Guilleminault Christian, Lee Ji Hyun, Chan Allison
Stanford University Sleep Disorders Program, Stanford, CA 94305, USA.
Arch Pediatr Adolesc Med. 2005 Aug;159(8):775-85. doi: 10.1001/archpedi.159.8.775.
To review evidence-based knowledge of pediatric obstructive sleep apnea syndrome (OSAS).
We reviewed published articles regarding pediatric OSAS; extracted the clinical symptoms, syndromes, polysomnographic findings and variables, and treatment options, and reviewed the authors' recommendations.
Orthodontic and craniofacial abnormalities related to pediatric OSAS are commonly ignored, despite their impact on public health. One area of controversy involves the use of a respiratory disturbance index to define various abnormalities, but apneas and hypopneas are not the only abnormalities obtained on polysomnograms, which can be diagnostic for sleep-disordered breathing. Adenotonsillectomy is often considered the treatment of choice for pediatric OSAS. However, many clinicians may not discern which patient population is most appropriate for this type of intervention; the isolated finding of small tonsils is not sufficient to rule out the need for surgery. Nasal continuous positive airway pressure can be an effective treatment option, but it entails cooperation and training of the child and the family. A valid but often overlooked alternative, orthodontic treatment, may complement adenotonsillectomy.
Many complaints and syndromes are associated with pediatric OSAS. This diagnosis should be considered in patients who report the presence of such symptoms and syndromes.
回顾小儿阻塞性睡眠呼吸暂停综合征（OSAS）的循证医学知识。
我们查阅了已发表的关于小儿OSAS的文章；提取了临床症状、综合征、多导睡眠图结果及变量，以及治疗方案，并审视了作者的建议。
尽管小儿OSAS相关的正畸和颅面异常对公众健康有影响，但通常被忽视。一个存在争议的领域涉及使用呼吸紊乱指数来定义各种异常情况，然而呼吸暂停和低通气并非多导睡眠图上唯一的异常情况，这些异常情况可用于诊断睡眠呼吸障碍。腺样体扁桃体切除术常被视为小儿OSAS的首选治疗方法。然而，许多临床医生可能无法辨别哪类患者群体最适合这种干预措施；仅发现扁桃体小不足以排除手术的必要性。鼻持续气道正压通气可能是一种有效的治疗选择，但这需要患儿及其家庭的配合与训练。正畸治疗作为一种有效但常被忽视的替代方法，可作为腺样体扁桃体切除术的补充。
许多主诉和综合征与小儿OSAS相关。对于报告有此类症状和综合征的患者，应考虑作出这一诊断。
