Başgül Elif, Celiker Varol, Gözaçan Ahmet
Department of Anesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Turk J Pediatr. 2005 Oct-Dec;47(4):348-58.
Sleep-related breathing disorders require special attention in children who spend a considerable time sleeping. Obstructive sleep apnea syndrome is characterized by episodes of upper airway obstruction during sleep. Symptoms include hyperactivity, enuresis, headache, failure to thrive, and increased respiratory effort and total sleep time. The most common cause is adenotonsillar hypertrophy. Coexisting diseases are obesity, neuromuscular and craniofacial anomalies, and Down's syndrome. Early diagnosis is important to minimize neurocognitive, cardiac and developmental complications. Polysomnography is the gold standard for diagnosis. Although the features of pediatric obstructive sleep apnea syndrome are distinctly different from that in adults, it may predispose to the adult type of the syndrome. As therapy concerns several surgical approaches as well as conservative techniques, anesthetic management calls for particular attention. Pre- and postoperative sedation must be performed cautiously and patients must be watched closely with respect to airway obstruction and hypoventilation. Difficult intubation must always be considered.
睡眠相关呼吸障碍在睡眠时间较长的儿童中需要特别关注。阻塞性睡眠呼吸暂停综合征的特征是睡眠期间上呼吸道阻塞发作。症状包括多动、遗尿、头痛、生长发育迟缓、呼吸努力增加和总睡眠时间增加。最常见的原因是腺样体扁桃体肥大。共存疾病有肥胖、神经肌肉和颅面畸形以及唐氏综合征。早期诊断对于将神经认知、心脏和发育并发症降至最低很重要。多导睡眠图是诊断的金标准。尽管小儿阻塞性睡眠呼吸暂停综合征的特征与成人明显不同，但它可能易患成人型综合征。由于治疗涉及多种手术方法以及保守技术，麻醉管理需要特别注意。术前和术后镇静必须谨慎进行，并且必须密切观察患者是否存在气道阻塞和通气不足。必须始终考虑困难插管情况。
