Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2022 Nov 1;77:100131. doi: 10.1016/j.clinsp.2022.100131. eCollection 2022.
To determine the clinical and anatomical characteristics associated with obstructive sleep apnea severity in children with adenotonsillar hypertrophy.
The authors conducted a cross-sectional multidisciplinary survey and selected 58 Brazilian children (4‒9 years old) with adenotonsillar hypertrophy, parental complaints of snoring, mouth-breathing, and witnessed apnea episodes. The authors excluded children with known genetic, craniofacial, neurological, or psychiatric conditions. Children with a parafunctional habit or early dental loss and those receiving orthodontic treatment were not selected. All children underwent polysomnography, and three were excluded because they showed an apnea-hypopnea index lower than one or minimal oxygen saturation higher than 92%. The sample consisted of 55 children classified into mild (33 children) and moderate/severe (22 children) obstructive sleep apnea groups. Detailed clinical and anatomical evaluations were performed, and anthropometric, otorhinolaryngological, and orthodontic variables were analyzed. Sleep disorder symptoms were assessed using the Sleep Disturbance Scale for Children questionnaire. All children also underwent teleradiography exams and Rickett's and Jarabak's cephalometric analyses.
The mild and moderate/severe obstructive sleep apnea groups showed no significant differences in clinical criteria. Facial depth angle, based on Ricketts cephalometric analysis, was significantly different between the groups (p = 0.010), but this measurement by itself does not express the child's growth pattern, as it is established by the arithmetic mean of the differences between the obtained angles and the normal values of five cephalometric measurements.
The clinical criteria and craniofacial characteristics evaluated did not influence the disease severity.
确定与腺样体肥大儿童阻塞性睡眠呼吸暂停严重程度相关的临床和解剖特征。
作者进行了一项横断面多学科调查，选择了 58 名巴西儿童（4-9 岁），这些儿童存在腺样体肥大、父母抱怨打鼾、口呼吸和观察到呼吸暂停发作。作者排除了有已知遗传、颅面、神经或精神疾病的儿童。有习惯性功能障碍或早期牙齿缺失以及正在接受正畸治疗的儿童也未被选择。所有儿童均接受多导睡眠图检查，其中 3 名因呼吸暂停低通气指数低于 1 或最低血氧饱和度高于 92%而被排除。该样本由 55 名儿童组成，分为轻度（33 名儿童）和中重度（22 名儿童）阻塞性睡眠呼吸暂停组。进行了详细的临床和解剖评估，并分析了人体测量、耳鼻喉和正畸变量。使用儿童睡眠障碍量表问卷评估睡眠障碍症状。所有儿童还接受了远程放射学检查和 Rickett 及 Jarabak 的头影测量分析。
轻度和中重度阻塞性睡眠呼吸暂停组在临床标准上无显著差异。基于 Rickett 头影测量分析的面深度角在两组间存在显著差异（p=0.010），但该测量值本身并不能表达儿童的生长模式，因为它是通过获得的角度与五个头影测量正常值之间的差异的算术平均值来确定的。
评估的临床标准和颅面特征并不影响疾病严重程度。
