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Role of ventilatory control instability in children with sleep-disordered breathing.

通气控制不稳定在睡眠呼吸障碍儿童中的作用。

  • 影响因子:3.15
  • DOI:10.1111/resp.13809
  • 作者列表:"Siriwardhana LS","Weichard A","Nixon GM","Davey MJ","Walter LM","Edwards BA","Horne RSC
  • 发表时间:2020-04-02
Abstract

BACKGROUND AND OBJECTIVE:The contribution of non-anatomical factors, such as ventilatory control instability (i.e. LG), to the pathogenesis of obstructive SDB in children is unclear. Therefore, we aimed to identify the relationship between LG and severity of SDB, demographic, anthropometric and anatomical characteristics in a clinically representative cohort of children. METHODS:Children (aged 3-18 years) with various severities of SDB (n = 110) and non-snoring controls (n = 36) were studied. Children were grouped according to their OAHI. Anthropometric and upper airway anatomical characteristics were measured. Spontaneous sighs were identified on polysomnography and LG, a measure of the sensitivity of the negative feedback loop that controls ventilation, was estimated by fitting a mathematical model of ventilatory control to the post-sigh ventilatory pattern. RESULTS:There was no difference in LG between controls and any of the SDB severity groups. However, LG was significantly lower in children with larger tonsils (tonsil grade 4) compared with children with smaller tonsils (tonsil grade 1) (median LG (range): 0.25 (0.20-0.42) vs 0.32 (0.25-0.44); P = 0.009) and in children with a modified Mallampati score of class III/IV compared with class I (0.28 (0.24-0.33) vs 0.37 (0.27-0.44); P = 0.009). CONCLUSION:A direct relationship was not found between the severity of paediatric SDB and LG. However, an altered ventilatory control sensitivity may contribute to SDB in a subgroup of children depending on their degree of anatomical compromise of the airway.

摘要

背景与目的: 非解剖因素的贡献,如通气控制不稳定 (LG),儿童阻塞性 SDB 的发病机制尚不清楚。因此,我们旨在确定临床代表性儿童队列中 LG 与 SDB 严重程度、人口统计学、人体测量和解剖学特征之间的关系。 方法: 对 3 ~ 18 岁不同程度 SDB 儿童 (n = 110) 和非鼾症对照组 (n = 36) 进行研究。根据 OAHI 对儿童进行分组。测量人体测量和上气道解剖特征。在多导睡眠图和 LG 上发现了自发叹气,LG 是控制通气的负反馈回路敏感性的指标,通过拟合呼吸控制的数学模型来估计叹气后通气模式。 结果: 对照组和任何 SDB 严重程度组之间的 LG 没有差异。然而,与扁桃体较小 (扁桃体 1 级) 的儿童相比,扁桃体较大 (扁桃体 4 级) 的儿童 LG 显著较低 (LG (范围) 中位数: 0.25 (0.20-0.42) vs 0.32 (0.25-0.44); P = 0.009)与 I 级相比,改良 Mallampati 评分为 III/IV 级的儿童 (0.28 (0.24-0.33) vs 0.37 (0.27-0.44); P = 0.009)。 结论: 儿童 SDB 的严重程度与 LG 之间未发现直接关系。然而,通气控制敏感性的改变可能有助于儿童亚组的 SDB,这取决于他们对气道解剖妥协的程度。

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