兒童睡眠呼吸疾病

Pediatric Sleep-Disordered Breathing

兒童睡眠呼吸疾患在小孩是一個很常見的問題。1976 年，Dr. Guilleminault 第一次提出兒童睡眠呼吸疾病（sleep-disorder breathing, SDB）這個疾病。其實，SDB 是一個廣泛的醫學名詞，它包括了許多睡眠呼吸疾病，比如阻塞性睡眠呼吸中止、中樞性呼吸中止、睡眠缺氧等等。其中阻塞性睡眠呼吸中止症（obstructive sleep apnea syndrome, OSA）是最常見的一種睡眠呼吸疾病。在兒童及青少年OSA 也是一種常見的睡眠呼吸疾病，它主要的臨床特徵是睡眠時重複出現「完全」或「部分」的呼吸道阻塞，這種情形會造成「間歇性的缺氧」及「多次睡眠覺醒（arousal）」，最後可能導致：（1）明顯增加心血管疾病、血壓升高、增加insulin resistance 的產生；（2）同時也會造成認知功能的影響或行為情緒問題（尤其是兒童或青少年會造成不專心、過動、執行功能等缺損，進而造成學習問題）；（3）此外，兒童OSA 也會造成生長激素不足及生長遲緩，或者某些腦部的問題。兒童SDB 不但是一個兒童健康的議題，同時也影響兒童未來身心發展、生長發育遲緩、學習問題，及生活品質問題。但到目前為止，研究兒童SDB 的學者並不多，相關文獻也不多，所以，本文將針對兒童SDB 的原因機轉以及其臨床症狀表現與治療，做一個綜合性的討論，並說明目前最新研究方向。

Pediatric sleep-disordered breathing (SDB) is a common sleep problem in children. In fact, SDB is a medical term referring to a spectrum of sleep and respiratory diseases, such as obstructive sleep apnea (OSA), central apnea, and hypopnea. In 1976, Guilleminault et al. first described and reported pediatric cases of OSA. OSA is common among children and adolescents, and is clinically characterized by complete or partial airway obstruction during sleep, which results in intermittent hypoxia and multiple arousals, and may ultimately cause (1) higher occurrence of cardiovascular diseases, hypertension and insulin resistance, (2) neurocognitive, neurobehavioral, and emotional problems (in children and adolescents specifically, inattention, hyperactivity, and learning problems) and, (3) growth insufficiency and growth retardation, or some brain problems. Therefore, pediatric SDB is not only a health issue for children, but also affects their mental development, growth delays, learning problems and quality of life issues. To date, there are few studies of pediatric SDB, and limited articles were published. In this review, the pathogenesis, clinical manifestation and treatment of pediatric SDB will be discussed and up-to-date research directions will be introduced.