Síndrome da apnéia e hipopnéia obstrutiva do sono em crianças: um estudo do perfil clínico e dos índices respiratórios polissonográficos

Submitted by Repositório Arca ([email protected]) on 2019-08-06T11:25:49Z No. of bitstreams: 1 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2019-08-07T17:25:30Z (GMT) No. of bitstreams: 2 Regina Terse Trindade Ramos Sindrome...2004.pdf: 51953927 bytes, checksum: 3617f7729320edafd75d670675b96399 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Made available in DSpace on 2019-08-07T17:25:30Z (GMT). No. of bitstreams: 2 Regina Terse Trindade Ramos Sindrome...2004.pdf: 51953927 bytes, checksum: 3617f7729320edafd75d670675b96399 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2004Escola Bahiana de Medicina e Saúde Pública. Salvador, Bahia, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil.A Síndrome da Apnéia e Hipopnéia Obstrutiva do Sono (SAHOS) vem sendo muito estudada em adultos; em crianças, entretanto, trata-se de uma condição séria que tem sido. subdiagnosticada, a despeito de uma prevalência estimada de 1-2 por cento. A SAHOS causa significativa morbidade e pode se associar a um pobre crescimento, alterações neurocognitivas e comportamentais além de complicações cardiovasculares. Sabe-se que a história clínica do paciente não é suficiente para estabelecer o diagnóstico definitivo de SAHOS, sendo a polissonografia durante toda a noite o método definitivo para estabelecimento do diagnóstico. Adenoidectomia e tonsilectomia são atualmente o tratamento fundamental da SAHOS na infância. Justifica-se este estudo pelo desconhecimento do problema na população de Salvador e pelá contribuição que possivelmente dará no sentido de facilitar o reconhecimento de SAHOS pelo pediatra e revisar os critérios para indicação de estudospolissonográficos com base nos dados locais. Descrever as características clínicas e dos índices respiratórios polissonográficos de uma população de crianças com SAHOS. DESENHO DO ESTUDO: série de casos. Foram estudadas 93 crianças entre 2 a 10 anos de idade com diagnóstico polissonográfico de SAHOS, encaminhadas aos laboratórios de sono do Hospital Português, no período de janeiro de 2002 a julho de 2003. Avaliou-se idade, gênero, raça, relação peso/altura, cefaléia matinal, ronco, sono agitado, respiração dificil ao dormir, obstrução nasal noturna, comportamento diurno, desempenho escolar, história familiar de ronco e tabagismo,doenças concomitantes, medicações em uso, enurese, índice de apnéia-hipopnéia, dessaturação da oxihemoglobina e índice de microdespertar. Os pacientes foram divididos em subgrupos de acordo com a faixa etária, avaliação nutricional e gravidade da SAHOS. 61,3 por cento das crianças eram do gênero masculino. A idade variou de 2 a 10 anos com média de 5,2 ± 2,1 anos. Dos pacientes estudados 76,3 por cento eram ré-escolares, 1 8,3 por cento escolares e 5,4 por cento eram adolescentes. 85 por cento da população era composta de mulatos e negros. As queixas que mais motivaram a realização do exame foram roncos em 24,7 por cento e sono inquieto em 24,7 por cento. As condições médicas associadas mais frequentemente relatadas foram rinite alérgica (98,9 por cento), hipertrofia de adenóides (50,6 por cento), a (33,4 por cento) e hipertrofia de amígdalas (31,3 por cento). Quanto ao peso encontramos 7,5 por cento dos eutróficos, 12,9 por cento com sobrepeso e 17,2 por cento obesos. O IAH variou de 1 a 34,6 eventos/hora de sono, sendo que 66% apresentavam apnéia leve, 14 por cento apnéia moderada e 5(VL grave. A saturação mínima de 02 variou de 79 por cento a 97 por cento com média de 89,06 ± 3,55 e o número de microdespertares variou de 0,1 a 47/hora com média de 8,4 ± 3,5 (mediana: 8,0).Baseando-se nos dados apresentados, as crianças do nosso estudo apresentaram na sua maioria SAHOS de leve intensidade com mínima dessaturação da oxihemoglobina. Os resultados chamam atenção para a suspeita clínica de SAHOS em crianças com doenças alérgicas e hipertrofia adenotonsilar, que apresentem queixas de ronco e sono inquieto.Obstaictive Sleep Apnea and Hypopnea Syndrome in Children (OSAHS) have being frequently studied in adults; however in children is a serious condition that has been underestimate and the prevalence is currently estimated at up to 2% of all children. OSAHS is a significant cause of morbidity and can be associated with poor growth, behavioural abnormalities neurocognitive impairment and cardiovascular complications. It’s know that patient’s clinical history isn’t enough to establish the final diagnosis of OSAHS and the polysomnography study all the night is the definitive diagnosis method. Adenotonsillectomy is the basic treatment for OSAHS in children. This study will collaborate to know this problem in Salvador and facilitate the pediatrician’s recognition of OSAHS besides to revise the polysomnographic’s criterions to realize this examination. OBJECTIVE: describe the clinical characteristics and the polysomnographic respiratory evaluations in children with OSAHS. STUDY DESIGN: cases serie. MATERIAL AND METHODS: 93 patients between 2 and 10-years-old with OSAHS polysomnographic diagnosis from the Sleep Laboratory of the Hospital Portugués, in Salvador - Bahia, had been studied in the period from January 2002 up to July 2003. We evaluated age, gender, race, weight/height, matinal headache, snoring, restless sleep, difficult breath when sleeping, nocturnal nasal blockage, daytime behaviour, school performance, familiar history of snoring and smoking, concomitant illnesses, medicines use, nocturnal enurese, apnea-hipopnea index (AHI), oxygen desaturations and microarousal index. Patients had been divided in sub-groups according to age, nutricional evaluation and OSAHS severity. RESULTS; 61,3% were male; age range was from 2 to 10-years-old, mean and SD 5,2 ± 2,1 years; 76,3%were preschool, 18,3% school age and 5,4% adolescent.The majority of population (85%/93) were composed by black and mulatto children. Complains that had more motivated the examination’s accomplishment had been snoring in 24,7% and restless sleep in 24,7%. Medical conditions that had been frequently told were allergic rhinitis (98,9%/93), adenoidal hypertrophy (50,6%/93), asthma (33,4/93), tonsil hypertrophy (31,3%/93). According to nutricional assessment, 7,5% were bad-nourished, 62,4% well-nourished, 12,9% over-weight and 17,2%obeses. AIH mean was 3,6 ± 5,1 events/sleep hour, range 1-34,6 events/sleep hour; 66% had mild OSAHS, 14% moderate OSAHS and 5% severe OSAHS. The oxygen saturation nadir values were 89,1 ±3,6, range 79%-97%. Microarousal index mean was 8,4 ± 3,5 (medium: 8,0) and range 0,1-47/microarousal sleep hour. CONCLUSION; Based on these data children had presented in their majority mild OSAHS and minimum oxygen desaturation. The results call attention for OSAHS clinical suspicion in children with allergic diseases, adenoidal and tonsil hypertrophy that present snoring and resteless sleep complains

Association between morphometric variables and nocturnal desaturation in sickle-cell anemia

OBJECTIVE: to evaluate associations between morphometric variables, cervical circumference (CC), and abdominal circumference (AC) with the presence of nocturnal desaturation in children and adolescents with sickle-cell anemia. METHODS: all patients were submitted to baseline polysomnography, oral cavity measurements (maxillary intermolar distance, mandibular intermolar distance, and overjet), and CC and AC measurements. RESULTS: a total of 85 patients were evaluated. A positive correlation was observed between the height/age Z-score and CC measurement (r = 0.233, p = 0.031). The presence of nocturnal desaturation was associated with CC (59.2± 9.3 vs. 67.5 ± 10.7, p = 0.006) and AC measurements (27.0 ± 2.0 vs. 29.0± 2.1, p = 0.028). There was a negative correlation between desaturation and maxillary intermolar distance (r = -0.365, p = 0.001) and mandibular intermolar distance (r = -0.233, p = 0.037). CONCLUSIONS: the morphometric variables of CC and AC may contribute to raise suspicion of nocturnal desaturation in children and adolescents with sickle-cell anemia

Obstructive sleep apnea and asthma

Symptoms of sleep-disordered breathing, especially obstructive sleep apnea syndrome (OSAS), are common in asthma patients and have been associated with asthma severity. It is known that asthma symptoms tend to be more severe at night and that asthma-related deaths are most likely to occur during the night or early morning. Nocturnal symptoms occur in 60-74% of asthma patients and are markers of inadequate control of the disease. Various pathophysiological mechanisms are related to the worsening of asthma symptoms, OSAS being one of the most important factors. In patients with asthma, OSAS should be investigated whenever there is inadequate control of symptoms of nocturnal asthma despite the treatment recommended by guidelines having been administered. There is evidence in the literature that the use of continuous positive airway pressure contributes to asthma control in asthma patients with obstructive sleep apnea and uncontrolled asthma

Association between severe asthma and changes in the stomatognathic system

ABSTRACT Objective: To describe orofacial muscle function in patients with severe asthma. Methods: This was a descriptive study comparing patients with severe controlled asthma (SCA) and severe uncontrolled asthma (SUA). We selected 160 patients, who completed a sociodemographic questionnaire and the 6-item Asthma Control Questionnaire (ACQ-6), as well as undergoing evaluation of orofacial muscle function. Results: Of the 160 patients evaluated, 126 (78.8%) and 34 (21.2%) presented with SCA and SUA, respectively, as defined by the Global Initiative for Asthma criteria. Regardless of the level of asthma control, the most frequent changes found after evaluation of muscle function were difficulty in chewing, oronasal breathing pattern, below-average or poor dental arch condition, and difficulty in swallowing. When the sample was stratified by FEV1 (% of predicted), was significantly higher proportions of SUA group patients, compared with SCA group patients, showed habitual open-mouth chewing (24.8% vs. 7.7%; p < 0.02), difficulty in swallowing water (33.7% vs. 17.3%; p < 0.04), and voice problems (81.2% vs. 51.9%; p < 0.01). When the sample was stratified by ACQ-6 score, the proportion of patients showing difficulty in swallowing bread was significantly higher in the SUA group than in the SCA group (66.6% vs. 26.6%; p < 0.01). Conclusions: The prevalence of changes in the stomatognathic system appears to be high among adults with severe asthma, regardless of the level of asthma control. We found that some such changes were significantly more common in patients with SUA than in those with SCA