儿童阻塞性睡眠呼吸暂停低通气综合征与血压相关性研究

摘要

目的：探讨儿童阻塞性睡眠呼吸暂停低通气综合征（ OSAHS）与血压的相关性。方法纳入2012年7月至2013年7月以睡眠打鼾为主诉于上海儿童医学中心睡眠障碍诊治中心就诊的3~18岁儿童青少年，行整夜多导睡眠图（ PSG）监测并测量睡前收缩压（ SBP）和舒张压（ DBP）。根据PSG监测结果分为非OSAHS组和OSAHS组，OSAHS组根据呼吸暂停低通气指数和最低血氧饱和度分为OSAHS轻、中和重度亚组。依据2010年中国儿童青少年血压参照标准诊断高血压。计算收缩压指数（ SBPI）和舒张压指数（ DBPI）。分析不同程度的OSAHS与血压的相关性。结果385例研究对象进入分析，平均年龄（5.5±2.3）岁，男262例，女123例。SBP（100.6±10.4）mmHg，DBP（63.2±8.5）mmHg，符合高血压诊断122例（31.7％），其中严重高血压42例（10.9％）。非OSAHS组261例（67.8％）；OSAHS组124例，其中轻、中和重度亚组分别有54、43和27例。BMI、BMI-Z评分、颈围、超重及肥胖患病率指标OSAHS组显著高于非OSAHS组。①OSAHS组SBP显著高于非OSAHS组，但调整年龄、性别和BMI-Z评分后SBP的组间差异无统计学意义。OSAHS轻、中和重度亚组SBP和DBP差异有统计学意义（ SBP：F=3.46，P=0.034；DBP：F=4.27，P=0.016），在调整了年龄、性别和BMI-Z评分后SBP和DBP的组间差异仍有统计学意义（ P＜0.05）。②非OSAHS组和OSAHS组SBPI和DBPI差异无统计学意义；OSAHS轻、中和重度亚组 SBPI 和 DBPI 差异有统计学意义（ SBPI：F =2.54，P =0.046；DBPI：F =3.25，P =0.042）。③OSAHS轻、中和重度亚组高血压检出率差异有统计学意义，调整了年龄、性别以及BMI-Z评分后，OSAHS重度亚组严重高血压的风险显著高于轻度亚组，OR=5.79（95％CI：1.45~23.11）。结论鼾症患儿高血压检出率显著高于正常人群，其中重度OSAHS患儿高血压及严重高血压的发生风险最高，提示应密切监测睡眠相关呼吸障碍患儿的血压。%Objective To explore the relationship between obstructive sleep apnea hypopnea syndrome( OSAHS)and blood pressure in children. Methods Overnight polysomnography( PSG)was conducted in the Pediatric Sleep Center of Shanghai Jiaotong University School of Medicine affiliated to Shanghai Children's Medical Center for children aged 3-18 years,who were recruited in outpatient clinic from July 2012 to July 2013 with complaint of sleep snoring. Systolic blood pressure( SBP)and diastolic blood pressure( DBP)were measured for everyone before sleep in the evening. All children were divided into non-OSAHS group and OSAHS group according to PSG result,and then OSAHS group was divided into mild,moderate and severe subgroups according to apnea hypopnea index( AHI)and lowest oxygen saturation( LSaO2 ). The diagnosis of hypertension was made according to blood pressure reference standards for Chinese children and adolescents 2010. Systolic blood pressure index( SBPI)and diastolic blood pressure index( DBPI)were calculated. Then further analysis was was performed to evaluate the relationship between severities of OSHAS and blood pressure levels. Results A total of 385 children were enrolled in our study,with average age( 5. 5 ± 2. 3 ) years,262 boys,SBP(100. 6 ± 10. 4)mmHg and DBP(63. 2 ± 8. 5)mmHg. 122(31. 7%)children met the criteria of hypertension and 42(10. 9%)were severe hypertension. 261(67. 8%)children were in non-OSAHS group,124(32. 2%)were in OSAHS group. In the OSAHS group,54,43 and 27 children were classified into mild,moderate and severe subgroups respectively. Compared with non-OSAHS group,the OSAHS group had higher BMI,BMI-Z scores,neck circumference,prevalence of overweight and obesity. ①SBP of OSAHS group was higher than non-OSAHS group,but it lost significance after adjustment of age,sex and BMI-Z. Both of the SBP and DBP statistically varied among different OSAHS severity groups(SBP:F=3. 46,P=0. 034;DBP:F=4. 27,P=0. 016),even adjusted by age,sex and BMI-Z scores. ②SBPI and DBPI did not significantly differ between OSAHS and non-OSAHS groups. In the OSAHS group,SBPI and DBPI significantly varied among different severity subgroups(SBPI:F=2. 54,P=0. 046;DBP:F=3. 25,P=0. 042). ③The hypertension prevalence was significantly different among 3 OSAHS subgroups. Severe OSAHS children had higher risk of hypertension compared with mild OSAHS children,OR=2. 87(95%CI:1. 03~7. 99),for severe hypertension,the OR increased to 5. 79,(95%CI:1. 45-23. 11). Conclusion The prevalence of hypertension is higher in children with sleep snoring than the general population,especially in the children with severe OSAHS. More attention should be paid to monitoring blood pressure for the children with sleep disordered breathing.