药物诱导睡眠内窥镜在儿童阻塞性睡眠呼吸暂停诊疗中的应用

doi:10.12372/jcp.2025.24e1292

摘要/Abstract

摘要：

目的探讨药物诱导睡眠内窥镜（DISE）在儿童阻塞性睡眠呼吸暂停（OSA）中的应用。方法回顾性分析2023年6月1日—2024 年6月1日于耳鼻咽喉头颈外科经多导睡眠监测（PSG）确诊OSA并行DISE检查患儿的临床资料。使用NAVOTEL评分系统对DISE进行评分，分析DISE评分与睡眠呼吸暂停低通气指数（AHI）、最低动脉血氧饱和度（SaO₂）之间的相关性。结果 163例患儿完成DISE检查，男114例、女49例，中位年龄7.0（5.0~9.0）岁。最常见的阻塞平面为腭咽（137例，84.0%），其次为咽侧壁（124例，76.1%）、鼻腔（95例，58.3%）、腺样体（92例，56.4%）、舌根（52例，31.9%）、会厌（30例，18.4%）、喉部（3例，1.8%）。不同年龄段（≤5岁、6~10岁和11~18岁）患儿最常见的阻塞部位均为腭咽部，分别占81.0%、86.2%和83.3%。Spearman秩相关分析显示163例患儿NAVOTEL评分总分与AHI呈显著正相关（r_s=0.48，P<0.01），与最低SaO₂呈显著负相关（r_s=－0.35，P<0.01）；腭咽阻塞平面NAVOTEL评分与AHI呈显著正相关（r_s=0.33，P<0.01），与最低SaO₂呈显著负相关（r_s=－0.48，P<0.01）。结论 DISE可用于评估OSA患儿上气道阻塞的部位及严重程度，其评分与AHI、最低SaO₂均有一定相关性，可与PSG相互协同提高儿童OSA的诊疗水平。

关键词: 阻塞性睡眠呼吸暂停, 药物诱导睡眠内镜, 儿童

Abstract:

Objective To investigate the application of drug-induced sleep endoscopy (DISE) in pediatric obstructive sleep apnea (OSA). Methods The clinical data of children diagnosed with OSA by polysomnography (PSG) and DISE examination were retrospectively analyzed from June 1, 2023 to June 1, 2024 in the Department of Otorhinolaryngology. The NAVOTEL scoring system was used to score DISE, and the correlation between DISE score and apnea-hypopnea index (AHI) and minimum arterial oxygen saturation (SaO₂) was analyzed. Results DISE tests were performed in 163 children (114 boys and 49 girls), and the median age was 7.0 (5.0-9.0) years. The most common obstructive site was the velopharynx (137 cases, 84.0%), followed by the lateral oropharynx (124 cases, 76.1%), nasal cavity (95 cases, 58.3%), adenoid (92 cases, 56.4%), base of the tongue (52 cases, 31.9%), epiglottis (30 cases, 18.4%), and larynx (3 cases, 1.8%). The most common obstruction site in children of different age groups (≤5 years old, 6~10 years old and 11~18 years old) was velopharynx, accounting for 81.0%, 86.2% and 83.3%, respectively. Spearman rank correlation analysis showed that the total NAVOTEL score of 163 children was significantly positively correlated with AHI (r_s=0.48, P<0.01), and significantly negatively correlated with the lowest SaO₂ (r_s=-0.35, P<0.01). The NAVOTEL score of palatopharyngeal obstruction was positively correlated with AHI (r_s=0.33, P<0.01) and negatively correlated with the lowest SaO₂(r_s=-0.48, P<0.01). Conclusions DISE can be used to evaluate the site and severity of upper airway obstruction in children with OSA, and its score is correlated with AHI and minimum SaO₂, which can cooperate with PSG to improve the diagnosis and treatment level of OSA in children.

Key words: obstructive sleep apnea, drug-induced sleep endoscopy, child

中图分类号:

张志海, 唐新业, 姚红兵, 王冰, 肖玲, 杨阳. 药物诱导睡眠内窥镜在儿童阻塞性睡眠呼吸暂停诊疗中的应用[J]. 临床儿科杂志, 2025, 43(11): 830-836.

ZHANG Zhihai, TANG Xinye, YAO Hongbing, WANG Bing, XIAO Ling, YANG Yang. Application of drug-induced sleep endoscopy in pediatric obstructive sleep apnea[J]. Journal of Clinical Pediatrics, 2025, 43(11): 830-836.

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项目	结果
男[n(%)]	114(69.9)
年龄[M(P₂₅~P₇₅)]/岁	7.0(5.0~9.0)
身高($\bar{x}±s$)/cm	125.3±18.2
体重[M(P₂₅~P₇₅)]/kg	28.0(20.0~37.0)
BMI($\bar{x}±s$)/kg·m^-2	18.1±4.1
肥胖[n(%)]	5(3.1)
偏瘦[n(%)]	88(54.0)
PSG[n(%)]
轻度OSA	95(58.3)
中度OSA	41(25.1)
重度OSA	27(16.6)
AHI[M(P₂₅~P₇₅)]/次·h^-1	8.8(6.9~16.3)
最低SaO₂($\bar{x}±s$)/%	72.9±11.8
BIS值($\bar{x}±s$)	72.0±1.7

阻塞部位	NAVOTEL评分[M(P₂₅~P₇₅)]	评分0[n(%)]	评分1[n(%)]	评分2[n(%)]	总阻塞[n(%)]
鼻腔	1.0(0~1.0)	68(41.7)	94(57.7)	1(0.6)	95(58.3)
腺样体	1.0(0~1.0)	71(43.6)	80(49.1)	12(7.4)	92(56.4)
腭咽	1.0(1.0~2.0)	26(16.0)	79(48.5)	58(35.6)	137(84.0)
咽侧壁	1.0(1.0~2.0)	39(23.9)	68(41.7)	56(34.4)	124(76.1)
舌根	0(0~1.0)	111(68.1)	46(28.2)	6(3.7)	52(31.9)
会厌	0(0~0)	133(81.6)	25(15.3)	5(3.1)	30(18.4)
喉部	0(0~0)	160(98.2)	3(1.8)	0(0)	3(1.8)

年龄	例数	阻塞部位[n(%)]
年龄	例数	鼻腔	腺样体	腭咽	咽侧壁	舌根	会厌	喉部
≤5岁	58	32(55.2)	32(55.2)	47(81.0)	41(70.7)	15(25.9)	14(24.1)	2(3.4)
6~10岁	87	53(60.9)	52(59.8)	75(86.2)	71(81.6)	29(33.3)	16(18.4)	0(0)
11~18岁	18	10(55.6)	8(44.4)	15(83.3)	12(66.7)	8(44.4)	0(0)	1(5.6)