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a lack of comprehensive analysis of attention deficit，and hyperactivity disorder in SDB children. Objective To investigate the
characteristics of attention deficit，and hyperactivity disorder in children with SDB，so as to provide a basis for making clinical
decisions for such patients. Methods Children aged 4-10 years with snoring or mouth breathing，who were admitted to the
Sleep Center，Beijing Children's Hospital，Capital Medical University from May 2020 to June 2021 were selected. Physiologic
parameters during sleep were measured by polysomnography. Attention deficit and hyperactivity disorder symptoms were assessed
by parent-rated attention deficit and hyperactivity disorder Symptoms Scale（PASS）. The severity of obstructive sleep apnea
（OSA） was classified by obstructive apnea-hypopnea index（OAHI）：OAHI ≤ 1 event/hour，1<OAHI ≤ 5 events/hour and
OAHI>5 events/hour were defined as primary snoring，mild OSA，and moderate to severe OSA，respectively. Polysomnographic
parameters〔total sleep time，sleep efficiency，non-rapid eye movement（NREM） sleep stage 1（N1%），stage 2（N2%），
and stage 3（N3%）and REM sleep percentage of total sleep time（R%），OAHI，arousal index（ArI），oxygen desaturation
index（ODI），average oxygen saturation（SpO 2 ）and SpO 2 nadir〕 were compared by the severity of OSA. The prevalence of
attention deficit，hyperactivity disorder，and attention deficit and hyperactivity disorder diagnosed by the PASS were compared by
the severity of OSA，sex and age. Results Seventy-six cases of primary snoring，86 cases of mild OSA and 77 cases of moderate
to severe OSA were included. Moderate to severe OSA children had greater N1%，OAHI，ArI，and ODI，and lower average
SpO 2 and SpO 2 nadir than other two groups（P<0.05）. The R% of moderate to severe OSA group was lower than that of primary
snoring group （P< 0.05）. OAHI，ArI and ODI were higher and SpO 2 nadir was lower in children with mild OSA than those with
primary snoring（P<0.05）. The prevalence of attention deficit，and attention deficit and hyperactivity disorder diagnosed by the
PASS in moderate to severe OSA group was statistically higher than that in primary snoring group （P '<0.016 7）. Male children
had higher prevalence of attention deficit，hyperactivity disorder，and attention deficit and hyperactivity disorder diagnosed
by the PASS than female children （P<0.05）. Compared with preschoolers，school-age children have higher prevalence of
attention deficit and attention deficit and hyperactivity disorder diagnosed by the PASS（P<0.05）. Conclusion The prevalence
of attention deficit and hyperactivity disorder in children with SDB was higher than that in the general population. Male children
had higher prevalence of attention deficit and hyperactivity disorder than female children. And the prevalence of attention deficit in
school-age children was higher than that in preschoolers.
【Key words】 Sleep apnea syndromes；Child；Attention deficit disorder with hyperactivity；Disease attributes

儿 童 睡 眠 呼 吸 障 碍（sleep disordered breathing， 2020-k-240），儿童监护人均签署知情同意书。
SDB）是一类睡眠过程中上气道功能异常的综合征，包 1.2 分组 （1）根据疾病严重程度分组，依据我国
括原发鼾症、上气道阻力综合征以及阻塞性睡眠呼吸暂 2020 年儿童 OSA 诊疗指南中诊断标准 ［3］ ，原发鼾症组
停（obstructive sleep apnea，OSA）。OSA 的反复缺氧及 〔有打鼾症状，但阻塞性呼吸暂停低通气指数（obstructive
睡眠片段化症状会诱发中枢神经系统细胞化学性或结构 apnea hypopnea index，OAHI）<1 次 /h〕，轻度 OSA 组
性的损伤，影响儿童的认知、执行力及情绪行为，引发 （1 次 /h<OAHI ≤ 5 次 /h），中重度 OSA 组（OAHI>5
日间困倦、注意缺陷、多动等症状 ［1-3］ 。研究表明， 次 /h）。（2）分别根据性别和年龄分组，学龄前（4~6
OSA 儿童中有注意缺陷、多动表现者高达 30% 以上， 岁），学龄期（7~10 岁）。
严重危害其学习能力、远期智力发展 ［4-6］ 。因此，应重 1.3 观察指标及判定标准 （1）体格检查：采用
视 SDB 儿童的注意缺陷、多动 - 冲动发生情况，了解 RGZ-120 身高体重秤（常州市武进衡器有限公司）测
其特点，从而为制订 SDB 儿童的临床决策提供依据。 量身高和体质量（分别精确至 0.1 cm 和 0.1 kg），并计
2
2
本研究旨在分析不同严重程度、不同性别、不同年龄 算体质指数（BMI），BMI= 体质量（kg）/ 身高 （m ）。
SDB 儿童的注意缺陷、多动 - 冲动的特征。 （2）多导睡眠监测（PSG）：采用 PSG 仪（澳大利亚
1 对象与方法 Compumedics E 系列、Grael 系列、美国飞利浦 Alice5、
1.1 研究对象 以 2020 年 5 月至 2021 年 6 月在首都 Alice6 系列或德国施曼诺 V5+ 系列监测仪）对研究对
医科大学附属北京儿童医院睡眠中心就诊的儿童为研究 象进行夜间 PSG。所有研究对象在自然状态下入睡，入
对象。纳入标准：（1）4~10 岁；（2）打鼾或张口呼 睡前禁止服用咖啡、茶、可乐及镇静催眠药物等，PSG
吸。排除标准：（1）有颅面部畸形、神经肌肉疾病及 时间均超过 7 h。PSG 监测的导联：脑电图（C3/M2，
遗传性疾病；（2）有精神障碍病史（如自闭症、抽动 C4/M1，O1/M2，O2/M1）、眼电图、下颌及胫前肌电图、
症）、癫痫等；（3）有早产或宫内发育迟缓病史；（4） 心电图、胸腹呼吸运动、血氧饱和度（SpO 2 ）、气流热
有急性感染或全身慢性疾病等可能影响神经系统发育的 敏电阻、鼾声传感器、体位等，检测参数为总睡眠时
疾病；（5）接受过腺样体和 / 或扁桃体切除手术治疗。 间、睡眠效率、非快速眼动睡眠 1 期占总睡眠时间比例
本研究通过了北京儿童医院伦理委员会审查（批号： （N1%）、非快速眼动睡眠2期占总睡眠时间比例（N2%）、