哮喘与重度睡眠呼吸障碍患儿需要CPAP的可能性相关
2019/03/21
摘要
目的：重度阻塞性睡眠呼吸暂停综合征（OSAS）患儿开始使用持续正压通气（CPAP）具有挑战性，并且需要应用CPAP的患儿很难界定。支气管哮喘在儿童中经常与OSAS同时存在。此项研究的目的是探讨支气管哮喘对重度OSAS患儿需要CPAP治疗的影响。
假设：合并哮喘的重度OSAS患儿需要CPAP的可能性比不合并哮喘的OSAS患儿高。
方法：对重度OSAS患儿的临床表现、危险因素、初始多导睡眠图参数。重度OSAS定义为阻塞性呼吸暂停低通气指数（AHI）≥10次/小时。分别研究哮喘与应用CPAP的之间的关系，并应用相关的协变量进行调整。
结果：共计400名符合条件的重度OSAS患儿（平均年龄7岁±SD 5.3）入组，其中133（33%）名患有支气管哮喘。与只患有OSAS的患儿（14%）相比，OSAS合并哮喘的患儿（29%）需要CPAP的比例明显升高（P＜0.01）。多元分析显示在重度OSAS患儿中，支气管哮喘与需要CPAP之间的关系与人口特征、OSAS严重性、肥胖及扁桃体切除无明显相关性。
结论：哮喘患儿合并重度OSAS需要CPAP的可能性较高，且独立于相关协变量。此研究证明了OSAS与支气管哮喘在儿童中的联系，并且指出诊断支气管哮喘可能需要对重度OSAS应用CPAP治疗。
Asthma is associated with increased probability of needing CPAP in children with severe obstructive sleep apnea.
Kilaikode S, Weiss M.
Abstract
OBJECTIVE:Initiation of continuous positive airway pressure (CPAP) in children with severe obstructive sleep apnea syndrome (OSAS) is challenging and the distinct features of the subset of children requiring CPAP are poorly defined. Asthma often coexists with OSAS in children. The goal of this study was to explore the influence of asthma in the need for CPAP therapy in children with severe OSAS.
HYPOTHESIS:Asthmatic children with severe OSAS have higher probability of needing CPAP than children with severe OSAS without asthma.
METHODS: Cross-sectional study of clinical presentation, individual risk factors, and initial overnight polysomnogram (PSG) parameters in children with severe OSAS. Severe OSAS was defined as an obstructive apnea hypopnea index ≥10/h. The association between asthma and CPAP initiation was studied individually and adjusted by pertinent covariates.
RESULTS: Four hundred eligible children (mean age 7 years, ±SD 5.3) with severe OSAS were enrolled and 133 individuals (33%) were identified to have asthma. The proportion of children needing CPAP was significantly higher in asthmatics with severe OSAS (29%) compared to those with OSAS alone (14%) (P < 0.01). Multivariate analysis demonstrated that the association between asthma and the need of CPAP in pediatric severe OSAS was independent of demographics, OSAS severity, obesity, and history of adenotonsillectomy (P < 0.01).
CONCLUSION: Asthmatic children with severe OSAS have higher probability of needing CPAP independent of relevant covariables. This study further substantiates the link between OSAS and asthma in children and suggests the diagnosis of asthma may influence the need of CPAP therapy for severe OSAS.
目的：重度阻塞性睡眠呼吸暂停综合征（OSAS）患儿开始使用持续正压通气（CPAP）具有挑战性，并且需要应用CPAP的患儿很难界定。支气管哮喘在儿童中经常与OSAS同时存在。此项研究的目的是探讨支气管哮喘对重度OSAS患儿需要CPAP治疗的影响。
假设：合并哮喘的重度OSAS患儿需要CPAP的可能性比不合并哮喘的OSAS患儿高。
方法：对重度OSAS患儿的临床表现、危险因素、初始多导睡眠图参数。重度OSAS定义为阻塞性呼吸暂停低通气指数（AHI）≥10次/小时。分别研究哮喘与应用CPAP的之间的关系，并应用相关的协变量进行调整。
结果：共计400名符合条件的重度OSAS患儿（平均年龄7岁±SD 5.3）入组，其中133（33%）名患有支气管哮喘。与只患有OSAS的患儿（14%）相比，OSAS合并哮喘的患儿（29%）需要CPAP的比例明显升高（P＜0.01）。多元分析显示在重度OSAS患儿中，支气管哮喘与需要CPAP之间的关系与人口特征、OSAS严重性、肥胖及扁桃体切除无明显相关性。
结论：哮喘患儿合并重度OSAS需要CPAP的可能性较高，且独立于相关协变量。此研究证明了OSAS与支气管哮喘在儿童中的联系，并且指出诊断支气管哮喘可能需要对重度OSAS应用CPAP治疗。
（中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校）
（Pediatr Pulmonol. 2019 Mar;54(3):342-347. doi: 10.1002/ppul.24245. Epub 2019 Jan 10.）
（Pediatr Pulmonol. 2019 Mar;54(3):342-347. doi: 10.1002/ppul.24245. Epub 2019 Jan 10.）
Asthma is associated with increased probability of needing CPAP in children with severe obstructive sleep apnea.
Kilaikode S, Weiss M.
Abstract
OBJECTIVE:Initiation of continuous positive airway pressure (CPAP) in children with severe obstructive sleep apnea syndrome (OSAS) is challenging and the distinct features of the subset of children requiring CPAP are poorly defined. Asthma often coexists with OSAS in children. The goal of this study was to explore the influence of asthma in the need for CPAP therapy in children with severe OSAS.
HYPOTHESIS:Asthmatic children with severe OSAS have higher probability of needing CPAP than children with severe OSAS without asthma.
METHODS: Cross-sectional study of clinical presentation, individual risk factors, and initial overnight polysomnogram (PSG) parameters in children with severe OSAS. Severe OSAS was defined as an obstructive apnea hypopnea index ≥10/h. The association between asthma and CPAP initiation was studied individually and adjusted by pertinent covariates.
RESULTS: Four hundred eligible children (mean age 7 years, ±SD 5.3) with severe OSAS were enrolled and 133 individuals (33%) were identified to have asthma. The proportion of children needing CPAP was significantly higher in asthmatics with severe OSAS (29%) compared to those with OSAS alone (14%) (P < 0.01). Multivariate analysis demonstrated that the association between asthma and the need of CPAP in pediatric severe OSAS was independent of demographics, OSAS severity, obesity, and history of adenotonsillectomy (P < 0.01).
CONCLUSION: Asthmatic children with severe OSAS have higher probability of needing CPAP independent of relevant covariables. This study further substantiates the link between OSAS and asthma in children and suggests the diagnosis of asthma may influence the need of CPAP therapy for severe OSAS.
上一篇：
在小鼠哮喘模型中牛乌头碱A可有效缓解过敏性肺部炎症
下一篇：
咽后清配方通过上调卵黄蛋白诱导的哮喘小鼠的Treg抑制Th2反应减轻过敏性气道炎症
