目的 调查体位性心动过速综合征(POTS)患儿的睡眠情况,分析睡眠干预在改善POTS患儿临床症状中的效果。方法 选择2018年5月-2019年5月确诊为POTS的40例患儿为病例组,儿保科体检的20例健康儿童为对照组。以直立试验或直立倾斜试验(HUTT)的结果作为POTS诊断依据。利用匹兹堡睡眠质量指数量表(PSQI)进行睡眠现况调查。POTS组患儿接受为期3个月的睡眠促进疗法,直立不耐受症状评分下降＞2分表示睡眠干预治疗有效,≤2分表示治疗干预无效。结果 POTS组和对照组平卧位心率(t=-2.117)、直立位最大心率(t=3.88)、卧立位心率差值(t=-7.86)比较,差异有统计学意义(P＜0.05)。与对照组相比,POTS组中有77.5%的患儿PSQI总分＞5分,POTS患儿与健康儿童相比,PSQI评分(t=8.31,P＜0.001)以及除睡眠药物以外的其他6项因子得分差异均有统计学意义(P＜0.001)。POTS组患儿睡眠促进疗法干预前后血压变化差异无统计学意义,干预后平卧位心率(t=-2.707)、直立位最大心率(t=2.656)、卧立位心率差值(t=4.771)较干预前降低,临床症状评分显著低于干预前(Z=-5.083),差异有统计学意义(P＜0.05)。与干预前相比,症状评分下降＞2分的患儿占60%,年龄＞10岁的POTS患儿,行睡眠疗法治疗有效的敏感度为91.7%,特异度为43.7%。结论 多数POTS患儿存在睡眠质量差的问题,采用睡眠干预疗法可促进儿童POTS临床症状的改善。
Abstract
Objective To explore the effects of sleep improvement intervention on the clinical symptoms of children with postural tachycardia syndrome (POTS) by investigating the sleep status.Methods Totally 40 children diagnosed with POTS from May 2018 to May 2019 were selected as the POTS group, and meanwhile 20 healthy children for physical examination in child healthcare department were selected as the control group.The diagnosis of POTS were based on the results of head-up tilt test (HUTT).The Pittsburgh Sleep Quality Index (PSQI) was used to investigate sleep status.POTS group received sleep improvement intervention for 3 months.A decrease of orthostatic intolerance score> 2 indicated that the sleep intervention was effective, and ≤2 indicated ineffective.Results Significant differences were found in supine heart rate (t=-2.117), upright maximum heart rate (t=3.88) and upright heart rate difference (t=-7.86) between POTS group and control group(P＜0.05).Compared with the control group, 77.5% of children in POTS group had a total PSQI score of > 5.Except from sleep drugs, significant differences were found in PSQI score (t=8.31,P＜0.001) and six factors of PSQI (P＜0.001) .There was no statistical difference on blood pressure before and after sleep improvement intervention in POTS group.While supine heart rate (t=-2.707), upright maximum heart rate (t=2.656), upright heart rate difference (t=4.771) and clinical symptoms score(Z=-5.083) dramatically decreased after intervention (P＜0.05).Furthermore, 60% of POTS children had a decrease of symptom score > 2.The ROC curve showed that the sleep improvement intervention for POTS would be predicted to be effective when the patients more than 10 years old, yielded a sensitivity of 91.7% and specificity of 43.7%. Conclusions Most children with POTS suffered from poor sleep quality, and sleep intervention therapy can effectively improve the clinical symptoms of POTS children.
关键词
体位性心动过速综合征 /
睡眠干预 /
儿童青少年
Key words
postural tachycardia syndrome /
sleep intervention /
children and adolescents
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基金
国家自然科学基金青年基金(81803263);浙江省卫生健康委员会科研项目(2020KY612)
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