儿童阻塞性睡眠呼吸暂停伴咽喉反流性疾病的临床特征分析

doi:10.3969/j.issn.1006-7795.2025.06.023

首都医科大学学报 ›› 2025, Vol. 46 ›› Issue (6): 1139-1146.doi: 10.3969/j.issn.1006-7795.2025.06.023

儿童阻塞性睡眠呼吸暂停伴咽喉反流性疾病的临床特征分析

汪媛浏瑾¹，汪晓宇^1,2，胡雯^3,4，陆颖霞^1,2，邰隽^1,2,4*

1.首都儿科研究所耳鼻咽喉头颈外科，北京 100020；2. 北京协和医学院研究生院/首都儿科研究所耳鼻咽喉头颈外科，北京100020；3.北京大学基础医学院，北京 100871；4.首都医科大学附属首都儿童医学中心耳鼻咽喉头颈外科，北京 100020

收稿日期:2025-07-03 修回日期:2025-07-23 出版日期:2025-12-21 发布日期:2025-12-19
通讯作者: 邰隽 E-mail:trenttj@163.com

Analysis of clinical characteristics of obstructive sleep apnea with laryngopharyngeal reflux disease in children

Wang Yuanliujin¹，Wang Xiaoyu^1,2，Hu Wen^3,4，Lu Yingxia^1,2，Tai Jun^1,2,4*

1. Department of Otolaryngology, Head and Neck Surgery, Capital Institute of Pediatrics, Beijing 100020, China；2. Department of Otolaryngology, Head and Neck Surgery, Capital Institute of Pediatrics, Chinese Academy of Medical Sciences /Peking Union Medical College, Beijing 100020, China；3. School of Basic Medical Science, Peking University, Beijing 100871, China；4. Department of Otolaryngology, Head and Neck Surgery, Capital Center for Children's Health, Capital Medical University, Beijing 100020, China

Received:2025-07-03 Revised:2025-07-23 Online:2025-12-21 Published:2025-12-19

摘要/Abstract

摘要： 目的探究阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)伴咽喉反流性疾病(laryngopharyngeal reflux disease, LPRD)患儿的临床特征。方法横断面研究2024年7月至2025年6月于首都儿科研究所耳鼻咽喉头颈外科因打鼾行多导睡眠监测（polysomnogram, PSG）的患儿。记录患儿基本临床资料，PSG前完成儿童睡眠问卷－睡眠相关呼吸紊乱分量表（Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder Scale，PSQ-SRBD）、阻塞性睡眠呼吸暂停18项生活质量调查表（Obstructive Sleep Apnea 18-Item Quality-Of-Life Questionnaire，OSA-18）、反流症状评分量表(Reflux Symptom Score, RSS)及反流体征评估量表(Reflux Sign Assessment, RSA)。根据RSS总分＞13为LPRD阳性组，RSS总分≤13为LPRD阴性组，根据PSG监测结果将OSA严重程度分级，阻塞性呼吸暂停低通气指数（obstructive apnea hypopnea index，OAHI）≤1次/h为非OSA，1＜OAHI≤5次/h为轻度OSA，5＜OAHI≤10次/h为中度OSA，10＜OAHI≤30次/h为重度OSA，OAHI＞30次/h为极重度OSA。结果纳入96例打鼾患儿，男性62例，女性34例，中位年龄7（5, 9）岁。91例OSA患儿中LPRD阳性率为69.2% (63/91)，与其余组相比，极重度OSA组患儿在RSS以及RSA评分上均明显升高（P＜0.05）。此外，LPRD阳性患儿较LPRD阴性组的PSQ-SRBD、OSA-18评分及OAHI均显著升高，同时最低血氧饱和度明显降低（P＜0.05）。结论 OSA患儿中LPRD发生比例较高，OSA患儿受LPRD影响严重。OSA合并LPRD患儿在症状及咽腔及喉腔体征方面存在特异性表现。

关键词: 阻塞性睡眠呼吸暂停, 咽喉反流, 儿童, 临床特征, 多导睡眠监测, 问卷调查

Abstract: Objective To investigate the clinical features of children with obstructive sleep apnea (OSA) and laryngopharyngeal reflux disease (LPRD). Methods A cross-sectional study was performed on children who underwent polysomnogram (PSG) due to snoring in the Department of Otorhinolaryngology, Childrens Hospital of Capital Institute of Pediatrics from July 2024 to June 2025. The basic clinical data of the children were recorded, and the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder Scale (PSQ-SRBD)， the Obstructive Sleep Apnea 18-Item Quality-Of-Life Questionnaire (OSA-18 ), Reflux Symptom Score (RSS), and Reflux Sign Assessment (RSA)were completed before polysomnography. The total RSS score>13 was the LPRD positive group, and the RSS total score ≤13 was the LPRD negative group, and the severity of OSA was graded according to the PSG monitoring results OAHI (obstructive apnea hypopnea index) ≤ 1 time/h was non-OSA, 1< OAHI ≤5 times/h was mild OSA, 5< OAHI ≤10 times/h was moderate OSA, 10< OAHI ≤30 times/h was severe OSA and OAHI>30 times/h was very severe OSA. Results A total of 96 children with snoring were enrolled, including 62 males and 34 females, with a median age of 7 (5, 9) years. Among the 91 children with OSA, the positive rate of LPRD was 69.2% (63/91), and compared with the other groups, the RSS and RSA scores in the extremely heavy group were significantly higher (P<0.05). In addition, compared with the LPRD-negative group, the PSQ-SRBD, OSA-18 scores and OAHI scores of LPRD-positive children were significantly increased, and the minimum oxygen saturation was significantly decreased (P<0.05). Conclusion The proportion of LPRD in children with OSA is higher, and the children with OSA are seriously affected by LPRD. Children with OSA and LPRD had specific manifestations in terms of symptoms and pharyngeal and laryngeal signs.

Key words: obstructive sleep apnea, laryngopharyngeal reflux, children, clinical characteristics, polysomnography monitoring, questionnaire

中图分类号:

R766

汪媛浏瑾, 汪晓宇, 胡雯, 陆颖霞, 邰隽. 儿童阻塞性睡眠呼吸暂停伴咽喉反流性疾病的临床特征分析[J]. 首都医科大学学报, 2025, 46(6): 1139-1146.

Wang Yuanliujin, Wang Xiaoyu, Hu Wen, Lu Yingxia, Tai Jun . Analysis of clinical characteristics of obstructive sleep apnea with laryngopharyngeal reflux disease in children[J]. Journal of Capital Medical University, 2025, 46(6): 1139-1146.

参考文献

［1］倪鑫. 中国儿童阻塞性睡眠呼吸暂停诊断与治疗指南（2020）［J］. 中国循证医学杂志, 2020, 20(8): 883－900.
［2］中华耳鼻咽喉头颈外科杂志编辑委员会咽喉组, 中华医学会耳鼻咽喉头颈外科学分会咽喉学组, 中华医学会耳鼻咽喉头颈外科学分会嗓音学组. 咽喉反流性疾病诊断与治疗专家共识（2022年，修订版）［J］. 中华耳鼻咽喉头颈外科杂志, 2022, 57(10): 1149－1172.
［3］Venkatesan N N, Pine H S, Underbrink M. Laryngopharyngeal reflux disease in children［J］. Pediatr Clin North Am, 2013, 60(4): 865－878.
［4］O’Reilly R C, He Z, Bloedon E, et al. The role of extraesophageal reflux in otitis media in infants and children［J］. Laryngoscope, 2008, 118(7 Part 2 Suppl 116): 1－9.
［5］Kilic M, Ozturk F, Kirmemis O, et al. Impact of laryngopharyngeal and gastroesophageal reflux on asthma control in children［J］. Int J Pediatr Otorhinolaryngol, 2013, 77(3): 341－345.
［6］Block B B, Brodsky L. Hoarseness in children: the role of laryngopharyngeal reflux［J］. Int J Pediatr Otorhinolaryngol, 2007, 71(9): 1361－1369.
［7］Bothwell M R, Parsons D S, Talbot A, et al. Outcome of reflux therapy on pediatric chronic sinusitis［J］. Otolaryngol Head Neck Surg, 1999, 121(3): 255－262.
［8］韩红蕾, 吕秋萍, 刘剑锋, 等. 反流症状评分量表中文版的信度和效度评估［J］. 中华耳鼻咽喉头颈外科杂志, 2022, 57(10): 1185－1190.
［9］Yu L, Ren J, Chen M, et al. Validity and reliability of the Mandarin Chinese version of the reflux sign assessment［J/OL］. J Voice, (2025-05-06)［2025-06-30］. https://www.jvoice.org/article/S0892-1997(25)00173-0/abstract..
［10］国家卫生健康委.体重管理指导原则［EB/OL］.(2024－03－28)［2025－06－30］.http://www.nhc.gov.cn/
［11］Li F, Lin Q, Yang Q, et al. The association between free sugars consumption and laryngopharyngeal reflux: a cross-sectional study among Chinese adolescents［J］. Nutrients, 2021, 13(9): 3012.
［12］Wu J, Yu L, Li J, et al. Characteristics of laryngopharyngeal reflux in the Chinese nurse population［J］. J Voice, 2025, 39(1): 288.e15－288.e20.
［13］Chervin R D, Hedger K, Dillon J E, et al. Pediatric Sleep Questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problemsq［J］. Sleep Med, 2000, 1(1): 21－32.
［14］李晓丹, 邰隽, 许志飞, 等. 简体中文版儿童睡眠问卷应用于北京地区阻塞性睡眠呼吸暂停综合征儿童筛查的信度和效度评估［J］. 中华耳鼻咽喉头颈外科杂志, 2016, 51(11): 812－818.
［15］Berry R B, Albertario C L, Harding S M, et al. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 2.5nd ed［M］. Darien: American Academy of Sleep Medicine,2018.
［16］Magliulo G, Iannella G, Polimeni A, et al. Laryngopharyngeal reflux in obstructive sleep apnoea patients: literature review and meta-analysis［J］. Am J Otolaryngol, 2018, 39(6): 776－780.
［17］Qadeer M A, Swoger J, Milstein C, et al. Correlation between symptoms and laryngeal signs in laryngopharyngeal reflux［J］. Laryngoscope, 2005, 115(11): 1947－1952.
［18］Sofokleous V, Papadopoulou A M, Giotakis E, et al. Pediatric laryngopharyngeal reflux in the last decade: what is new and where to next?［J］. J Clin Med, 2023, 12(4): 1436.
［19］Belafsky P C, Postma G N, Koufman J A. Validity and reliability of the reflux symptom index (RSI)［J］. J Voice, 2002, 16(2): 274－277.
［20］Belafsky P C, Postma G N, Koufman J A. The validity and reliability of the reflux finding score (RFS)［J］. Laryngoscope, 2001, 111(8): 1313－1317.
［21］Gouveia C J, Yalamanchili A, Ghadersohi S, et al. Are chronic cough and laryngopharyngeal reflux more common in obstructive sleep apnea patients?［J］. Laryngoscope, 2019, 129(5): 1244－1249.
［22］Ji P, Shi L, Xing D, et al. The effect of laryngopharyngeal reflux on arousal in patients with obstructive sleep apnea［J］. Acta Otolaryngol, 2022, 142(5): 438－442.
［23］Tang X, Tang Q, Li S, et al. Changes in laryngopharyngeal reflux after uvulopalatopharyngoplasty for obstructive sleep apnea: an observational study［J］. Laryngoscope Investig Otolaryngol, 2022, 7(1): 266－273.
［24］Zhou Y, Ma R, Luo J, et al. Role of laryngopharyngeal reflux changes in children with adenoid hypertrophy: a randomized controlled prospective study［J］. Evid Based Complement Alternat Med, 2023, 2023: 5628551.
［25］何畅. RSI及RFS评分表在学龄前儿童咽喉反流性疾病诊断中的意义的初步探讨［D］. 沈阳：中国医科大学, 2019.
［26］黄俣栋. 儿童腺样体肥大与咽喉反流的相关性研究［D］. 广州：南方医科大学, 2019.
［27］林枫, 赵晶, 陆颖霞, 等. 儿童腺样体肥大伴咽喉反流的临床特征分析［J］. 中华耳鼻咽喉头颈外科杂志, 2024, 59(2): 140－146.
［28］谢冬雪. 阻塞性睡眠呼吸暂停低通气综合征与咽喉反流的相关性研究［D］. 承德：承德医学院, 2022.
［29］Elhennawi D M, Ahmed M R, Abou-Halawa A S. Correlation of obstructive sleep apnoea and laryngopharyngeal reflux: phmetry study［J］. Clin Otolaryngol, 2016, 41(6): 758－761.［30］Caparroz F, Campanholo M, Stefanini R, et al. Laryngopharyngeal reflux and dysphagia in patients with obstructive sleep apnea: is there an association?［J］. Sleep Breath, 2019, 23(2): 619－626.
［31］Lechien J R, Bobin F, Muls V, et al. Laryngopharyngeal Reflux disease is more severe in obese patients: a prospective multicenter study［J］. Laryngoscope, 2021, 131(11): E2742-E2748.
［32］吴晓玉, 王雪红, 常祎. 青少年儿童咽喉反流性疾病的危险因素分析［J］. 中国妇幼健康研究, 2022, 33(4): 63－67.
［33］刘伟清, 季永红, 张国华. 腺样体肥大患者的临床特征及咽喉反流与病情严重程度的相关性分析［J］. 系统医学, 2023, 8(3): 167－170, 193.
［34］Panek J, Reszec′ J, Rogowski M, et al. Histological evaluation of soft palate tissues in patients with sleep disordered breathing［J］. Otolaryngol Pol, 2019, 74(1): 6－12.
［35］李冬阳.成人分泌性中耳炎患者中耳积液中胃蛋白酶与IL-6、IL-8、MUC5B及临床指标的相关性分析［D］.沈阳：中国医科大学, 2023.

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儿童阻塞性睡眠呼吸暂停伴咽喉反流性疾病的临床特征分析

Analysis of clinical characteristics of obstructive sleep apnea with laryngopharyngeal reflux disease in children

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