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Vol. 43. Issue 12.
Pages 655-661 (January 2007)
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Vol. 43. Issue 12.
Pages 655-661 (January 2007)
ORIGINAL ARTICLES
DOI: 10.1016/S1579-2129(07)60151-7
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Sleep Apnea-Hypopnea Syndrome in a Pediatric Population: Differences Between Children With Tonsillar Hypertrophy and Those With Concomitant Disease
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Mónica Llombart
Corresponding author
llombart_mon@gva.es

Correspondence: Dra. M. Llombart. Sección de Neumología. Hospital Universitari Sant Joan d'Alacant. Ctra. Alicante-Valencia, s/n. 03550 San Juan de Alicante. Alicante. Espa ña.
, Eusebi Chiner, Elia Gómez-Merino, Ada Andreu, Esther Pastor, Cristina Senent, Ana Camarasa, Jaime Signes-Costa
Unidad de Trastornos de Sueño, Sección de Neumología, Hospital Universitari Sant Joan d'Alacant, San Juan de Alicante, Alicante. Spain
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OBJECTIVE

Our aim was to compare clinical and polysomnographic variables in pediatric patients with sleep apnea-hypopnea syndrome (SAHS) secondary to tonsillar hypertrophy with those in patients with concomitant disease.

PATIENTS AND METHODS

We studied 42 children with SAHS (mean [SD] age, 8 [4] years; body mass index [BMI], 19.6 [5.2] kg/m2; neck circumference, 29 [4] cm; and BMI percentile, 67 [36]), 26 of whom were otherwise healthy (group A) and 16 of whom had concomitant disease (group B).

RESULTS

A comparison of groups A and B showed no significant differences in age (7.7 [3.9] years vs 8.4 [3.9] years; P=not significant [NS]); sex, BMI (17.6 [4] kg/m2 vs 20.4 [6] kg/m2; P=NS), neck circumference (29.3 [4.7] cm vs 30.7 [3.5] cm; P=NS), or BMI percentile (61 [37] vs 76 [34]; P=NS). Tonsillar hypertrophy was more frequent in group A (P=.02) and craniofacial abnormalities (P=.008), macroglossia (P=.04), and dolichocephalia (P=.04) were more frequent in group B. No significant differences were observed in neurophysiologic variables or in the respiratory disturbance index, although group A presented higher oxygen saturation levels (97 [1.7] vs 95 [2]; P<.007), lower oxygen desaturation index scores (7 [7] vs 15 [10]; P=.007), and a lower cumulative percentage of time with oxygen saturation lower than 90% (2.2 [4] vs 16.4 [4]; P=.01). Twenty-three patients (88.5%) in group A underwent tonsillectomies compared to 7 (44%) patients in group B (P=.003). Seven patients (44%) in group B were treated with continuous positive airway pressure (CPAP) and 2 patients were treated with bilevel positive airway pressure (BiPAP), compared to 1 patient (3.8%) treated with CPAP in group A (P=.003). Three children in group B underwent maxillary surgery. The evolution of clinical and polygraphic variables was more favorable in group A (P=.04).

CONCLUSIONS

Children with SAHS suffer from repeated infections, delayed weight gain, hyperactivity, and neuropsychiatric manifestations. Obesity (associated with concomitant disease) and sleepiness are uncommon. Although most patients require surgery, as many as a third require treatment with CPAP or BiPAP. Furthermore, children with SAHS and concomitant disease show no specific clinical characteristics, although they tend to be more obese, have more craniofacial abnormalities, and greater nocturnal hypoventilation.

Key words:
Sleep apnea-hypopnea syndrome
Children
SAHS
Diagnosis
Treatment
OBJETIVO

Comparar la expresión clínica y polisomnográfica del síndrome de apneas-hipopneas durante el sueño (SAHS) en niños con hipertrofia amigdalar y enfermedad concomitante.

PACIENTES Y MÉTODOS

Se estudió a 42 niños con SAHS -con una edad media (± desviación estándar) de 8 ± 4 años, índice de masa corporal (IMC) de 19,6 ± 5,2 kg/m2, cuello de 29 ± 4 cm y percentil de IMC de 67 ± 36-, 26 sanos (grupo A) y 16 con enfermedad concomitante (grupo B).

RESULTADOS

Al comparar los grupos A y B no se observa-ron diferencias en la edad (7,7 ± 3,9 frente a 8,4 ± 3,9 años; p = no significativa [NS]), el sexo, el IMC (17,6 ± 4 frente a 20,4 ± 6 kg/m2; p = NS), el perímetro del cuello (29,3 ± 4,7 frente a 30,7 ± 3,5 cm; p = NS) ni el percentil de IMC (61 ± 37 frente a 76 ± 34; p = NS). En el grupo A fue más frecuente la hipertrofia amigdalar (p = 0,02), y en B, las alteraciones del macizo facial (p = 0,008), macroglosia (p = 0,04) y dolico-cefalia (p = 0,04). No se observaron diferencias en las varia-bles neurofisiológicas ni en el índice de alteración respirato-ria, aunque el grupo A presentó mayor saturación de oxígeno basal (97 ± 1,7 frente a 95 ± 2%; p < 0,007), menor índice de desaturaciones/h (7 ± 7 frente a 15 ± 10; p = 0,007) y menor porcentaje de tiempo de sueño con saturación de oxihemoglobina inferior al 90% (2,2 ± 4 frente a 16,4 ± 4; p = 0,01). Fueron tratados con amigdalectomía 23 pacientes del grupo A (88,5%) frente a 7 (44%) del B (p = 0,003). En el grupo B, 7 pacientes recibieron tratamiento con presión posi-tiva continua de la vía aérea (44%) y 2 con BiPAP®, frente a uno (3,8%) en el grupo A (p = 0,003). Se realizó cirugía ma-xilar a 3 niños del grupo B. La evolución clínica y poligráfica fue más favorable en el grupo A (p = 0,04).

CONCLUSIONES

Los niños con SAHS cursan con infec-ciones de repetición, retraso ponderal, hiperactividad y manifestaciones neuropsíquicas, mientras que son poco fre-cuentes la somnolencia y la obesidad, la cual se asocia a en-fermedad concomitante. Aunque la mayoría necesitará ciru-gía, hasta un tercio precisará tratamiento con presión positiva continua de la vía aérea/BiPAP®. Además, los niños con SAHS y enfermedad concomitante no muestran caracte-rísticas especiales en su expresión clínica, aunque tienden a ser más obesos, con mayores alteraciones del macizo facial y mayor hipoventilación nocturna.

Palabras clave:
Síndrome de apneas-hipopneas durante el sueño
Niños
SAHS infantil
Diagnóstico
Tratamiento
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