Joosten Koen F, Larramona Helena, Miano Silvia, Van Waardenburg Dick, Kaditis Athanasios G, Vandenbussche Nele, Ersu Refika
Erasmus MC, Pediatric Intensive Care, Sophia Children's Hospital, Rotterdam, The Netherlands.
Paediatric Pulmonology Unit, Department of Pediatrics, University Autonoma of Barcelona, Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain.
Pediatr Pulmonol. 2017 Feb;52(2):260-271. doi: 10.1002/ppul.23639. Epub 2016 Nov 16.
Obstructive sleep-disordered breathing includes a spectrum of clinical entities with variable severity ranging from primary snoring to obstructive sleep apnea syndrome (OSAS). The clinical suspicion for OSAS is most often raised by parental report of specific symptoms and/or abnormalities identified by the physical examination which predispose to upper airway obstruction (e.g., adenotonsillar hypertrophy, obesity, craniofacial abnormalities, neuromuscular disorders). Symptoms and signs of OSAS are classified into those directly related to the intermittent pharyngeal airway obstruction (e.g., parental report of snoring, apneic events) and into morbidity resulting from the upper airway obstruction (e.g., increased daytime sleepiness, hyperactivity, poor school performance, inadequate somatic growth rate or enuresis). History of premature birth and a family history of OSAS as well as obesity and African American ethnicity are associated with increased risk of sleep-disordered breathing in childhood. Polysomnography is the gold standard method for the diagnosis of OSAS but may not be always feasible, especially in low-income countries or non-tertiary hospitals. Nocturnal oximetry and/or sleep questionnaires may be used to identify the child at high risk of OSAS when polysomnography is not an option. Endoscopy and MRI of the upper airway may help to identify the level(s) of upper airway obstruction and to evaluate the dynamic mechanics of the upper airway, especially in children with combined abnormalities. Pediatr Pulmonol. 2017;52:260-271. © 2016 Wiley Periodicals, Inc.
阻塞性睡眠呼吸障碍包括一系列临床病症，严重程度各异，从原发性打鼾到阻塞性睡眠呼吸暂停综合征（OSAS）。对于OSAS的临床怀疑通常源于家长报告的特定症状和/或体格检查发现的易导致上呼吸道阻塞的异常情况（如腺样体扁桃体肥大、肥胖、颅面异常、神经肌肉疾病）。OSAS的症状和体征分为与间歇性咽部气道阻塞直接相关的症状（如家长报告的打鼾、呼吸暂停事件）以及上呼吸道阻塞导致的发病情况（如白天嗜睡增加、多动、学业成绩差、身体生长速率不足或尿床）。早产史、OSAS家族史以及肥胖和非裔美国人种族与儿童睡眠呼吸障碍风险增加相关。多导睡眠图是诊断OSAS的金标准方法，但并非总是可行，尤其是在低收入国家或非三级医院。当无法进行多导睡眠图检查时，夜间血氧测定和/或睡眠问卷可用于识别OSAS高危儿童。上呼吸道内镜检查和MRI有助于确定上呼吸道阻塞的部位，并评估上呼吸道的动态力学，特别是对于合并异常的儿童。《儿科肺脏病学》。2017年；52:260 - 271。© 2016威利期刊公司。
