Balbani Aracy P S, Weber Silke A T, Montovani Jair C
Medical School of Botucatu, UNESP.
Braz J Otorhinolaryngol. 2005 Jan-Feb;71(1):74-80. doi: 10.1016/s1808-8694(15)31288-x. Epub 2006 Jan 2.
The prevalence of OSAS in children is 0.7-3%, with peak incidence in pre-schoolers. It is characterised by partial or complete upper airway obstruction during sleep, causing intermittent hypoxia. Both anatomical (severe nasal obstruction, craniofacial anomalies, hypertrophy of the pharyngeal lymphoid tissue, laryngeal anomalies, etc.) and functional factors (neuromuscular diseases) predispose to OSAS during childhood. The main cause of OSAS in children in adenotonsillar hypertrophy. The most common clinical manifestations of OSAS are: nocturnal snoring, respiratory pauses, restless sleep and mouth breathing. Nocturnal pulse oximetry, nocturnal noise audio/videotape recording and nap polysomnography are useful tools for screening suspected cases of OSAS in children, and the gold-standard for diagnosis is overnight polysomnography in the sleep laboratory. On the contrary of SAOS adults, children usually present: less arousals associated to apnea events, more numerous apneas/hypopneas during REM sleep, and more significant oxyhemoglobin desaturation even in short apneas. The treatment of OSAS may be surgical (adenotonsillectomy, craniofacial abnormalities correction, tracheostomy) or clinical (sleep hygiene, continuous positive airway pressure--CPAP).
儿童阻塞性睡眠呼吸暂停低通气综合征（OSAS）的患病率为0.7%-3%，在学龄前儿童中发病率最高。其特征是睡眠期间上呼吸道部分或完全阻塞，导致间歇性缺氧。解剖学因素（严重鼻塞、颅面畸形、咽淋巴组织肥大、喉部畸形等）和功能因素（神经肌肉疾病）均易导致儿童期发生OSAS。儿童OSAS的主要病因是腺样体扁桃体肥大。OSAS最常见的临床表现为：夜间打鼾、呼吸暂停、睡眠不安和张口呼吸。夜间脉搏血氧饱和度测定、夜间噪音音频/视频记录和午睡多导睡眠图是筛查儿童疑似OSAS病例的有用工具，诊断的金标准是在睡眠实验室进行整夜多导睡眠图检查。与成人睡眠呼吸暂停低通气综合征（SAOS）相反，儿童通常表现为：与呼吸暂停事件相关的觉醒较少、快速眼动（REM）睡眠期间呼吸暂停/低通气更多，以及即使在短暂呼吸暂停时氧合血红蛋白饱和度下降也更显著。OSAS的治疗方法可以是手术治疗（腺样体扁桃体切除术、颅面畸形矫正、气管切开术）或临床治疗（睡眠卫生、持续气道正压通气——CPAP）。
