The Study Of Screening And Diagnosis Of Obstructive Sleep Apnea-hypopnea Syndrome And Its Correlation With Rhinitis In Children

Objective1.To investigate the significance of the disease specific quality of life for children with obstructive sleep apnea 18 items survey（OSA-18）and blood oxygen-related indicators in screening children with obstructive sleep apnea hypopnea syndrome（OSAHS）.2.To study the correlation between OSAHS and allergic rhinitis（AR）or non-allergic rhinitis（NAR）in children.Materials and Methods92 children who were diagnosed in the department of pediatrics of Fujian Provincial Hospital as SDB due to snoring were selected for monitoring respiratory parameters in sleep with portable monitoring from October 2019 to December 2020.Detailed medical history and physical examination were recorded,especially in the degree of adenoids hypertrophy.Some of the children were completed with nasopharyngeal radiographs or nasopharyngeal computer tomography（CT）scanned.Allergen examination was performed in all children,and their parents filled out an OSA-18 scale with the Questionnaire APP before monitoring the respiratory condition in sleep.They were divided into primary snoring group（PS）,mild OSAHS group,moderate-severe OSAHS group by the results of OAHI.The general data,degree of adenoids hypertrophy degree of tonsils hypertrophy,respiratory parameters in sleep,total score of OSA-18 scale,5 dimensions and 18 sub-variables among the three groups were compared.The variables with statistical differences were determined by correlation analysis and binary Logistic regression analysis further.According to drawing operating characteristic curve（ROC）,the cut-off point value was determined to distinguish OSAHS and PS.the sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio of the indexes were calculated.According to clinical manifestations and allergens,92 children with snoring were divided into AR,NAR and non-rhinitis groups.The general data,degree of adenoids hypertrophy,degree of tonsils hypertrophy,respiratory parameters,total score of OSA-18 scale,5 dimensions and 18 sub-variables among the three groups were compared.Results1.There were significant differences in the constituent ratio of degree of adenoids hypertrophy among PS,mild OSAHS and moderate to severe OSAHS,but there was no significant differences in the degree of tonsils hypertrophy among the three groups.There were some correlation between the ratio of adenoid to nasopharyngeal cavity and OAHI（Correlation coefficient r was 0.330）.2.There were statistical differences between PS,mild OSAHS and moderate-severe OSAHS in oxygen depletion index（ODI）and Lowest saturation of oxygen（LSa O₂）,Spearman correlation analysis indicated that ODI,LSa O₂were correlated with OAHI（Correlation coefficient r was 0.774,-0.372 respectively）.Binary Logistic regression analysis showed that ODI and LSa O₂ were important factors in the diagnosis of OSAHS.When the ODI cut-off value was 2.65 times per hour,the specificity and sensitivity of predicting OSAHS was 0.826 and 0.826 respectively.The positive predictive value was 0.934,the negative predictive value was 0.613,the positive likelihood ratio was 4.7,and the negative likelihood ratio was 0.21.When the LSa O₂ cut-off value was 89.5%,the specificity and sensitivity of predicting OSAHS was 0.609 and 0.754 respectively,Positive predictive value was 0.753,negative predictive value was 0.45,positive likelihood ratio was 2.47 and negative likelihood ratio was 0.518.3.There was no statistical difference in the total score of OSA-18 scale among PS,mild OSAHS and moderate-severe OSAHS group,there was statistical difference in the score of sleep disorders.Especially in the three sub-variables that included loud snoring,sleep apnea at night,wheezing or asphyxia during sleep among the three groups.Added the scores of the three sub-variables,The scores from0 to 21,the sores of the three sub-variables could predict the occurrence of OSAHS by Logistic regression analysis.According to the ROC working curve,used 9 points as the cut-off point value,the specificity and sensitivity of OSAHS were 82.6%and46.4%.Positive predictive value was 0.889,negative predictive value was 0.339,positive likelihood ratio was 2.67,and negative likelihood ratio was 2.67.4.There was no statistical difference in the constituent ratio of AR,NAR and non-rhinitis among PS,mild OSAHS and moderate-severe OSAHS groups,There was no significant difference in OAHI,LSa O₂,MSa O₂,ODI and TS90%among AR,NAR and non-rhinitis groups,which indicated that there was no correction between rhinitis and the degree of OSAHS.The total scores of OSA-18 scale in AR,NAR group and non-rhinitis group were statistically different,which suggested that SDB with rhinitis would reduce the quality of life of children.Especially in some aspects,such as nasal obstruction and mouth breathing,more mucus and affecting the guardian’s work.The score of AR group was higher than NAR and non-rhinitis group in some aspect such as sleep disturbance,hyperactivity or frequent arousal.Conclusions1.The degree of adenoid hypertrophy was correlated with the severity of SDB in children,adenoid hypertrophy was one of the pathogenesis factors of OSAHS.if a child has adenoid hypertrophy combined with snoring,sleep monitoring is recommended to confirm the diagnosis of OSAHS.2.ODI and LSa O₂ could be used as screening and diagnosis indicators of OSAHS in children,and ODI has better diagnostic value than LSa O₂.3.When the score of the sleep disorders exceeds 9,it is an independent predictor for the OSAHS in children.4.AR and NAR were often associated with OSAHS in children.AR and NAR will not make the OSAHS and blood oxygen-related indicators worse,but AR and NAR will make the quality of life of children with OSAHS worse.Therefore,Doctor should pay more attention to the quality of life of children instead of focusing on OAHI parameter only.