目的:我们研究了患有综合征性颅骨融合症(SCS)的儿童脉搏传导时间(PTT)与阻塞性睡眠呼吸暂停(OSA)之间的关系,其中OSA是一个常见的问题,可能会导致心肺功能紊乱。
方法:对患有SCS和中度至重度OSA的儿童(年龄<18岁)的回顾性研究(即,阻塞性呼吸暂停低通气指数[oAHI]≥5),或无OSA(oAHI<1),接受过夜多导睡眠图(PSG)。无SCS和正常PSG的儿童作为对照。通过非参数自举分析计算PTT的参考间隔(RI)。基于控件的RI,确定PTT检测OSA的敏感性和特异性。在线性混合模型中,评估的解释变量是性别,年龄,睡眠阶段,和阻塞事件后的时间。
结果:在所有68名儿童中(19名患有OSA的SCS,30SCS无OSA,19个控件),阻塞性事件发生在所有睡眠阶段,在快速眼动睡眠(REM)和非REM睡眠阶段N1和N2期间最明显,并伴有明显的PTT变化。事件发生后4-8s观察到最大的减少(p<0.05)。在带有OSA的SCS中,与没有OSA的SCS相比,所有睡眠阶段的PTTRI均较低。在N1期间观察到最高的灵敏度(55.5%),在REM期间特异性最高(76.5%)。在N1期间鉴定出最低PTT值。
结论:阻塞性事件发生在所有睡眠阶段,PTT短暂降低。然而,PTT作为OSA检测的变量受到其灵敏度和特异性的限制。
OBJECTIVE: We examined the association between pulse transit time (PTT) and obstructive sleep apnea (OSA) in children with syndromic craniosynostosis (SCS), where OSA is a common problem and may cause cardiorespiratory disturbance.
METHODS: A retrospective study of children (age < 18 years) with SCS and moderate-to-severe OSA (ie, obstructive apnea-hypopnea index ≥ 5) or no OSA (obstructive apnea-hypopnea index < 1) who underwent overnight polysomnography. Children without SCS and normal polysomnography were included as controls. Reference intervals for PTT were computed by nonparametric bootstrap analysis. Based on reference intervals of controls, the sensitivity and specificity of PTT to detect OSA were determined. In a linear mixed model, the explanatory variables assessed were sex, age, sleep stage, and time after obstructive events.
RESULTS: In all 68 included children (19 with SCS with OSA, 30 with SCS without OSA, 19 controls), obstructive events occurred throughout all sleep stages, most prominently during rapid eye movement (REM) sleep and non-REM sleep stages N1 and N2, with evident PTT changes. The greatest reductions were observed 4-8 seconds after an event (P < .05). In SCS with OSA, PTT reference intervals were lower during all sleep stages compared with SCS without OSA. The highest sensitivity was observed during N1 (55.5%), and the highest specificity during REM sleep (76.5%). The lowest PTT values were identified during N1.
CONCLUSIONS: Obstructive events occur throughout all sleep stages with transient reductions in PTT. However, PTT as a variable for OSA detection is limited by its sensitivity and specificity.
BACKGROUND: Yang S, van Twist E, van Heesch GGM, et al. Severe obstructive sleep apnea in children with syndromic craniosynostosis: analysis of pulse transit time. J Clin Sleep Med. 2024;20(8):1233-1240.