目的 评估阻塞性睡眠呼吸暂停(OSA)患儿生活质量及影响因素,为临床干预提供参考依据。方法 收集2021—2023年就诊于西安交通大学第二附属医院并完成整夜多导睡眠(PSG)监测的儿童527例,在专业技术人员指导下完成儿童睡眠监测调查问卷、儿童及青少年嗜睡评估量表和OSA特异性生活质量调查(OSA-18)等。根据PSG结果分组,评估OSA患儿生活质量情况,并进一步按照OSA-18结果对生活质量影响程度分组,分为轻度,中度及重度影响组,通过单因素分析和有序多元logistics回归对数据进行统计分析。结果 527例儿童中单纯打鼾组116例(22.0%),轻度OSA组310例(58.8%),中重度OSA组101例(19.2%)。各组儿童随着OSA病情严重程度增加,打鼾和呼吸暂停占比明显升高,同时患儿在上床后20min内入睡(χ2=6.599, P=0.037)及起床后需要长时间清醒的占比(χ2=25.617, P<0.001)也明显增高,OSA-18得分同样提示其对生活影响程度增加,差异有统计学意义(χ2=17.74, P=0.001)。按照对生活影响程度进行分组发现, N3期睡眠占比、阻塞性事件总次数、阻塞性事件最长时间、混合性呼吸事件总次数、混合性呼吸事件最长时间、低通气总次数、低通气最长时间、最低血氧饱和度、睡眠呼吸紊乱指数、氧减指数在各组中差异有统计学意义(P<0.05),而有序多元logistics回归分析结果提示,最低血氧饱和度可能是影响患儿生活质量的重要影响因素(OR=0.861, 95%CI:0.746~0.993,P=0.040)。结论 与单纯打鼾儿童相比,OSA对患儿生活质量的影响程度随病情有所增加,此外,最低血氧饱和度是影响患儿生活质量的保护因素,在临床工作中应给予重视。
Abstract
Objective To evaluate the quality of life (QoL) and its influencing factors in children with obstructive sleep apnea (OSA), providing a reference for clinical intervention. Methods A total of 527 children who underwent overnight polysomnography (PSG) at the Second Affiliated Hospital of Xi′an Jiaotong University between 2021 and 2023 were enrolled.Under the guidance of professional technicians, participants completed the Pediatric Sleep Questionnaire, the Epworth Sleepiness Scale for Children and Adolescents, and the OSA-18 quality of life survey.Based on PSG results, children were categorized into groups to assess QoL.Further stratification was performed according to OSA-18 scores into mild, moderate, and severe impact groups.Statistical analysis was conducted using univariate analysis and ordered multivariate logistic regression. Results Among the 527 children, 116 (22.0%) were in the primary snoring group, 310 (58.8%) in the mild OSA group, and 101 (19.2%) in the moderate-to-severe OSA group.As OSA severity increased, the proportion of children with snoring and apnea significantly rose (both P<0.05).Additionally, the percentage of children falling asleep within 20 minutes of bedtime (χ2=6.599, P=0.037) and requiring prolonged wakefulness after rising (χ2=25.617, P<0.001) also increased significantly.OSA-18 scores indicated a progressive deterioration in QoL with disease severity (χ2=17.74, P=0.001).When stratified by QoL impact, significant differences were observed among groups in N3 sleep proportion, total obstructive event count, longest obstructive event duration, total mixed event count, longest mixed event duration, total hypopnea count, longest hypopnea duration, lowest oxygen saturation (SaO2), apnea-hypopnea index, and oxygen desaturation index (all P<0.05).Ordered multivariate logistic regression identified lowest SaO2 as an independent influencing factor for reduced QoL (OR=0.861, 95%CI:0.746~0.993,P=0.040). Conclusions Compared with primary snoring, OSA exerts a progressively greater impact on children′s QoL as disease severity increases.Furthermore, lowest SaO2 is an independent protective factor for diminished QoL, warranting clinical attention.
关键词
阻塞性睡眠呼吸暂停 /
生活质量 /
儿童
Key words
obstructive sleep apnea /
life quality /
children
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基金
国家自然科学基金面上项目(82371129);陕西省重点产业创新链(群)(2024SF-ZDCYL-O1-04)
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