| Apnea obstructiva del sueño en pediatría y el papel crítico del crecimiento orofacial: evidencias |
Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences.
Huang YS, Guilleminault C.
Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and University Taiwan, China.
Front Neurol. 2012;3:184. doi: 10.3389/fneur.2012.00184. Epub 2013 Jan 22.
Abstract
Aims: Review of evidence in support of an oral-facial growth impairment in the development of pediatric sleep apnea in non-obese children. Method: Review of experimental data from infant monkeys with experimentally induced nasal resistance. Review of early historical data in the orthodontic literature indicating the abnormal oral-facial development associated with mouth breathing and nasal resistance. Review of the progressive demonstration of sleep-disordered-breathing (SDB) in children who underwent incomplete treatment of OSA with adenotonsillectomy, and demonstration of abnormal oral-facial anatomy that must often be treated in order for the resolution of OSA. Review of data of long-term recurrence of OSA and indication of oral-facial myofunctional dysfunction in association with the recurrence of OSA. Results: Presentation of prospective data on premature infants and SDB-treated children, supporting the concept of oral-facial hypotonia. Presentation of evidence supporting hypotonia as a primary element in the development of oral-facial anatomic abnormalities leading to abnormal breathing during sleep. Continuous interaction between oral-facial muscle tone, maxillary-mandibular growth and development of SDB. Role of myofunctional reeducation with orthodontics and elimination of upper airway soft tissue in the treatment of non-obese SDB children. Conclusion: Pediatric OSA in non-obese children is a disorder of oral-facial
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551039/pdf/fneur-03-00184.pdf
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| Características específicas de los niños con apnea obstructiva del sueño y cor pulmonar |
The specific characteristics in children with obstructive sleep apnea and cor pulmonale.
Lee PC, Hwang B, Soong WJ, Meng CC.
Division of Pediatric Cardiology, Departments of Pediatrics, National Yang-Ming University and Taipei Veterans General Hospital, No 201 Sec 2, Shih-Pai Road, Taipei 112, Taiwan. pichang lee@yahoo.com
ScientificWorldJournal. 2012;2012:757283. doi: 10.1100/2012/757283. Epub 2012 May 3.
Abstract
BACKGROUND: The prevalence of obstructive sleep apnea (OSA) in the pediatric population is currently estimated at 1-2% of all children. The purpose of this study was to investigate the clinical and hemodynamic characteristics in pediatric patients with cor pulmonale and OSA. METHODS: Thirty children with the diagnosis of OSA were included. These patients consisted of 26 male and 4 female children with a mean age of 7 ± 4 years old. Five of those children were found to be associated with cor pulmonale, and 25 had OSA but without cor pulmonale. RESULTS: The arousal index was much higher in children with OSA and cor pulmonale. The children with OSA and cor pulmonale had much lower mean and minimal oxygen saturation and a higher incidence of bradycardia events. All 5 patients with OSA and cor pulmonale underwent an adenotonsillectomy, and the pulmonary arterial pressure dropped significantly after the surgery. CONCLUSION: This study demonstrated that the OSA pediatric patients with cor pulmonale had the different clinical manifestations and hemodynamic characteristics from those without cor pulmonale. The adenotonsillectomy had excellent results in both the OSA pediatric patients with and without cor pulmonale.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356724/pdf/TSWJ2012-757283.pdf
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| Manejo perioperatorio de los infantes con apnea obstructiva del sueño |
Perioperative management of children with obstructive sleep apnea.
Schwengel DA, Sterni LM, Tunkel DE, Heitmiller ES.
Johns Hopkins Medical Institutions, Johns Hopkins University School of Medicine, Department of Anesthesiology/Critical Care Medicine, 600 North Wolfe St., Blalock 1412, Baltimore, MD 21287-8711, USA.dschwen1@jhmi.edu
Anesth Analg. 2009 Jul;109(1):60-75.
doi: 10.1213/ane.0b013e3181a19e21.
Abstract
Obstructive sleep apnea syndrome (OSA) affects 1%-3% of children. Children with OSA can present for all types of surgical and diagnostic procedures requiring anesthesia, with adenotonsillectomy being the most common surgical treatment for OSA in the pediatric age group. Thus, it is imperative that the anesthesiologist be familiar with the potential anesthetic complications and immediate postoperative problems associated with OSA. The significant implications that the presence of OSA imposes on perioperative care have been recognized by national medical professional societies. The American Academy of Pediatrics published a clinical practice guideline for pediatric OSA in 2002, and cited an increased risk of anesthetic complications, though specific anesthetic issues were not addressed. In 2006, the American Society of Anesthesiologists published a practice guideline for perioperative management of patients with OSA that noted the pediatric-related risk factor of obesity, and the increased perioperative risk associated with adenotonsillectomy in children younger than 3 yr. However, management of OSA in children younger than 1 yr-of-age was excluded from the guideline, as were other issues related specifically to the pediatric patient. Hence, many questions remain regarding the perioperative care of the child with OSA. In this review, we examine the literature on pediatric OSA, discuss its pathophysiology, current treatment options, and recognized approaches to perioperative management of these young and potentially high-risk patients.
http://www.anesthesia-analgesia.org/content/109/1/60.full.pdf
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