BACKGROUND:Limited data are available on the relationship between seasonal factors and obstructive sleep apnea-hypopnea syndrome (OSAHS) in China. The aim of this study was to investigate the effects of seasonal factors on the severity of OSAHS in children. METHODS:Children 2.0 to 16 years old presenting with snoring and/or mouth breathing, suspected of having OSAHS, and admitted to the Department of Respiratory Medicine of Children's Hospital of Soochow University from December 2016 to February 2022 were enrolled in this study. The severity of OSAHS was determined by full-night polysomnography (PSG) in the sleep laboratory. The correlation between seasonal factors and PSG monitoring results was analyzed. RESULTS:Of the 589 included patients, 301 cases (51.1%) were diagnosed with OSAHS. In the OSAHS group, 77 cases (25.6%) were detected in spring, 74 cases (24.6%) were detected in summer, 59 cases (19.6%) were detected in autumn, and 91 cases (30.2%) were detected in winter. There were 238 cases (79.1%) of tonsillitis hypertrophy, 276 cases (91.7%) of adenoid hypertrophy, 215 cases (71.4%) of rhinitis/sinusitis, and 36 cases (12.0%) of asthma. The proportion of rhinitis/sinusitis and tonsillar hypertrophy in spring was higher than that in summer (P = .015 and P = .036, respectively), and the proportion of adenoid hypertrophy in winter was higher than that in summer (P = .024). The diagnostic rate of severe OSAHS in winter was higher than that in summer (χ2 = 7.053, P = .008). The respiratory arousal index in winter was higher than that in summer (H = -39.297, P = .018), and the spontaneous arousal index in spring was higher than that in autumn (H = 44.059, P = .020). It was found that the rapid eye movement (REM)-apnea index (AI) in spring and winter was higher than that in summer (H = 52.292, -52.554; all P < .05). The comparison of PSG results of children with OSAHS ≤6 years old in different seasons showed that REM-AI in winter was higher than that in summer (H = 8.570, P < .05). CONCLUSION:Severe OSAHS is more common in winter. Respiratory events are increased in spring and winter, mainly in children ≤6 years old. Seasonal factors may have a certain impact on OSAHS.

Abstract Obstructive sleep apnoea hypopnea syndrome（OSAHS） can result in neurobehavioral and cardiovascular complications and growth impairment ,especially sereve OSAHS，We explored risk factors for severe OSAHS in children who snored and who visited the Children's Hospital of Soochow University from June 2017 to October 2021.A total of 142 patients were enrolled, including 104 patients in the mild-moderate OSAHS group and 38 patients in the severe OSAHS group. Our study found that age、tonsillar hypertrophy were risk factors for severe OSAHS, indicating that this factor has certain clinical significance for the identification of patients with severe OSAHS.

Purpose: To explore the screening value of the adenoidectomy / nasopharyngeal (A/N) ratio from nasopharyngeal lateral radiography in children with obstructive sleep apnoea hypopnea syndrome (OSAHS). Methods: Children who had visited the respiratory department due to snoring and/or mouth breathing’ were enrolled. Nasopharyngeal lateral radiography and polysomnography (PSG) were performed. PSG monitoring is the gold standard for OSAHS. The differences in PSG monitoring results among different A/N groups were compared, and the correlation between the A/N ratio and PSG monitoring results was analysed. The receiver operating characteristic curve (ROC) was plotted to evaluate the screening value of OSAHS in children with the A/N ratio from nasopharyngeal lateral radiography to determine the diagnostic critical point. Results: A total of 425 children were enrolled. A total of 183 patients (43.1%) were diagnosed with OSAHS, including 113 cases (26.6%) of mild OSAHS and 70 cases (16.5%) of moderate to severe OSAHS. A total of 52 patients (12.2%) had an A/N ratio ≤ 0.60, 77 patients (18.1%) had an A/N ratio from 0.61~0.70, 142 patients (33.4%) had an A/N ratio from 0.71~0.80, and 154 patients (36.2%) had an A/N ratio ≥0.80 The patients with moderate-severe OSAHS had a higher A/N ratio than those with mild OSAHS and non-OSAHS. The OAHI, ODI, and the diagnostic rate of OSAHS were higher and the LSaO 2 was lower in the A/N≥0.80 group than in the other three groups. Spearman’s rank correlation showed that the A/N ratio was correlated with OAHI, ODI, and LSaO 2 (r=0.275, 0.227, -0.225, respectively). The area under the ROC curve for the diagnosis of OSAHS by the A/N ratio was 0.659, the critical value was 0.825, and the sensitivity and specificity were 45.1% and 80.9%, respectively. An A/N ratio ≥0.825 was identified as the main influencing factor of OSAHS by logistic multivariable regression analysis. Conclusion: There is a correlation between the degree of adenoid hypertrophy and OSAHS, and an A/N ratio ≥0.825 has good suggestive value for the diagnosis of OSAHS but is not a substitute for PSG.

目的 通过分析不同季节阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿临床及多导睡眠监测(PSG)资料,探讨季节因素对苏州地区儿童OSAHS的影响.方法 选取自2017年3月-2019年2月因"打鼾、张口呼吸"等症状就诊于苏州大学附属儿童医院呼吸科,行PSG检查的患儿为研究对象.根据年龄分为两组(≤6岁;＞6岁),比较两组OSAHS患儿在不同季节的诊断情况、睡眠结构、阻塞性呼吸暂停低通气指数(OAHI)、氧减指数(ODI)、最低血氧饱和度(LSaO2)等指标在不同季节的差异.结果 1)227例OSAHS患儿夏季诊断率最低(x2 =8.964,P=0.03).2)轻、中、重度OSAHS患儿季节诊断率比较,差异无统计学意义(P＞0.05).3)春季OSAHS患儿非快动眼睡眠2期(NREM2)比例低于夏季、冬季(P＜0.05),春季快动眼睡眠期(REM)比例高于夏季、冬季(P＜0.05),而非快动眼睡眠3期(NREM3)比例夏季低于春季、冬季(P＜0.05).4)春季LSaO2低于夏季(P=0.011),快动眼睡眠期呼吸暂停指数(REM AI)高于秋冬季(P＜0.05).5)≤6岁OSAHS患儿春季NREM2期比例低于夏季(P＜0.001);夏季NREM3期比例低于春冬季(P＜0.05);春季REM期比例高于冬季(P=0.048),LSaO2(％)低于夏季(P=0.004),REM-AI高于冬季(P＜0.01).结论 季节因素对于儿童OSAHS严重程度无明显影响,不同季节OSAHS睡眠结构及呼吸事件有所不同,主要见于≤6岁患儿.

Obstructive sleep apnea hypopnea syndrome(OSAHS)is a serious health hazard in children.It can cause damage to multiple systems, including cardiovascular, metabolic, endocrine and neurocognitive systems, especially for cognitive impairment.OSAHS may cause sleep fragmentation and intermittent ventilation abnormalities due to repeated partial or total upper airway obstruction, resulting in hypoxemia and hypercarbia, affect attention, intelligence, memory, language, executive function, etc.

目的 分析学龄前期及学龄期阻塞性睡眠呼吸暂停低通气综合征(OSAHS)儿童的临床及睡眠结构特点.方法 纳入2016年12月-2019年11月于苏州大学附属儿童医院呼吸科就诊,经多导睡眠监测诊断为OSAHS的123例患儿为研究对象,选择同期诊断为鼾症(PS)的313例患儿为对照组,根据年龄将两组患儿分为学龄前期组及学龄期组,收集临床资料及多导睡眠监测(PSG)结果.结果 学龄前期及学龄期OSAHS患儿夜间及日间症状均较对照组显著(P＜0.05).学龄前OSAHS患儿快动眼睡眠期(REM)比例高于对照组(Z=2.467,P＜0.05);学龄期OSAHS患儿总睡眠时间(TST)及睡眠效率低于学龄前OSHAS患儿(t=2.518,Z=1.527),NREM2期比例升高(t=4.080),NREM3期比例下降(Z= 1.832),氧减指数(ODI)升高(Z=1.653,P＜0.05).呼吸暂停低通气指数(AHI)与学龄前期患儿NREM 1期睡眠比例呈正相关(r=0.217),与REM期比例呈负相关(r=-0.220),体重指数(BMI)与学龄期OSAHS患儿NREM 3期比例呈负相关(r=-0.429,PP＜0.05).结论 OSAHS患儿临床表现与鼾症患儿不同,且不同年龄症状有所差异;学龄期OSAHS患儿睡眠结构改变较学龄前期患儿明显;学龄前期、学龄期OSAHS患儿睡眠结构改变分别与AHI、BMI有关.

OBJECTIVE:To compare and analyze the clinical manifestations and sleep structure of children with obstructive sleep apnea-hypopneasyndrome (OSAHS) with different body mass index (BMI). METHODS:452 children who were diagnosed with OSAHS between December 2016 and February 2021 by the Department of Respiratory Medicine, Children's Hospital of Soochow University were included in the study. All of them did polysomnography (PSG). They were divided, according to their BMI, into the normal BMI group, the overweight group, and the obesity group. Their clinical data and PSG results were collected. RESULTS:287 boys (63.5%) and 165 girls (36.5%) were enrolled, with their age ranging between 3 and 15, and the median age being 5.5 (4.5, 7.0). Their BMI ranged between 12.09 kg/m 2 and 38.48 kg/m 2, with the median being 16.29 kg/m 2. 275 cases (60.8%) had normal BMI, 76 cases (16.8%) were overweight, and 101 cases (22.3%) were obese. There was no significant difference in the distribution of clinical manifestations and severity of OSAHS among the three groups. The duration and proportion of rapid eye movement (REM) stage sleep in the obese group was lower than that of the overweight and the normal BMI groups ( P<0.05). The lowest oxyhemoglobin saturation (LSaO 2) of children in the overweight group was lower than that of the normal BMI group ( P=0.050). The oxygen desaturation index (ODI) of the obese group was higher than that of the normal BMI and the overweight groups ( P<0.05). CONCLUSION:Obesity worsens the degree of hypoxia in children with OSAHS and affects their sleep structure.