Potsic W P
University of Pennsylvania School of Medicine, Philadelphia.
Otolaryngol Clin North Am. 1989 Jun;22(3):537-44.
Sleep apnea in children develops when airway obstruction at night is severe; however, lesser degrees of obstruction may also cause problems. The most common cause of nighttime obstruction with or without apnea is hyperplasia of the tonsils and adenoids. Other conditions such as craniofacial anomalies and neuromuscular disorders may predispose children to obstruction of the airway during sleep. Although cor pulmonale, heart failure, and cardiorespiratory arrest are the most dramatic results of obstructive apnea, before these occur many other problems may develop that are detrimental to the child's health, including failure to thrive. A careful history and physical examination are usually sufficient to determine if obstruction and apnea are present at night. Additional studies such as sleep sonography and polysomnography are helpful for documentation of the disorder. The treatment of obstructive apnea, unless associated with central apnea, is surgical. The vast majority of children with obstruction have dramatic resolution of their obstruction following a tonsillectomy and adenoidectomy. Occasionally additional procedures including uvulopalatopharyngoplasty and tracheotomy are needed.
当夜间气道阻塞严重时，儿童会出现睡眠呼吸暂停；然而，较轻程度的阻塞也可能引发问题。无论有无呼吸暂停，夜间阻塞最常见的原因是扁桃体和腺样体增生。其他情况，如颅面畸形和神经肌肉疾病，可能使儿童在睡眠期间易发生气道阻塞。虽然肺心病、心力衰竭和心搏呼吸骤停是阻塞性呼吸暂停最严重的后果，但在这些情况发生之前，可能会出现许多其他对儿童健康有害的问题，包括发育不良。详细的病史和体格检查通常足以确定夜间是否存在阻塞和呼吸暂停。睡眠超声检查和多导睡眠图等其他检查有助于记录该病症。阻塞性呼吸暂停的治疗（除非与中枢性呼吸暂停相关）是手术治疗。绝大多数有阻塞问题的儿童在扁桃体切除术和腺样体切除术后，阻塞情况会显著缓解。偶尔还需要进行包括悬雍垂腭咽成形术和气管切开术在内的其他手术。
