行为儿科上海交通大学医学院附属上海儿童医学中心耳鼻咽喉科

出处《中国循证儿科杂志》 CSCD 北大核心 2015年第4期265-268,共4页 Chinese Journal of Evidence Based Pediatrics

基金上海市科学技术委员会科技支撑项目:124119a2800 上海交通大学医学院附属新华集团基金

关键词阻塞性睡眠呼吸暂停综合征抗炎治疗生命质量注意力儿童 Obstructive sleep apnea syndrome Anti-inflammatory therapy Quality of life Attention Children

分类号 R766 [医药卫生—耳鼻咽喉科]

引文网络
相关文献

参考文献23

1Li AM, So HK, Au CT, et al. Epidemiology of obstructive sleep apnoea syndrome in Chinese children: a two-phase community study. Thorax, 2010, 65( 11): 991-997.
2Marcus CL, Brooks LJ, Draper KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics, 2012, 130(3): 576-584.
3Editorial Board of Chinese Journal of Otorhinolary(中华医学会耳鼻咽喉科学分会),Chinese Otorhinolaryngology of Chinese Medical Ass. Draft of guidelines for the diagnosis and treatment of pediatric sleep apnea hypopnea syndrome(Urumqi). 中华耳鼻咽喉科杂志,2007, 24(2):83-84.
4Redline S, Amin R, Beebe D, et al. The Childhood Adenotonsillectomy Trial (CHAT): rationale, design, and challenges of a randomized controlled trial evaluating a standard surgical procedure in a pediatric population. Sleep, 2011, 34(11):1509-1517.
5Bourke RS, Anderson V, Yang JS, et al. Neurobehavioral function is impaired in children with all severities of sleep disordered breathing. Sleep Med, 2011, 12(3): 222-229.
6Kheirandish-Gozal L, Bhattacharjee R, Bandla HP, et al. Antiinflammatory therapy outcomes for mild OSA in children. Chest, 2014,146(1):88-95.
7de Onis M, Lobstein T. Defining obesity risk status in the general childhood population: which cut-offs should we use?Int J Pediatr Obes, 2010, 5(6): 458-460.
8Iber C A-IS CA QS. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. American Academy of Sleep Medicine, 2007.
9Tauman R, O'Brien LM, Holbrook CR, et al. Sleep pressure score: a new index of sleep disruption in snoring children. Sleep, 2004, 27(2):274-278.
10Tinius TP. The Integrated Visual and Auditory Continuous Performance Test as a neuropsychological measure. Arch Clin Neuropsychol, 2003,18(5):439-454.