DISTURBIOS RESPIRATORIOS DO SONO NA CRIANÇA





DISTURBIOS RESPIRATORIOS DO SONO NA CRIANÇA

(especial para SIIC © Derechos reservados)
Atualização no diagnóstico e tratamento da apnéia obstrutiva do sono na criança
balbani9.jpg Autor:
Aracy Pereira Silveira Balbani
Columnista Experto de SIIC

Institución:
Faculdade de Medicina de Botucatu (UNESP)


Artículos publicados por Aracy Pereira Silveira Balbani
Aprobación
7 de Septiembre, 2006
Primera edición
6 de Septiembre, 2007
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
Crianças podem apresentar vários distúrbios respiratórios durante o sono: ronco primário, apnéia, hipopnéia e síndrome da resistência das vias aéreas superiores. A prevalência de distúrbios respiratórios do sono em crianças é de 0.7%-9%, com pico de incidência nos pré-escolares. Fatores anatômicos (obstrução nasal severa, más-formações craniofaciais, hipertrofia do tecido linfático da faringe, anomalias laríngeas, etc.) e funcionais (doenças neuromusculares) predispõem à síndrome da apnéia obstrutiva do sono (SAOS) na infância. A principal causa da SAOS em crianças é a hipertrofia adenotonsilar. As manifestações clínicas mais comuns são: ronco noturno, pausas respiratórias, sono agitado e respiração bucal. A oximetria de pulso noturna e a polissonografia breve diurna são métodos úteis para triagem dos casos suspeitos de SAOS em crianças, e o padrão-ouro para diagnóstico é a polissonografia em laboratório de sono durante uma noite inteira. Ao contrário dos adultos com SAOS, as crianças costumam apresentar: menos despertares associados aos eventos de apnéia, maior número de apnéias/hipopnéias durante o sono REM e dessaturação mais acentuada da oxihemoglobina mesmo nas apnéias de curta duração. O tratamento da SAOS pode ser cirúrgico (adenotonsilectomia, correção de anomalias craniofaciais, traqueostomia) ou clínico (higiene do sono, pressão positiva contínua nas vias aéreas - CPAP).

Palabras clave
Criança, apnéia do sono tipo obstrutiva, ronco, educação médica


Artículo completo

(castellano)
Extensión:  +/-6.21 páginas impresas en papel A4
Exclusivo para suscriptores/assinantes

Abstract
Children may suffer several breathing disorders during sleep: primary snoring, apnea, hypopnea and upper airway resistance syndrome. The prevalence of sleep disordered breathing in children is 0.7-9%, with peak incidence in pre-schoolers. It is characterised by partial or complete upper airway obstruction during sleep, causing intermittent hypoxia. Both anatomical (severe nasal obstruction, craniofacial anomalies, hypertrophy of the pharyngeal lymphoid tissue, laryngeal anomalies, etc.) and functional factors (neuromuscular diseases) predispose to obstructive sleep apnea syndrome (OSAS) during childhood. The main cause of OSAS in children is adenotonsillar hypertrophy. The most common clinical manifestations of OSAS are: nocturnal snoring, respiratory pauses, restless sleep and mouth breathing. Nocturnal pulse oximetry and nap polysomnography are useful tools for screening suspected cases of OSAS in children, and the gold-standard for diagnosis is overnight polysomnography in the sleep laboratory. On the contrary of SAOS adults, children usually present: less arousals associated to apnea events, more numerous apneas/hypopneas during REM sleep, and more significant oxihemoglobin dessaturation even in short apneas. The treatment of OSAS may be surgical (adenotonsillectomy, craniofacial abnormalities correction, tracheostomy) or clinical (sleep hygiene, continuous positive airway pressure - CPAP).

Key words
Child, obstructive sleep apnea, snoring, medical education


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Pediatría
Relacionadas: Atención Primaria, Medicina Familiar, Neumonología, Neurología, Otorrinolaringología



Comprar este artículo
Extensión: 6.21 páginas impresas en papel A4

file05.gif (1491 bytes) Artículos seleccionados para su compra



Enviar correspondencia a:
Aracy Pereira Silveira Balbani, Disciplina de Otorrinolaringologia e Cirugia de Cabeça e Pescoço, Faculdade de Medicina de Botucatu (UNESP), 18270-070, Rua Capitão Lisboa, 715, cj. 33, Tatuí, Brasil
Bibliografía del artículo
1. Anstead M. Pediatric sleep disorders: new developments and evolving understanding. Curr Opin Pulm Med 2000; 6:501-6.
2. Marcus CL, Omlin KJ, Basinki DJ et al. Normal polysomnographic values for children and adolescents. Am Rev Respir Dis 1992; 146:1235-9.
3. Marcus CL. Sleep-disordered breathing in children. Am J Respir Crit Care Med 2001; 164:16-30.
4. Schechter MS. Technical report: diagnosis and management of childhood obstructive sleep apnea. Pediatrics 2002; 109:e69.
5. Brunetti L, Rana S, Lospalluti Ml et al. Prevalence of obstructive sleep apnea in a cohort of 1207 children of Southern Italy. Chest 2001; 120:1930-5.
6. Bower C, Buckmiller L. What's new in pediatric obstructive sleep apnea. Curr Opin Otolaryngol Head Neck Surg 2001; 9:352-8.
7. Sterni LM, Tunkel DE. Obstructive sleep apnea in children - an update. Pediatr Clin N Am 2003; 50:427-43.
8. Amin RS, Kimball TR, Bean JA et al. Left ventricular hypertrophy and abnormal geometry in children and adolescents with obstructive sleep apnea. Am J Respir Crit Care Med 2002; 165:1395-9.
9. Lipton AJ, Gozal D. Treatment of obstructive sleep apnea in children: do we really know how? Sleep Med Rev 2003; 7:61-80.
10. Nieminen P, Löppönen T, Tolonen U, Lanning P, Knip M, Löppönen H. Growth and biochemical markers of growth in children with snoring and obstructive sleep apnea. Pediatrics 2002; 109:e55.
11. Owens JA. The practice of pediatric sleep medicine: results of a community survey. Pediatrics 2001; 108:e51.
12. Chervin RD, Archbold KH, Panahi P, Pituch KJ. Sleep problems seldom addressed at two general Pediatric clinics. Pediatrics 2001; 107:1375-80.
13. Balbani APS, Weber SAT, Montovani JC, Carvalho LR. Pediatras e os distúrbios respiratórios do sono na criança Rev Assoc Med Bras 2005; 51:80-6.
14. Görür K, Döven O, Ünal M, Akkus N, Özcan C. Preoperative and postoperative cardiac and clinical findings of patients with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2001; 59:41-6.
15. Marcus CL, Greene MG, Carroll JL. Blood pressure in children with obstructive sleep apnea. Am J Respir Crit Care Med 1998; 157:1098-103.
16. Sánchez Armengol A, Rodríguez Puras MJ, Fuentes Pradera MA et al. Echocardiographic parameters in adolescents with sleep-related breathing disorders. Pediatr Pulmonol 2003; 36:27-33.
17. Kalra M, Kimball TR, Daniels SR M et al. Structural cardiac changes as a predictor of respiratory complications after adenotonsillectomy for obstructive breathing during sleep. Sleep Med 2005; 6:241-5.
18. De la Eva RC, Baur LA, Donaghue KC, Waters KA. Metabolic correlates with obstructive sleep apnea in obese subjects. J Pediatr 2002; 140:654-9.
19. Gozal D, Wang M, Pope Jr. DW. Objective sleepiness measures in pediatric obstructive sleep apnea. Pediatrics 2001; 108:693-7.
20. Blunden S, Lushington K, Kennedy D, Martin J, Dawson D. Behavior and neurocognitive performance in children aged 5-10 years who snore compared to controls. J Clin Exp Neuropsychol 2000; 22:554-68.
21. Gozal D. Sleep-disordered breathing and school performance in children. Pediatrics 1998; 102:616-20.
22. Chervin RD, Dillon JE, Archbold KH, Ruzicka DH. Conduct problems and symptoms of sleep disorders in children. Am Acad Child Adolesc Psychiatry 2003; 42:201-8.
23. O'Brien LM, Holbrook CR, Mervis CB et al. Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder. Pediatrics 2003; 111:554-63.
24. American Academy of Pediatrics. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002; 109:704-12.
25. Li AM, Wong E, Kew J, Hui S, Fok TF. Use of tonsil size in evaluation of obstructive sleep apnoea. Arch Dis Child 2002; 87:156-9.
26. Caulfield H. Investigations in pediatric obstructive sleep apnoea: do we need them? Int J Pediatr Otorhinolaryngol 2003; 67S1:S107-10.
27. Kelly A, Marcus CL. Childhood obesity, inflammation and apnea. Am J Respir Crit Care Med 2005; 171:202-3.
28. Katz ES, Greene MG, Carson KA et al. Night-to-night variability of polysomnography in children with suspected obstructive sleep apnea. J Pediatr 2002; 140:589-94.
29. Scholle S, Scholle H-C, Kemper A et al. First night effect in children and adolescents undergoing polysomnography for sleep-disordered breathing. Clin Neurophysiol 2003; 114:2138-45.
30. American Thoracic Society. Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 1996; 153:866-78.
31. Marcus CL. Pathophysiology of childhood obstructive sleep apnea: current concepts. Respir Physiol 2000; 119:143-54.
32. Goh DYT, Galster P, Marcus CL. Sleep architecture and respiratory disturbances in children with obstructive sleep apnea. Am J Respir Crit Care Med 2000; 162:682-6.
33. American Thoracic Society. Cardiorespiratory sleep studies in children: establishment of normative data and polysomnographic predictors of morbidity. Am J Respir Crit Care Med 1999; 160:1381-7.
34. Harvey JMM, O'Callaghan MJ, Wales PD, Harris MA, Masters IB. Aetiological factors and development in subjects with obstructive sleep apnea. J Paediatr Child Health 1999; 35:140-4.
35. Newman JP, Clerk AA, Moore M, Utley DS, Terris DJ. Recognition and surgical management of the Upper Airway Resistance Syndrome. Laryngoscope 1996; 106:1089-93.
36. Goodwin JL, Enright PL, Kaemingk KL, Rosen GM, Morgan WJ, Fregosi RF et al. Feasability of using unattended polysomnography in children for research - report of the Tucson Children's Assessment of Sleep Apnea Study (TuCASA). Sleep 2001; 24:937-44.
37. Brouillette RT, Morielli A, Leimanis A, Waters KA, Luciano R, Ducharme F. Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Pediatrics 2000; 105:405-12.
38. Finkelstein Y, Wexler D, Berger G, Nachmany A, Shapiro-Feinberg M, Ophir D. Anatomical basis of sleep-disordered breathing abnormalities in children with nasal obstruction. Arch Otolaryngol Head Neck Surg 2000; 126:593-600.
39. Monahan KJ, Larkin EK, Rosen CL, Graham G, Redline S. Utility of nonivasive pharyngometry in epidemiologic studies of childhood sleep-disordered breathing. Am J Respir Crit Care Med 2002; 165:1499-503.
40. James D, Lian M. Mandibular reconstruction in children with obstructive sleep apnea due to micrognatia. Plas Reconst Surg 1997; 100:1131-7.
41. Linen LH, Marcus CL. Ventilatory management of sleep-disordered breathing in children. Curr Opin Pediatrics 2006; 18:272-6.

 
 
 
 
 
 
 
 
 
 
 
 
Está expresamente prohibida la redistribución y la redifusión de todo o parte de los contenidos de la Sociedad Iberoamericana de Información Científica (SIIC) S.A. sin previo y expreso consentimiento de SIIC.
ua31618