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

Associação entre hipertrofia adenotonsilar, tonsilites e crises álgicas na anemia falciforme Association between adenotonsillar hypertrophy, tonsillitis and painful crises in sickle cell disease

OBJETIVOS: Determinar a prevalência da hipertrofia adenotonsilar obstrutiva em crianças e adolescentes portadores de anemia falciforme; investigar possível associação entre presença de mais de cinco episódios de tonsilite nos últimos 12 meses e episódios de crise álgica no mesmo período; e comparar a hemoglobina anual média entre os que apresentam e os que não apresentam hipertrofia adenotonsilar obstrutiva. MÉTODOS: Trata-se de estudo prospectivo, observacional do tipo corte transversal, com 85 crianças e adolescentes com anemia falciforme. Todos responderam questionário e avaliação otorrinolaringológica, incluindo endoscopia nasossinusal. Para o diagnóstico da hipertrofia adenotonsilar obstrutiva foram adotados os critérios de Brodsky. RESULTADOS: A prevalência da hipertrofia adenotonsilar obstrutiva foi de 55,3%. A hipertrofia adenotonsilar obstrutiva associou-se à história de dificuldade para alimentar-se (76,7 versus 23,5%; p = 0,003), presença de mais de cinco episódios de tonsilites nos últimos 12 meses (70,6 versus 29,4%; p = 0,021), roncar alto (73,0 versus 27,0%; p = 0,004) e apneia do sono assistida (71,8 versus 28,2%; p = 0,005). Portadores de hipertrofia adenotonsilar obstrutiva apresentaram maior número de infecções das vias aéreas superiores (62,5 versus 37,5; p = 0,010). Também foi observada associação entre presença de mais de cinco episódios de tonsilite nos últimos 12 meses e episódios de crise álgica no mesmo período (mediana = 12 versus 2; p = 0,017). Não houve diferença significante da hemoglobina anual média entre portadores de hipertrofia adenotonsilar obstrutiva versus hipertrofia adenotonsilar não-obstrutiva (7,6 versus 8,2 g/dL; p = 0,199). CONCLUSÃO: A prevalência da hipertrofia adenotonsilar obstrutiva foi de 55,3% em crianças e adolescentes com anemia falciforme. A presença de mais de cinco episódios de tonsilite nos últimos 12 meses associaram-se com episódios de crise álgica no mesmo período; e não houve diferença quanto ao valor da hemoglobina anual média entre os que apresentaram e os que não apresentaram hipertrofia adenotonsilar obstrutiva.<br>OBJECTIVES: To determine the prevalence of obstructive adenotonsillar hypertrophy in children and adolescents with sickle cell anemia; to investigate possible association between the presence of more than five episodes of tonsillitis in the last 12 months and episodes of painful crises in the same period; and to compare the mean annual hemoglobin level in children and adolescents with and without obstructive adenotonsillar hypertrophy. METHODS: Prospective, observational, cross-sectional study involving 85 children and adolescents with sickle cell anemia. All patients answered a questionnaire and underwent a standard otolaryngology examination, including endoscopic endonasal approach. The diagnosis of obstructive adenotonsillar hypertrophy was made according to the Brodsky scale. RESULTS: The prevalence of obstructive adenotonsillar hypertrophy was 55.3%. Obstructive adenotonsillar hypertrophy was associated with history of difficulty in eating (76.7 vs. 23.5%, p = 0.003), presence of more than five episodes of tonsillitis in the last 12 months (70.6 vs. 29.4%, p = 0.021), loud snoring (73.0 vs. 27.0%, p = 0.004), and sleep apnea (71.8 vs. 28.2%, p = 0.005). Patients with obstructive adenotonsillar hypertrophy had more episodes of recurrent upper airway tract infection (62.5 vs. 37.5; p = 0.010). The presence of more than five episodes of tonsillitis in the last 12 months was associated with episodes of painful crises (median = 12 vs. 2, p = 0.017). There was no significant difference between mean annual hemoglobin levels of patients with obstructive adenotonsilar hypertrophy vs. nonobstructive adenotonsillar hypertrophy: 7.6 vs. 8.2 g/dL, p = 0.199. CONCLUSION: The prevalence of obstructive adenotonsillar hypertrophy was 55.3% in children and adolescents with sickle cell anemia; the presence of more than five episodes of tonsillitis in the last 12 months was associated with episodes of painful crises in the same period; and there was no difference in the mean annual hemoglobin value among those with or without obstructive adenotonsillar hypertrophy

Treatment of latent tuberculosis in patients with juvenile rheumatic diseases: a systematic review

ABSTRACT Introduction: Children and adolescents with rheumatic diseases receiving TNF blockers are at risk for the activation of latent Mycobacterium tuberculosis infection (LTBI). Although LTBI treatment is indicated in this group, there are different therapeutic regimens in the literature, without a definite consensus. Objectives: To review in the literature therapeutic schemes used and indicated for the treatment of LTBI in these patients. Methods: Systematic review of the literature, using health databases, selecting studies that addressed the treatment of LTBI in patients with juvenile rheumatic diseases using TNF blockers, from 1990 to 2015. All study designs were considered. Results: A total of 162 studies were identified through the electronic databases and one was found through a manual search by the author, totaling 163 articles. We excluded studies that did not meet the mentioned inclusion criteria, and included a retrospective cohort study and two prospective cohort studies. The three studies addressed treatment with isoniazid (INH) for 9 months and one of them also addressed INH treatment associated with rifampicin for 3 months. Conclusions: Only one case of LTBI activation was observed; there was good treatment adherence and absence of complications during follow-up. More studies are necessary to evaluate the response to the other available therapeutic regimens, with better tolerability assessment and a larger sample. However, the results showed that INH therapy for 9 months and INH therapy plus rifampicin for 3 months had a low rate of LTBI activation and complications