1 Department of Pediatric Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.
2 Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.
Otolaryngol Head Neck Surg. 2018 Feb;158(2):364-367. doi: 10.1177/0194599817726286. Epub 2017 Sep 5.
Objective In 2011, the American Academy of Pediatrics published a guideline for children with Down syndrome (DS), recommending a polysomnogram (PSG) by age 4 years regardless of symptoms. Their rationale was based on 2 publications with small cohorts, where at least 50% of the children had no obstructive sleep apnea (OSA) symptoms but their PSG results were abnormal. The American Academy of Otolaryngology-Head and Neck Surgery Foundation published a clinical practice guideline recommending PSG prior to adenotonsillectomy for these children. This study aimed to assess parents' accuracy of their children's breathing patterns as compared with PSGs in a larger cohort of children with DS. Study Design Case series with chart review. Setting Tertiary care academic pediatric hospital. Subjects and Methods Sleep intake forms assessing frequency of parent-observed apnea, snoring, and restless sleep were analyzed. None of the children had a previous tonsillectomy. Two groups were analyzed according to symptoms: infrequent (<3 nights per week on all questions answered) and frequent (≥6 nights per week on at least 1 question). OSA severity was categorized as follows: normal, <2 events per hour; mild, 2 to 4.9; moderate, 5 to 9.9; and severe, ≥10. Results A total of 113 children met inclusion criteria: 34% (n = 38) had infrequent symptoms, and 66% (n = 75) had frequent symptoms. Parents were unable to predict the presence or absence of OSA by nighttime symptoms ( P = .60). The risk of OSA for children with frequent symptoms versus those with infrequent symptoms was 1.04 (95% CI, 0.89-1.3). Conclusion Parents of DS children are unable to predict the presence or absence of OSA by nighttime symptoms, nor are they able to determine its severity.
目的 2011 年，美国儿科学会发布了针对唐氏综合征（DS）儿童的指南，建议无论症状如何，所有儿童均应在 4 岁时进行多导睡眠图（PSG）检查。他们的依据是两篇小样本队列研究，这两篇研究中至少有 50%的儿童没有阻塞性睡眠呼吸暂停（OSA）症状，但 PSG 结果异常。美国耳鼻咽喉头颈外科学会基金会发布了一项临床实践指南，建议对这些儿童行扁桃体腺样体切除术前行 PSG 检查。本研究旨在评估父母对其子女呼吸模式的准确性，与更大队列的 DS 儿童 PSG 结果进行比较。 研究设计 病例系列，图表回顾。 地点 三级保健学术儿科医院。 患者和方法 分析睡眠摄入量表，评估父母观察到的儿童呼吸暂停、打鼾和睡眠不安的频率。所有儿童均未行扁桃体切除术。根据症状将两组进行分析：不频繁（所有回答问题中每周<3 晚）和频繁（至少 1 个问题每周>6 晚）。OSA 严重程度分类如下：正常，<2 次/小时；轻度，2 至 4.9 次；中度，5 至 9.9 次；重度，≥10 次。 结果 共有 113 名儿童符合纳入标准：34%（n=38）症状不频繁，66%（n=75）症状频繁。父母无法通过夜间症状预测 OSA 的存在或不存在（P=.60）。与症状不频繁的儿童相比，症状频繁的儿童发生 OSA 的风险为 1.04（95%CI，0.89-1.3）。 结论 DS 儿童的父母无法通过夜间症状预测 OSA 的存在或不存在，也无法确定其严重程度。
