Clinical Characteristics of Chinese Pediatric Obstructive Sleep Apnea Hypopnea Syndrome

Clinical Characteristics of Chinese Pediatric Obstructive Sleep Apnea Hypopnea Syndrome | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Characteristics of Chinese Pediatric Obstructive Sleep Apnea Hypopnea Syndrome Yanyu He, Xueyun Xu, Wenjing Gu, xinxing Zhang, Yuqing Wang, Xunwu Dou, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-375980/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract We aim to analyze the clinical characteristics of obstructive sleep apnea hypopnea syndrome (OSAHS) in children. Polysomnography (PSG) and nasopharynx lateral film were performed, and clinical data were collected in 469 children who came to the outpatient department due to "snoring during sleep with mouth opening breathing, hard breathing or suffocation". Among the enrolled children, 123 (22.6%) were diagnosed with OSAHS, with 70 were mild and 53 were moderate-severe. Percentage of adenoid hypertrophy was higher in OSAHS patients ( p <0.01), instead of tonsil enlargement. The OSAHS children were agged 5 (4, 7). Compared with PS, the percentage of snoring, apnea, dyspnea, increased nocturia, and daytime sleepness were significsntly higher in moderate-severe patients ( p <0.01). In OSAHS groups, AHI, ODI, Longest time of apnea were increased, while minimum SpO2 and mean SpO2 during sleep were decreased significantly ( p <0.01) than PS. Time ratio of NREM1 was elevated in moderate-severe OSAHS patients ( p <0.01). Time ratio of REM was elevated in mild patients( p <0.01). Compared with the preschoolers, the percentage of leg movement and sleepness were significsntly higher in school-agers ( p <0.05). The youngers had higher time ratio of NREM3 and better sleep efficieny (p<0.01). However, AHI(p<0.05) and ODI(p<0.01) were higher in elder OSAHS significantly. Snoring (OR =5.745, p < 0.01), adenoid hypertrophy (OR =4.381, p < 0.01), apnea (OR =2.670, p < 0.001), dyspnea (OR =1.975, p < 0.01), and CRP (OR =1.172, p < 0.001) were independent risk factors for OSAHS. Conclusion AHI, ODI, Longest time of apnea, minimum SpO2 and mean SpO2 should be considered and analyzed simultaneously in diagnosis. The school-age OSAHS patients seems to more serious than the preschoolers. Snoring, apnea, dyspnea, adenoid hypertrophy, and CRP are risk factors for OSAHS. Pediatrics Children Clinical characteristics OSAHS Risk factors Figures Figure 1 Introduction Obstructive sleep apnea hypopnea syndrome (OSAHS) is a frenquent health problem in children with sleep disordered breathing. As reported, the incidence of OSAHS in children is as high as 1.2-5.7%, and the peak age is 2-8 years old[1-3]. OSAHS is a common disease characterized by the presence of recurrent episodes of increased upper airway resistance during sleep, leading to spells of apnea/hypopnea, hypercapnia, nocturnal sleep fragmentation, etc. It can also cause multiple problems, such as hypertension, glucose and lipid metabolism disorder, cognitive function damage, and growth and development delay. OSAHS in children is very much defferent from that in adult, and OSAHS in children is also variable in different age group. It is still complex to diagnose and manage in childhood, and AHI is considered insufficient to assess OSAHS. Pediatricians should attach more importance to the clinical manifestations and signs. In this study, we analyzed the clinical characteristics of OSAHS diagnosed in our sleep centre, and excepted to be heipful for better diagnosis. Materials And Methods Patient All 469 cases were consecutively recruited between December 2016 and November 2019, who met the following inclusion criteria: (1) aged older than 3 and younger than 15 ; (2) compllaining about snoring, mouth breathing, dyspnea or apnea, labored or paradoxical breathing and gasping during sleep; (3) Patients with recent infectious diseases, known sleep apnea on regular therapy, maxillofacial dysplasia, autoimmune diseases, congenital pulmonary and heart disease, neuromuscular diseases, and other serious disease were excluded. Data collection The medical records of patients were reviewed retrospectively. Parental complaint was recorded which consisted of snoring, mouth breathing, salivation, labored breathing, bruxism, apnea, increased nocturia(IE), night enuresis(NE), nightmare, oppressive wake and so on. Physical examination, nasopharyngeal lateral film, and report of polysomnography were also integrated. IE was defned as the frequency of urinating at night reaching three or more times after falling asleep. NE was defned as bed wetting for more than twice a week for 3 consecutive months, or a child 5–6 years old should have two or more bed-wetting episodes per month, and a child older than 6 years of age should have one or more bed-wetting episodes per month[4,5]. Tonsil and adenoid size assessment Tonsil grade was determined using the Brodsky grading scale, in which the tonsils are assigned a grade from 1 to 4. This is dependent on the percentage of oropharyngeal airway occupied by the tonsils. Grade 1 = 25%, grade 2 = 26-50%, grade 3 =51-75%, and grade 4 >75%. The Clemens and McMurray adenoid grading system was used[6]. Grade 1 has adenoid tissue filling 1/3 the vertical height of the choana; Grade 2 up to 2/3; Grade 3 from 2/3 to nearly all but not complete filling of the choana and Grade 4 with complete choanal obstruction[7]. A lateral neck X-ray was used to determine the size of adenoid. Adenoid/tonsil size can be determined using adenoidal-nasopharyngeal (A/N) ratio. A: The perpendicular distance from the maximum convexity of the adenoid to the lateral surface of the occipital slope of the skull. N: The distance between the posterior end of the hard palate to the pterygoid and the intersection of the skull base is the width of the nasopharyngeal space[8]. A/N≤0.6 is normal. Between 0.61 and 0.7 is physiological hypertrophy. And A/N≥0.71 is Pathological hypertrophy[9]. Assessment of anthropometry Height(m) and weight(kg) of the children were measured. According to the Body Mass Index Growth Carves For Chinese Children And Adolescents Aged 0 To 18 Years[10], obesity was defned as a body mass index (BMI, kg/m 2 ) >95th percentile of peers with the same age and gender. Polysomnography Overnight PSG (Compumedics E series and Greal series, Australia) was performed for all patients at the first night of admission starting from 10 p.m. to 6 a.m. next morning, and at least 7 h of recording time was considered a successful monitoring. Alcohol, tea, caffeine, sedatives or hypnotics were forbidden 24h before. PSG included electroencephalography (4 channels: C3–A2, C4–A1, O1–A2, O2–A1), electrooculogram (2 channels: LOC-A2, ROC-A1), electromyogram (1 channels: mandibular muscle), electrocardiogram (1 channels), and recording of snoring and body position. The airflow was monitored with a thermistor and a pressure cannula. Respiratory efforts were detected with ribcage and abdominal piezo sensors. Arterial oxygen saturation was monitored by pulse oximetry. All PSG studies were analyzed by trained technicians and sleep physicians according to the criteria of the American Academy of Sleep Medicine 2012[11]. Diagnosis of OSAHS and grouping According to the Draft guidelines for diagnosis and treatment of obstructive sleep apnea hypopnea syndrome in children (urumqi). Mild OSAHS was defingd as 5＜AHI ≤10 or 1＜OAI≤5, moderate was defingd as 10＜AHI≤20 or 5＜OAI≤10, severe was defingd as AHI＞20 or OAI＞10[12]. Primary snoring (PS) was defingd as AHI≤5 and OAI≤1, and other sleep related diseases were excluded. Blood sampling and biochemical investigations Samples of venous blood were collected after overnight fasting. C-reactive protein (CRP) was measured. Statistical analyses Variables exhibiting a normal distribution are represented as mean ± standard deviation (SD) , whereas those with a non-normal distribution are represented by the corresponding nonparametric statistics. Statistical testings between the two groups (OSAHS vs. PS) were carried out by Student’s t-test, non-parametric test (Mann-Whitney) or Chi-square test when appropriate. When the three groups (mild OSAHS, moderate-severe OSAHS and PS) were compared, variance analysis or non-parametric test (Mann-Whitney) were used appropriately. In addition, binary logistic regression analyses were performed to investigate the relationships between OSAHS against the clinical and PSG parameters. All statistical analyses were conducted using SPSS 22 .0 software for Windows. All probabilities were 2-tailed, and values of p <0.05 were considered statistically significant. Results 469 children were enrolled, ranging from 2 to 15 years old, with a median age of 5 (4, 7). There were 283 males and 162 females. 123(22.6%) cases were diagnosed as OSAHS. 70 were mild OSAHS, 20 were moredate OSAHS, and 33 were severe OSAHS. 322 were primary snoring (PS). 24 were excluded because of central sleep apnea syndrome, narcolepsy, restless legs syndrome, and so on. The OSAHS patients were aging from 3 to 12 years old, with a median age of 5 (4, 7) (seen in picture 1). There were 86 boys and 37 girls. There was no significant difference between boy and girl with OSAHS. Picture 1 The age distribution of the OSAHS patients C linical manifestations of OSAHS Cases of the night performence of with OSAHS children was as follow: 120 cases (97.6%) with snoring, 104 cases (84.6%) with mouth breathing, 77 cases (62.6%) with salivation, 69 cases (56.1%) with labored breathing, 68 cases (55.3%) with IE, 52 cases (42.3%) with bruxism, 52 cases (42.3%) with leg movement, 46 cases (37.4%) with apnea, 27 cases (22%) with NE, 26 cases (21.1%) with nightmare, 24 cases (19.5%) with oppressive wake. Cases of the daytime symptoms of with OSAHS children was in the order: 55 cases (44.7%) with difficulty getting up in the morning, 49 cases (39.8%) with mouth parched in the morning, 49 cases(39.8%) with hyperactivity, 47 cases (38.2%) with difficulty concentrating, 38 cases (30.9%) with morning fatigue, 29 cases (23.6%) with daytime sleepiness, 11 cases (8.9%) with social withdrawal, 9 cases (7.3%) with memory impairment, 5 cases (4.1%) with morning headaches. Percentage of adenoid hypertrophy was higher in OSAHS patients ( p <0.01). 5 children had no adenoid hypertrophy, while 53 had slight adenoid hypertrophy, 35 had moderate adenoid hypertrophy, and 30 had severe adenoid hypertrophy. However, Percentage of tonsil enlargement was slightly higher in OSAHS patients. The body mass index (BMI) of 123 children with OSAHS was ranged from 12.43-33.82 kg/m 2 , with a mean value of 17.4±4.0 kg/m 2 . 23 cases (18.7%) were achieving the standards for obese. There was no significant difference in BMI between OSAHS group and PS group (Table 1). Table 1 Comparison of general information between OSAHS and PS OSAHS(N=123) PS(N=322) P value Age(year) 5.0(4.0,7.0) 5.0(4.0,7.0) 0.739 male/female(N,%) 86(69.9)/37(30.1) 197(61.2)/125(38.8) 0.099 Disease course(month) 24.0(8.0,36.0) 12.0(6.0,36.0) 0.007 BMI(kg/m 2 ) 17.4±4.0 16.7±2.7 0.087 Tonsil enlargement(N,%) 105(85.4) 252(78.3) 0.110 Adenoid hypertrophy(N,%) 118(95.9) 275(85.4) 0.003 Rhinitis/sinusitis(N,%) 94(76.4) 259(80.4) 0.361 Asthma(N,%) 10(8.1) 44(13.7) 0.143 Cigarettes exposure(N,%) 51(41.5) 132(41.0) 1.000 Family snoring(N,%) 93(75.6) 251(78.0) 0.614 CRP(mg/L) 0.32(0.14, 0.79) 0.51(0.21, 2.12) 0.000 Data are expressed as mean ± SD, median (25%(C), 75%(D)), or as indicated. Symptoms and PSG parametres of mild OSA H S , moderate-severe OSA H S and PS patients Compared with PS, the percentage of snoring, apnea, dyspnea, increased nocturia, and sleepness were significsntly higher in moderate-severe OSAHS patients ( p <0.01). Apnea( p <0.05) and dyspnea( p <0.01) were elevated in mild OSAHS patients, too (Table 2). In mild and moderate-severe group, AHI, ODI, Longest time of apnea, were increased, while minimum SpO2 and mean SpO2 during sleep were decreased significantly( p <0.01) than PS. Time ratio of NREM1 was elevated in moderate-severe OSAHS patients( p <0.01). Time ratio of REM was elevated in mild patients( p <0.01) ( Table 3). The moderate-severe patients were much more sleepness than PS (p<0.01). However, there is no difference between the groups in common daytime symptoms, including difficulty in concentration, behavioral and emotional problems, and morning headaches. Table 2 Comparison of Nocturnal and daytime symptoms PS(N=322) Mild(N=70) Moderate-severe(N=53) P value Snoring 283 67 53 # 0.006 Salivation 172 45 32 0.199 mouth breathing 239 59 45 0.068 dyspnea 105 36** 33 ## 0.000 apnea 46 50* 26 ##+ 0.000 oppressive wake 36 11 13 # 0.026 night enuresis 44 15 12 0.101 increased nocturia 134 37 31 ## 0.029 bruxism 158 33 19 0.204 leg movement 121 30 22 0.654 nightmare 69 16 10 0.865 sleepness 29 14 15 ## 0.001 *，PS & mild OSAHS，p<0.05，**，p<0.01; #, PS & Moderate-severe OSAHS，p<0.05，##，p<0.01; +，mild & Moderate-severe OSAHS，p<0.05，++，p<0.01. Table 3 Comparison of sleep and respiratory parameters PSG PS mild Moderate-severe P value Total sleep time 471.59±76.24 461.90±67.70 481.76±77.68 0.212 Sleep efficiency 82.85(73.68, 89.80) 82.10(72.88,89.32) 83.00(78.70,90.40) 0.262 Arousal index(AI) 1.88(1.36,2.64) 1.89(1.29,2.52) 1.86(1.28,2.52) 0.595 AI of REM 3.10(1.50,5.85) 3.60(1.88,8.13) 6.20(2.85,14.30) ## 0.000 N1% 12.48±5.36 13.42±5.54 14.91±4.89 ## 0.002 N2% 44.43±8.79 42.17±8.05 43.03±9.23 0.288 N3% 23.66±9.95 22.63±6.73 21.75±6.79 0.181 REM 20.04±4.50 21.80±4.63** 20.01±4.85 0.971 AHI 1.10(0.60, 2.10) 6.35(4.80,8.00)** 21.70(14.90,33.60) ##++ 0.000 OAI 0.00(0.00, 0.00) 1.40(0.50,2.82)** 10.00(2.35,15.75) ## 0.000 Longest time of apnea 11.00(9.00, 13.00) 17.00(12.75,22.25)** 23.00(19.00,36.50) ## 0.000 ODI 0.30(.010,0.60) 1.90(0.80,3.73)** 12.10(6.55,19.75) ##++ 0.000 Minimum SpO2 91.45±2.91 86.59±5.48** 77.57±11.06 ##++ 0.000 Mean SpO2 97.11±0.70 96.74±0.85** 94.65±3.09 ##++ 0.000 Data are presented as mean ± SD and/or median (minimum, maximum). REM, rapid eye movement; AHI, apnea hypopnea index; OAI, Obstructive apnea index; SpO2, pulse oxygen saturation; ODI, oxygen desaturation index. Comparison of OSA H S children in preschool and school age Children with OSAHS were divided into two group: Preschoolers: 3~6 year old (N=87) , and School-agers: 7~12 year old (N=36). Compared with preschoolers, the percentage of leg movement and sleepness were significsntly higher in school-agers ( p <0.05) ( Table 4). The younger ones had higher time ratio of NREM3 and better sleep efficieny (p<0.01). time ratio of REM was also elevated in younger children. However, AHI(p<0.05) and ODI(p<0.01) were higher in elder OSAHS (Table 5). Among the patients over 5 years old, increased nocturia in moderate-severe OSAHS occured more often (p<0.05). Pearson correlation analysis had shown that nocturnal urination was positively correlated with OAI (p<0.01) , and negatively correlated with average SpO 2 (p<0.01) . Table 4 Comparison of Nocturnal and daytime symptoms in different age group 3~6 year old 7~12 year old P value Snoring 85 (97.7) 35 (97.2) 1.000 b Salivation 53 (60.9) 24 (66.7) 0.683 mouth breathing 76 (87.4) 28 (77.8) 0.271 dyspnea 52 (59.8) 17 (47.2) 0.234 apnea 35 (40.2) 11 (30.6) 0.413 oppressive wake 18 (20.7) 6 (16.7) 0.632 night enuresis 18 (20.7) 9 (25.0) 0.163 increased nocturia 52 (59.8) 16 (44.4) 0.636 bruxism 38 (43.7) 14 (38.9) 0.691 leg movement 43 (49.4) 9 (25.0) 0.016 nightmare 19 (21.8) 7 (19.4) 0.814 sleepness 15 (17.2) 14 (38.9) 0.012 headache 3 (3.4) 2 (5.6) 0.629 b fatigue 24 (27.6) 14 (38.9) 0.284 dificult to get up 34 (39.1) 21 (58.3) 0.072 Data are presented as N (n%). b, Fisher exact test. Table 5 Comparison of PSG results of OSAHS children in preschool and school age 3~6 year old 7~12 year old P value Total sleep time 482.2±62.7 442.1±86.6 0.015 Sleep efficiency 84.4（78.0,90.7） 76.3±13.3 0.004 Arousal index(AI) 14.0（10.0,18.0） 17.0（10.5,22.8） 0.142 AI of REM 5.0(2.8,10.6) 3.2(1.6,9.5) 0.135 N1% 68.3±27.2 59.5±21.7 0.083 N2% 194.9±44.7 207.0±55.4 0.206 N3% 23.2±6.4 19.1（16.2,22.1） 0.001 REM% 21.5（19.0,24.6） 19.1±4.4 0.010 AHI 8.3(5.8,17.6) 11.2(7.1,24.4) 0.022 Longest time of apnea 20.0(15.0,27.0) 19.0(14.3,25.8) 0.856 ODI 3.2(1.0,6.8) 5.7(3.1,13.8) 0.007 Minimum SpO2 85.0（80.0,88.0) 86.0（79.5,89.0) 0.940 Correlation of anthropometry and clinical variables with OSAHS To investigate the relationships between anthropometry and clinical variables with OSAHS, Pearson correlation analysis was performed which demonstrated that OSAHS had been correlated with symptoms of snoring, mouth breathing, dyspnea, apnea, oppressive wake, increased nocturia and night enuresis, and signs of adenoid hypertrophy (p < 0.05). In addition, course of disease, CRP and BMI were positively correlated with OSAHS (p < 0.05). Regression analyses were performed among the anthropometry and clinical parameters and CRP, and it revealed that OSAHS was signifificantly associated with snoring (odds ratio:5.745, 95% CI: 1.616-20.424; p < 0.01), adenoid hypertrophy (odds ratio: 4.381, 95% CI: 1.619-11.858; p < 0.01), apnea (odds ratio:2.670, 95% CI: 1.554-4.587; p < 0.001), dyspnea (odds ratio:1.975, 95% CI: 1.223-3.190; p < 0.01), and CRP (odds ratio: 1.172, 95% CI: 1.077-1.276; p < 0.001). Discussion Obstructive sleep apnea hypopnea syndrome is one of the common type of sleep disordered breathing in children. It may cause multiple complications in organs and systems, affecting children’s growth and development negtively. However, it is still complex to diagnose and manage in the pediatric age. This study retrospectively analyzed the clinical and PSG manifestations of OSAHS in children dignosed in our centre. In our study, the median age of OSAHS in children is 5 (4, 7) years old in this study, and 25.6% of the children recruited were diagnosisd OSAHS, which was consistent with the reports[13 ] . Adenoidal and tonsillar hypertrophy is recognized to be closely with OSAHS severity[14]. In our study, adenoidal hypertrophy were the prominent elements found in OSAHS patient, and it was independently related to OSAHS. But there was no significant difference in tonsillar hypertrophy between the groups. Researchers have thought that using tonsil size only in diagnosis was limited, even the clear parent-reported history of habitual snoring was more valuable[15,16]. Moderate-severe patients had higher frequency of rhinitis and/or nasosinusitis, which was obviously correlated with OSAHS. In our study, C-reaction protein was associated with OSAHS independently. Therefore, recurrent inflaming in upper airway must be treated effectively and in time and was considered to be related to OSAHS[17]. It may lead to a persistent systemic inflammatory response in the children. Inflammatory response is considered as an important pathophysiological process of OSAHS. Daytime symptoms of OSAHS chilldren usually included difficulty concentrating, behavioral and emotional problems, morning headaches, excessive daytime sleepiness, and dysplasia[18]. In our study, sleepiness was the only factor found to be different between the groups. We may need to expand the data sources through asking teachers from preschool or school. The common nocturnal symptoms of children with OSAHS include snoring, excessive sweating, restless sleep, mouth breathing, apnea, wheezing, dyspnea or abnormality, and excessive neck extension during sleep. We found that the symptoms of snoring, dyspnea, apnea, nocturia, and oppressive wake were more discriminative. Increased nocturia was an interesting symptom of OSAHS, especially the moderate-severe ones. Nocturia has been shown to be a complication of OSAHS in children. A meta-analysis found a strong correlation between OSAHS and nocturia, and significant improvement in nocturia symptoms was found in treated children[19,20]. Su et al. had found that the risk of nocturia in children with OSAHS was increased markedly[21]. In our data, we found that the increased nocturia in moderate-severe OSAHS was particularly evident among the patients over 5 years old. Pearson correlation analysis had shown that nocturnal urination was positively correlated with hypoxia. This reminds us to pay special attention to the symptoms of increased nocturia in snoring children over 5 years old. Cardiopulmonary and renal refex-induced neuroendocrine disorder may play an important role in the mechanism of night enuresis in children with OSAHS[22]. As we known, It was accepted that sleep architecture changed a lot in adult OSAHS patients. OSAHS initiates the sleep structure disorder, increase of shallow sleep, and decrease of deep sleep and REM sleep. For children, deep sleep is important for a variety of metabolic and endocrine processes, such as growth hormone secretion and other anabolic processes. Concludes of studies about OSAHS and sleep structure of children are inconsistent. Sun et al. found that the NREM3 sleep of school-age OSAHS patients was significantly reduced, and NREM1 sleep was prolonged[23]. In the study of durdik P et al., there were no significant differences in REM sleep, NREM2 sleep and sleep efficiency between the OSAHS and control group, but the NREM3 sleep of OSAHS children was significantly shorter, and the NREM1 sleep was significantly longer[24]. However, Goh DY found that children with OSA H S have normal sleep stage distribution[25]. In our data, time ratio of NREM1 was elevated in Moderate-severe OSAHS patient, and REM was higher in mild OSAHS patients. OSAHS in children is variable in different age groups. The school age group had significantly decreased proportion of NREM3 and REM, and increased AHI and ODI than the preschool one. It seems that the condition of elder children was much more serious, which is worthy of further exploring. Limitation Due to the limitation of sample size, no further analysis was made in different age. We will continue to collect cases. Conclusion We found that the median age of OSAHS in children was 5 (4, 7) years old. Compared with PS, snoring, dyspnea, apnea, oppressive wake, nocturia and daytime sleepiness were more common in OSAHS children. The school-age OSAHS patients seems to more serious than the preschoolers. Sleep structure disorder was found more often in children with OSAHS aged from 7 to 12 years old, mainly including shortening in the stage of NREM3 and REM. Chileren with snoring, apnea, dyspnea, adenoid hypertrophy and high lever of CRP were more likely to be OSAHS patients. We hope to give clinicians better diagnosis basis. Declarations Acknowledgements We thank the children and their parents for participation in our study. Funding This study was supported by research grants from Natural Science Foundation of China (81573167) , the Key Scientific and Technological Social Development Projects of Jiangsu Province(No.BE2016676，No.BE2017657) , and the People's Livelihood Science and Technology Project of Soochow(No.SYS2019087). Data availability All data generated or analyzed during this study are included in this published article. Code availability N/A Author Contributions Yuqing Wang and Xunwu Dou designed the study. Yanyu He and Xueyun Xu conducted and interpreted the statistical analysis and had the primary responsibility in the formation of the initial draft. 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Am J Respir Crit Care Med 162(2):682–686. http://doi.org/10.1164/ajrccm.162.2.9908058 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-375980","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":21141594,"identity":"af01ea50-3fa5-4d4a-a60c-62756b3537fa","order_by":0,"name":"Yanyu He","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIie3QsWrDMBCA4TMCeZHxKmNIXkFFQ5K3OVHolA4li4fQqhgyJXiNIfQZPGU2FOzFdPbU1jFkzugpVNmDnW4Z9A036Yc7AVjWHRKXgQDMd5Om7SI+8m9NRsG6IhKqqQz0LYkhRT2nobOKVDaUTNzN8fQbfatUP+fhywd3MiDNoe5JZutSbrFaqAS+UKZ7TiZApZz3LVY/EVArVOm7FujtOZ1pRsPe5OdokjOq7BNE7u04E/lQUlOTaJSiYA+xpzkfTiqzGBZoPpk+OtuCiyAeuqUsiNMtkfnjtuxOy9e3xI2bti+5gvzvuWVZlnXFH8/vTFd1GgsEAAAAAElFTkSuQmCC","orcid":"","institution":"Soochow University Affiliated Children's Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yanyu","middleName":"","lastName":"He","suffix":""},{"id":21141595,"identity":"98feebe0-906c-4099-88b6-f58fc5028eae","order_by":1,"name":"Xueyun Xu","email":"","orcid":"","institution":"Soochow University Affiliated Children's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xueyun","middleName":"","lastName":"Xu","suffix":""},{"id":21141596,"identity":"024f3a4f-6fcd-4589-915a-db25416a0e4a","order_by":2,"name":"Wenjing Gu","email":"","orcid":"","institution":"Soochow University Affiliated Children's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wenjing","middleName":"","lastName":"Gu","suffix":""},{"id":21141597,"identity":"f4017505-04c7-4d76-9ca6-b990132e53c9","order_by":3,"name":"xinxing Zhang","email":"","orcid":"","institution":"Soochow University Affiliated Children's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"xinxing","middleName":"","lastName":"Zhang","suffix":""},{"id":21141598,"identity":"4d6d9371-5803-4a59-bbeb-44057602039a","order_by":4,"name":"Yuqing Wang","email":"","orcid":"","institution":"Soochow University Affiliated Children's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yuqing","middleName":"","lastName":"Wang","suffix":""},{"id":21141599,"identity":"af54507c-798f-49b6-9fe7-5ce252f2e732","order_by":5,"name":"Xunwu Dou","email":"","orcid":"","institution":"Soochow University Affiliated Children's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xunwu","middleName":"","lastName":"Dou","suffix":""},{"id":21141600,"identity":"c9eb44df-6615-4611-be5c-9e0daebfa135","order_by":6,"name":"Chuangli Hao","email":"","orcid":"","institution":"Soochow University Affiliated Children's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chuangli","middleName":"","lastName":"Hao","suffix":""}],"badges":[],"createdAt":"2021-03-30 08:04:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-375980/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-375980/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":8021710,"identity":"e6226b9c-b066-4bb5-a2dd-093e4617218b","added_by":"auto","created_at":"2021-04-14 21:41:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":7583,"visible":true,"origin":"","legend":"The age distribution of the OSAHS patients","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-375980/v1/3874d733cf419368a8242faf.png"},{"id":13686368,"identity":"c9eb80c5-93e8-449f-acc8-bbfa911e4dbe","added_by":"auto","created_at":"2021-09-17 12:14:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":344351,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-375980/v1/2f3d415f-827f-4e0d-baf5-521c26a5d086.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eClinical Characteristics of Chinese Pediatric Obstructive Sleep Apnea Hypopnea Syndrome\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eObstructive sleep apnea hypopnea syndrome (OSAHS) is a frenquent health problem in children with sleep disordered breathing. As reported, the incidence of OSAHS in children is as high as 1.2-5.7%, and the peak age is 2-8 years old[1-3]. OSAHS is a common disease characterized by the presence of recurrent episodes of increased upper airway resistance during sleep, leading to spells of apnea/hypopnea, hypercapnia, nocturnal sleep fragmentation, etc. It can also cause multiple problems, such as hypertension, glucose and lipid metabolism disorder, cognitive function damage, and growth and development delay. OSAHS in children is very much defferent from that in adult, and OSAHS in children is also variable in different age group. It is still complex to diagnose and manage in childhood, and AHI is considered insufficient to assess OSAHS. Pediatricians should attach more importance to the clinical manifestations and signs. In this study, we analyzed the clinical characteristics of OSAHS diagnosed in our sleep centre, and excepted to be\u0026nbsp;heipful\u0026nbsp;for\u0026nbsp;better diagnosis.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003e\u003cstrong\u003ePatient\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll 469\u0026nbsp;cases\u0026nbsp;were\u0026nbsp;consecutively recruited\u0026nbsp;between December 2016 and November 2019, who met the following inclusion criteria: (1) aged older than 3 and younger than 15 ; (2) compllaining about snoring, mouth breathing, dyspnea or apnea, labored or paradoxical breathing and gasping during sleep; (3) Patients with recent infectious diseases, known sleep apnea on regular therapy, maxillofacial dysplasia, autoimmune diseases, congenital pulmonary and heart disease, neuromuscular diseases, and other serious\u0026nbsp;disease were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe medical records of patients were reviewed retrospectively. Parental complaint was recorded which consisted of snoring, mouth breathing, salivation, labored breathing, bruxism, apnea, increased\u0026nbsp;nocturia(IE), night enuresis(NE), nightmare, oppressive wake and so on. Physical examination, nasopharyngeal\u0026nbsp;lateral\u0026nbsp;film, and report of polysomnography were also integrated.\u003c/p\u003e\n\u003cp\u003eIE was defned as the frequency of urinating at night reaching three or more times after falling asleep. NE was defned as bed wetting for more than twice a week for 3 consecutive months, or a child 5\u0026ndash;6\u0026nbsp;years old should have two or more bed-wetting episodes per month, and a child older than 6\u0026nbsp;years of age should have one or more bed-wetting episodes per month[4,5].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTonsil \u003c/strong\u003e\u003cstrong\u003eand adenoid \u003c/strong\u003e\u003cstrong\u003esize assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTonsil grade was determined using the Brodsky grading scale, in which the tonsils are assigned a grade from 1 to 4. This is dependent on the percentage of oropharyngeal airway occupied by the tonsils. Grade 1 = 25%, grade 2 = 26-50%, grade 3 =51-75%, and grade 4 \u0026gt;75%. The Clemens and McMurray adenoid grading system was used[6]. Grade 1 has adenoid tissue filling 1/3 the vertical height of the choana; Grade 2 up to 2/3; Grade 3 from 2/3 to nearly all but not complete filling of the choana and Grade 4 with complete choanal obstruction[7].\u003c/p\u003e\n\u003cp\u003eA lateral neck X-ray was used to determine the size of adenoid. Adenoid/tonsil size can be determined using adenoidal-nasopharyngeal (A/N) ratio. A: The perpendicular distance from the maximum convexity of the adenoid to the lateral surface of the occipital slope of the skull. N: The distance between the posterior end of the hard palate to the pterygoid and the intersection of the skull base is the width of the nasopharyngeal space[8]. A/N\u0026le;0.6 is normal. Between 0.61 and 0.7 is physiological hypertrophy. And A/N\u0026ge;0.71 is Pathological hypertrophy[9].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssessment\u003c/strong\u003e\u003cstrong\u003e of anthropometry\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHeight(m) and weight(kg) of the children were measured. According to the Body Mass Index Growth Carves For Chinese Children And Adolescents Aged 0 To 18 Years[10], obesity was defned as a body mass index (BMI, kg/m\u003csup\u003e2\u003c/sup\u003e) \u0026gt;95th percentile of peers with the same age and gender.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePolysomnography\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOvernight PSG (Compumedics E series and Greal series, Australia) was performed for all patients at the first night of admission starting from 10 p.m. to 6 a.m. next morning, and at least 7 h of recording time was considered a successful monitoring. Alcohol, tea, caffeine, sedatives or hypnotics were forbidden 24h before.\u003c/p\u003e\n\u003cp\u003ePSG included electroencephalography (4 channels: C3\u0026ndash;A2, C4\u0026ndash;A1, O1\u0026ndash;A2, O2\u0026ndash;A1), electrooculogram (2 channels: LOC-A2, ROC-A1), electromyogram (1 channels: mandibular muscle), electrocardiogram (1 channels), and recording of snoring and body position. The airflow was monitored with a thermistor and a pressure cannula. Respiratory efforts were detected with ribcage and abdominal piezo sensors. Arterial oxygen saturation was monitored by pulse oximetry. All PSG studies were analyzed by trained technicians and sleep physicians according to the criteria of the American Academy of Sleep Medicine 2012[11].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnosis of OSAHS and grouping \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the Draft guidelines for diagnosis and treatment of obstructive sleep apnea hypopnea syndrome in children (urumqi). Mild OSAHS was defingd as 5＜AHI \u0026le;10 or 1＜OAI\u0026le;5, moderate was defingd as 10＜AHI\u0026le;20 or 5＜OAI\u0026le;10, severe was defingd as AHI＞20 or OAI＞10[12]. Primary snoring (PS) was defingd as AHI\u0026le;5 and OAI\u0026le;1, and other sleep related diseases were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBlood sampling and biochemical investigations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSamples of venous blood were collected after overnight fasting. C-reactive protein (CRP) was measured.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVariables exhibiting a normal distribution are represented as mean \u0026plusmn; standard deviation (SD) , whereas those with a non-normal distribution are represented by the corresponding nonparametric statistics. Statistical testings between the two groups (OSAHS vs. PS) were carried out by Student\u0026rsquo;s t-test, non-parametric test (Mann-Whitney) or Chi-square test when appropriate. When the three groups (mild OSAHS, moderate-severe OSAHS and PS) were compared, variance analysis or non-parametric test (Mann-Whitney) were used appropriately. In addition, binary logistic regression analyses were performed to investigate the relationships between OSAHS against the clinical and PSG parameters. All statistical analyses were conducted using \u003cem\u003eSPSS \u003c/em\u003e\u003cem\u003e22\u003c/em\u003e\u003cem\u003e.0\u003c/em\u003e software for Windows. All probabilities were 2-tailed, and values of \u003cem\u003ep \u003c/em\u003e\u0026lt;0.05 were considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e469 children were enrolled, ranging from 2 to 15 years old, with a median age of 5 (4, 7). There were 283 males and 162 females. 123(22.6%) cases were diagnosed as OSAHS. 70 were mild OSAHS, 20 were moredate OSAHS, and 33 were severe OSAHS. 322 were primary snoring (PS). 24 were excluded because of central sleep apnea syndrome, narcolepsy, restless legs syndrome, and so on.\u003c/p\u003e\n\u003cp\u003eThe OSAHS patients were aging from 3 to 12 years old, with a median age of 5 (4, 7)\u0026nbsp; (seen in picture 1). There were 86 boys and 37 girls. There was no significant difference between boy and girl with OSAHS.\u003c/p\u003e\n\u003cp\u003ePicture 1 The age distribution of the OSAHS patients\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003cstrong\u003elinical manifestations\u003c/strong\u003e\u003cstrong\u003e of OSAHS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCases of the night performence of with OSAHS children was as follow: 120 cases (97.6%) with snoring, 104 cases (84.6%) with mouth breathing, 77 cases (62.6%) with salivation, 69 cases (56.1%) with labored breathing, 68 cases (55.3%) with IE, 52 cases (42.3%) with bruxism, 52 cases (42.3%) with leg movement, 46 cases (37.4%) with apnea, 27 cases (22%) with NE, 26 cases (21.1%) with nightmare, 24 cases (19.5%) with oppressive wake.\u003c/p\u003e\n\u003cp\u003eCases of the daytime symptoms of with OSAHS children was in the order: 55 cases (44.7%) with difficulty getting up in the morning, 49 cases (39.8%) with mouth parched in the morning, 49 cases(39.8%) with hyperactivity, 47 cases (38.2%) with difficulty concentrating, 38 cases (30.9%) with morning fatigue, 29 cases (23.6%) with daytime sleepiness, 11 cases (8.9%) with social withdrawal, 9 cases (7.3%) with memory impairment, 5 cases (4.1%) with morning headaches.\u003c/p\u003e\n\u003cp\u003ePercentage of adenoid hypertrophy was higher in OSAHS patients (\u003cem\u003ep \u003c/em\u003e\u0026lt;0.01). 5 children had no adenoid hypertrophy, while 53 had slight adenoid hypertrophy, 35 had moderate adenoid hypertrophy, and 30 had severe adenoid hypertrophy. However, Percentage of tonsil enlargement was slightly higher in OSAHS patients.\u003c/p\u003e\n\u003cp\u003eThe body mass index (BMI) of 123 children with OSAHS was ranged from 12.43-33.82 kg/m\u003csup\u003e2\u003c/sup\u003e, with a mean value of 17.4\u0026plusmn;4.0 kg/m\u003csup\u003e2\u003c/sup\u003e. 23 cases (18.7%) were achieving the standards for obese. There was no significant difference in BMI between OSAHS group and PS group (Table 1).\u003c/p\u003e\n\u003cp\u003eTable 1 Comparison of general information between OSAHS and PS\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003eOSAHS(N=123)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"176\"\u003e\n\u003cp\u003ePS(N=322)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003eAge(year)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e5.0(4.0,7.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"176\"\u003e\n\u003cp\u003e5.0(4.0,7.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.739\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003emale/female(N,%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e86(69.9)/37(30.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"176\"\u003e\n\u003cp\u003e197(61.2)/125(38.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.099\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003eDisease course(month)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e24.0(8.0,36.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"176\"\u003e\n\u003cp\u003e12.0(6.0,36.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.007\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003eBMI(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e17.4\u0026plusmn;4.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"176\"\u003e\n\u003cp\u003e16.7\u0026plusmn;2.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.087\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003eTonsil enlargement(N,%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e105(85.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"176\"\u003e\n\u003cp\u003e252(78.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.110\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003eAdenoid hypertrophy(N,%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e118(95.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"176\"\u003e\n\u003cp\u003e275(85.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003eRhinitis/sinusitis(N,%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e94(76.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"176\"\u003e\n\u003cp\u003e259(80.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.361\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003eAsthma(N,%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e10(8.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"176\"\u003e\n\u003cp\u003e44(13.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.143\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003eCigarettes exposure(N,%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e51(41.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"176\"\u003e\n\u003cp\u003e132(41.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003eFamily snoring(N,%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e93(75.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"176\"\u003e\n\u003cp\u003e251(78.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.614\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003eCRP(mg/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e0.32(0.14, 0.79)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"176\"\u003e\n\u003cp\u003e0.51(0.21, 2.12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are expressed as mean \u0026plusmn; SD, median (25%(C), 75%(D)), or as indicated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSymptoms and PSG parametres of mild \u003c/strong\u003e\u003cstrong\u003eOSA\u003c/strong\u003e\u003cstrong\u003eH\u003c/strong\u003e\u003cstrong\u003eS\u003c/strong\u003e\u003cstrong\u003e, moderate-severe \u003c/strong\u003e\u003cstrong\u003eOSA\u003c/strong\u003e\u003cstrong\u003eH\u003c/strong\u003e\u003cstrong\u003eS and PS\u003c/strong\u003e\u003cstrong\u003e patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompared with PS, the percentage of snoring, apnea, dyspnea, increased\u0026nbsp;nocturia, and sleepness were significsntly higher in moderate-severe OSAHS patients (\u003cem\u003ep \u003c/em\u003e\u0026lt;0.01). Apnea(\u003cem\u003ep \u003c/em\u003e\u0026lt;0.05) and dyspnea(\u003cem\u003ep \u003c/em\u003e\u0026lt;0.01) were elevated in mild OSAHS patients, too (Table 2). In mild and moderate-severe group, AHI, ODI, Longest time of apnea, were increased, while minimum SpO2 and mean SpO2 during sleep were decreased significantly(\u003cem\u003ep \u003c/em\u003e\u0026lt;0.01) than PS. Time ratio of NREM1 was elevated in moderate-severe OSAHS patients(\u003cem\u003ep \u003c/em\u003e\u0026lt;0.01). Time ratio of REM was elevated in mild patients(\u003cem\u003ep \u003c/em\u003e\u0026lt;0.01) ( Table 3).\u003c/p\u003e\n\u003cp\u003eThe moderate-severe patients were much more sleepness than PS (p\u0026lt;0.01). However, there is no difference between the groups in common daytime symptoms, including difficulty in concentration, behavioral and emotional problems, and morning headaches.\u003c/p\u003e\n\u003cp\u003eTable 2 Comparison of Nocturnal and daytime symptoms\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003ePS(N=322)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003eMild(N=70)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003eModerate-severe(N=53)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003eSnoring\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003e283\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e67\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003e53\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e0.006\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003eSalivation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003e172\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e0.199\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003emouth\u0026nbsp;breathing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003e239\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e0.068\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003edyspnea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003e105\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e36**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003e33\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eapnea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003e46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e50*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003e26\u003csup\u003e##+\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eoppressive\u0026nbsp;wake\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003e13\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e0.026\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003enight enuresis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003e44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e0.101\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eincreased\u0026nbsp;nocturia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003e134\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003e31\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e0.029\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003ebruxism\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003e158\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e0.204\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eleg movement\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003e121\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e0.654\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003enightmare\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003e69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e0.865\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003esleepness\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"117\"\u003e\n\u003cp\u003e29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003e15\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*，PS \u0026amp; mild OSAHS，p\u0026lt;0.05，**，p\u0026lt;0.01; #, PS \u0026amp; Moderate-severe OSAHS，p\u0026lt;0.05，##，p\u0026lt;0.01; +，mild \u0026amp; Moderate-severe OSAHS，p\u0026lt;0.05，++，p\u0026lt;0.01. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3 Comparison of sleep and respiratory parameters PSG\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003ePS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003emild\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003eModerate-severe\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"59\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003eTotal sleep time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e471.59\u0026plusmn;76.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003e461.90\u0026plusmn;67.70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e481.76\u0026plusmn;77.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"59\"\u003e\n\u003cp\u003e0.212\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003eSleep efficiency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e82.85(73.68, 89.80)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003e82.10(72.88,89.32)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e83.00(78.70,90.40)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"59\"\u003e\n\u003cp\u003e0.262\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003eArousal\u0026nbsp;index(AI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e1.88(1.36,2.64)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003e1.89(1.29,2.52)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e1.86(1.28,2.52)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"59\"\u003e\n\u003cp\u003e0.595\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003eAI of REM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e3.10(1.50,5.85)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003e3.60(1.88,8.13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e6.20(2.85,14.30)\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"59\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003eN1%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e12.48\u0026plusmn;5.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003e13.42\u0026plusmn;5.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e14.91\u0026plusmn;4.89\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"59\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003eN2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e44.43\u0026plusmn;8.79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003e42.17\u0026plusmn;8.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e43.03\u0026plusmn;9.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"59\"\u003e\n\u003cp\u003e0.288\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003eN3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e23.66\u0026plusmn;9.95\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003e22.63\u0026plusmn;6.73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e21.75\u0026plusmn;6.79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"59\"\u003e\n\u003cp\u003e0.181\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003eREM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e20.04\u0026plusmn;4.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003e21.80\u0026plusmn;4.63**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e20.01\u0026plusmn;4.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"59\"\u003e\n\u003cp\u003e0.971\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003eAHI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e1.10(0.60, 2.10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003e6.35(4.80,8.00)**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e21.70(14.90,33.60)\u003csup\u003e##++\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"59\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003eOAI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e0.00(0.00, 0.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003e1.40(0.50,2.82)**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e10.00(2.35,15.75)\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"59\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003eLongest time of apnea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e11.00(9.00, 13.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003e17.00(12.75,22.25)**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e23.00(19.00,36.50)\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"59\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003eODI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e0.30(.010,0.60)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003e1.90(0.80,3.73)**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e12.10(6.55,19.75)\u003csup\u003e##++\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"59\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003eMinimum SpO2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e91.45\u0026plusmn;2.91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003e86.59\u0026plusmn;5.48**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e77.57\u0026plusmn;11.06\u003csup\u003e##++\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"59\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003eMean SpO2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e97.11\u0026plusmn;0.70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003e96.74\u0026plusmn;0.85**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e94.65\u0026plusmn;3.09\u003csup\u003e##++\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"59\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as mean \u0026plusmn; SD and/or median (minimum, maximum).\u003c/p\u003e\n\u003cp\u003eREM, rapid eye movement; AHI, apnea hypopnea index; OAI, Obstructive apnea index; SpO2, pulse oxygen saturation; ODI, oxygen\u0026nbsp;desaturation\u0026nbsp;index.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of OSA\u003c/strong\u003e\u003cstrong\u003eH\u003c/strong\u003e\u003cstrong\u003eS children \u003c/strong\u003e\u003cstrong\u003ein\u003c/strong\u003e \u003cstrong\u003epreschool and school age\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChildren with OSAHS were divided into two group: Preschoolers: 3~6 year old (N=87) , and School-agers: 7~12 year old (N=36). Compared with preschoolers, the percentage of leg movement and sleepness were significsntly higher in school-agers (\u003cem\u003ep \u003c/em\u003e\u0026lt;0.05) ( Table 4). The younger ones had higher time ratio of NREM3 and better sleep efficieny (p\u0026lt;0.01). time ratio of REM was also elevated in younger children. However, AHI(p\u0026lt;0.05) and ODI(p\u0026lt;0.01) were higher in elder OSAHS (Table 5). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmong the patients over 5 years old, increased\u0026nbsp;nocturia in moderate-severe OSAHS occured more often (p\u0026lt;0.05). Pearson correlation analysis had shown that nocturnal urination was positively\u0026nbsp;correlated\u0026nbsp;with OAI (p\u0026lt;0.01) , and negatively correlated\u0026nbsp;with average SpO\u003csub\u003e2 \u003c/sub\u003e(p\u0026lt;0.01) . \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4\u0026nbsp; Comparison of Nocturnal and daytime symptoms in different age group\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e3~6 year old\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e7~12 year old\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eSnoring\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e85 (97.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e35 (97.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e1.000\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eSalivation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e53 (60.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e24 (66.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.683\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003emouth\u0026nbsp;breathing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e76 (87.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e28 (77.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.271\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003edyspnea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e52 (59.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e17 (47.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.234\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eapnea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e35 (40.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e11 (30.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.413\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eoppressive\u0026nbsp;wake\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e18 (20.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e6 (16.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.632\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003enight enuresis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e18 (20.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e9 (25.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.163\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eincreased\u0026nbsp;nocturia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e52 (59.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e16 (44.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.636\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003ebruxism\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e38 (43.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e14 (38.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.691\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eleg movement\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e43 (49.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e9 (25.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.016\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003enightmare\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e19 (21.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e7 (19.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.814\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003esleepness\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e15 (17.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e14 (38.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.012\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eheadache\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e3 (3.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e2 (5.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.629\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003efatigue\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e24 (27.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e14 (38.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.284\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003edificult to get up\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e34 (39.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e21 (58.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.072\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as N (n%).\u003c/p\u003e\n\u003cp\u003eb, Fisher exact test.\u003c/p\u003e\n\u003cp\u003eTable 5\u0026nbsp; Comparison of PSG results of OSAHS children in preschool and school age\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e3~6 year old\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e7~12 year old\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eTotal sleep time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e482.2\u0026plusmn;62.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e442.1\u0026plusmn;86.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.015\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eSleep efficiency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e84.4（78.0,90.7）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e76.3\u0026plusmn;13.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.004\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eArousal\u0026nbsp;index(AI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e14.0（10.0,18.0）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e17.0（10.5,22.8）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.142\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eAI of REM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e5.0(2.8,10.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e3.2(1.6,9.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.135\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eN1%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e68.3\u0026plusmn;27.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e59.5\u0026plusmn;21.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.083\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eN2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e194.9\u0026plusmn;44.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e207.0\u0026plusmn;55.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.206\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eN3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e23.2\u0026plusmn;6.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e19.1（16.2,22.1）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eREM%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e21.5（19.0,24.6）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e19.1\u0026plusmn;4.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.010\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eAHI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e8.3(5.8,17.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e11.2(7.1,24.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.022\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eLongest time of apnea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e20.0(15.0,27.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e19.0(14.3,25.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.856\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eODI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e3.2(1.0,6.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e5.7(3.1,13.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.007\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"149\"\u003e\n\u003cp\u003eMinimum SpO2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e85.0（80.0,88.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e86.0（79.5,89.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"140\"\u003e\n\u003cp\u003e0.940\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation of anthropometry and clinical variables with OSAHS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo investigate the relationships between anthropometry and clinical variables with OSAHS, Pearson correlation analysis was performed which demonstrated that OSAHS had been correlated with symptoms of snoring, mouth\u0026nbsp;breathing, dyspnea, apnea, oppressive\u0026nbsp;wake, increased\u0026nbsp;nocturia and night enuresis, and signs of adenoid hypertrophy (p \u0026lt; 0.05). In addition, course of disease, CRP and BMI were positively correlated with OSAHS (p \u0026lt; 0.05). Regression analyses were performed among the anthropometry and clinical parameters and CRP, and it revealed that OSAHS was signifificantly associated with snoring (odds ratio:5.745, 95% CI: 1.616-20.424; p \u0026lt; 0.01), adenoid hypertrophy (odds ratio: 4.381, 95% CI: 1.619-11.858; p \u0026lt; 0.01), apnea (odds ratio:2.670, 95% CI: 1.554-4.587; p \u0026lt; 0.001), dyspnea (odds ratio:1.975, 95% CI: 1.223-3.190; p \u0026lt; 0.01), and CRP (odds ratio: 1.172, 95% CI: 1.077-1.276; p \u0026lt; 0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eObstructive sleep apnea hypopnea syndrome is one of the common type of sleep disordered breathing in children. It may cause multiple complications in organs and systems, affecting children\u0026rsquo;s growth and development negtively. However, it is still complex to diagnose and manage in the pediatric age. This study retrospectively analyzed the clinical and PSG manifestations of OSAHS in children dignosed in our centre.\u003c/p\u003e\n\u003cp\u003eIn our study, the median age of OSAHS in children is 5 (4, 7) years old in this study, and 25.6% of the children recruited were diagnosisd OSAHS, which was consistent with the reports[13\u003csup\u003e]\u003c/sup\u003e. Adenoidal and tonsillar hypertrophy is recognized to be closely with OSAHS severity[14]. In our study, adenoidal hypertrophy were the prominent elements found in OSAHS patient, and it was independently related to OSAHS. But there was no significant difference in tonsillar hypertrophy between the groups. Researchers have thought that using tonsil size only in diagnosis was limited, even the clear parent-reported history of habitual snoring was more valuable[15,16].\u003c/p\u003e\n\u003cp\u003eModerate-severe patients had higher frequency of rhinitis and/or nasosinusitis, which was obviously correlated with OSAHS. In our study, C-reaction protein was associated with OSAHS independently. Therefore, recurrent inflaming in upper airway must be treated effectively and in time and was considered to be related to OSAHS[17]. It may lead to a persistent systemic inflammatory response in the children. Inflammatory response is considered as an important pathophysiological process of OSAHS.\u003c/p\u003e\n\u003cp\u003eDaytime symptoms of OSAHS chilldren usually included difficulty concentrating, behavioral and emotional problems, morning headaches, excessive daytime sleepiness, and dysplasia[18]. In our study, sleepiness was the only factor found to be different between the groups. We may need to expand the data sources through asking teachers from preschool or school.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe common nocturnal symptoms of children with OSAHS include snoring, excessive sweating, restless sleep, mouth breathing, apnea, wheezing, dyspnea or abnormality, and excessive neck extension during sleep. We found that the symptoms of snoring, dyspnea, apnea, nocturia, and oppressive\u0026nbsp;wake were more discriminative. Increased\u0026nbsp;nocturia was an interesting symptom of OSAHS, especially the moderate-severe ones. Nocturia has been shown to be a complication of OSAHS in children. A meta-analysis found a strong correlation between OSAHS and nocturia, and significant improvement in nocturia symptoms was found in treated children[19,20]. Su et al. had found that the risk of nocturia in children with OSAHS was increased markedly[21]. In our data, we found that the increased\u0026nbsp;nocturia in moderate-severe OSAHS was particularly\u0026nbsp;evident among the patients over 5 years old. Pearson correlation analysis had shown that nocturnal urination was positively\u0026nbsp;correlated\u0026nbsp;with hypoxia. This reminds us to pay special attention to the symptoms of increased nocturia in snoring children over 5 years old. Cardiopulmonary and renal refex-induced neuroendocrine disorder may play an important role in the mechanism of night enuresis in children with OSAHS[22].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs we known, It was accepted that sleep architecture changed a lot in adult OSAHS patients. OSAHS initiates the sleep structure disorder, increase of shallow sleep, and decrease of deep sleep and REM sleep. For children, deep sleep is important for a variety of metabolic and endocrine processes, such as growth hormone secretion and other anabolic processes. Concludes of studies about OSAHS and sleep structure of children are inconsistent. Sun et al. found that the NREM3 sleep of school-age OSAHS patients was significantly reduced, and NREM1 sleep was prolonged[23]. In the study of durdik P et al., there were no significant differences in REM sleep, NREM2 sleep and sleep efficiency between the OSAHS and control group, but the NREM3 sleep of OSAHS children was significantly shorter, and the NREM1 sleep was significantly longer[24]. However, Goh DY found that children with\u0026nbsp;\u003cem\u003eOSA\u003c/em\u003e\u003cem\u003eH\u003c/em\u003e\u003cem\u003eS\u003c/em\u003e\u0026nbsp;have normal sleep stage distribution[25]. In our data, time ratio of NREM1 was elevated in Moderate-severe OSAHS patient, and REM was higher in mild OSAHS patients.\u003c/p\u003e\n\u003cp\u003eOSAHS in children is variable in different age groups. The school age group had significantly decreased proportion of NREM3 and REM, and increased AHI and ODI than the preschool one. It seems that the condition of elder children was much more serious, which is worthy of further exploring.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the limitation of sample size, no further analysis was made in different age. We will continue to collect cases.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe found that the median age of OSAHS in children was 5 (4, 7) years old. Compared with PS, snoring, dyspnea, apnea, oppressive\u0026nbsp;wake, nocturia and daytime sleepiness were more common in OSAHS children. The school-age OSAHS patients seems to more serious than the preschoolers. Sleep structure disorder was found more often in children with OSAHS aged from 7 to 12 years old, mainly including shortening in the stage of NREM3 and REM. Chileren with snoring, apnea, dyspnea, adenoid hypertrophy and high lever of CRP were more likely to be OSAHS patients. We hope to give clinicians better diagnosis basis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e We thank the children and their parents for participation in our study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u003c/strong\u003eThis study was supported by research grants from Natural Science Foundation of China (81573167) , the Key Scientific and Technological Social Development Projects of Jiangsu Province(No.BE2016676，No.BE2017657) , and the People's Livelihood Science and Technology Project of Soochow(No.SYS2019087).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e All data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability\u003c/strong\u003e N/A\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e Yuqing Wang and Xunwu Dou designed the study. Yanyu He and Xueyun Xu conducted and interpreted the statistical analysis and had the primary responsibility in the formation of the initial draft. All authors provided substantial contributions to the design of the work, or the acquisition, analysis, or interpretation of the data, revised the initial draft, approved the final manuscript, and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e The study protocol was approved by the Children\u0026rsquo;s Hospital Affiliated to Soochow University (Approval number: 2020CS038).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e N/A\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e N/A\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e The authors declare that they have no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTan HL, David G, Leila KG (2013) Obstructive sleep apnea in children: a critical update. 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Am J Respir Crit Care Med 162(2):682\u0026ndash;686. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1164/ajrccm.162.2.9908058\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Children, Clinical characteristics, OSAHS, Risk factors","lastPublishedDoi":"10.21203/rs.3.rs-375980/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-375980/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWe aim to analyze the clinical characteristics of obstructive sleep apnea hypopnea syndrome (OSAHS) in children. Polysomnography (PSG) and nasopharynx lateral film were performed, and clinical data were collected in 469 children who came to the outpatient department due to \"snoring during sleep with mouth opening breathing, hard breathing or suffocation\".\u003cstrong\u003e \u003c/strong\u003eAmong the enrolled children, 123 (22.6%) were diagnosed with OSAHS, with 70 were mild and 53 were moderate-severe. Percentage of adenoid hypertrophy was higher in OSAHS patients (\u003cem\u003ep \u003c/em\u003e\u0026lt;0.01), instead of tonsil enlargement. The OSAHS children were agged 5 (4, 7). Compared with PS, the percentage of snoring, apnea, dyspnea, increased\u0026nbsp;nocturia, and daytime sleepness were significsntly higher in moderate-severe patients (\u003cem\u003ep \u003c/em\u003e\u0026lt;0.01). In OSAHS groups, AHI, ODI, Longest time of apnea\u003cstrong\u003e \u003c/strong\u003ewere increased, while minimum SpO2 and mean SpO2 during sleep were decreased significantly (\u003cem\u003ep \u003c/em\u003e\u0026lt;0.01) than PS. Time ratio of NREM1 was elevated in moderate-severe OSAHS patients (\u003cem\u003ep \u003c/em\u003e\u0026lt;0.01). Time ratio of REM was elevated in mild patients(\u003cem\u003ep \u003c/em\u003e\u0026lt;0.01). Compared with the preschoolers, the percentage of leg movement and sleepness were significsntly higher in school-agers (\u003cem\u003ep \u003c/em\u003e\u0026lt;0.05). The youngers had higher time ratio of NREM3 and better sleep efficieny (p\u0026lt;0.01). However, AHI(p\u0026lt;0.05) and ODI(p\u0026lt;0.01) were higher in elder OSAHS significantly. Snoring (OR =5.745, p \u0026lt; 0.01), adenoid hypertrophy (OR =4.381, p \u0026lt; 0.01), apnea (OR =2.670, p \u0026lt; 0.001), dyspnea (OR =1.975, p \u0026lt; 0.01), and CRP (OR =1.172, p \u0026lt; 0.001) were independent risk factors for OSAHS.\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConclusion\u003c/em\u003e\u003c/strong\u003e AHI, ODI, Longest time of apnea,\u003cstrong\u003e \u003c/strong\u003eminimum SpO2 and mean SpO2 should be considered and analyzed simultaneously in diagnosis. The school-age OSAHS patients seems to more serious than the preschoolers. Snoring, apnea, dyspnea, adenoid hypertrophy, and CRP are risk factors for OSAHS.\u003c/p\u003e","manuscriptTitle":"Clinical Characteristics of Chinese Pediatric Obstructive Sleep Apnea Hypopnea Syndrome","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-04-14 21:41:28","doi":"10.21203/rs.3.rs-375980/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bfc1b912-6b14-4092-940b-b32a2ccb7e37","owner":[],"postedDate":"April 14th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":3643391,"name":"Pediatrics"}],"tags":[],"updatedAt":"2021-07-09T12:47:16+00:00","versionOfRecord":[],"versionCreatedAt":"2021-04-14 21:41:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-375980","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-375980","identity":"rs-375980","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}