Vaienti Benedetta, Di Blasio Marco, Arcidiacono Luisa, Santagostini Antonio, Di Blasio Alberto, Segù Marzia
Department of Medicine and Surgery, University Center of Dentistry, University of Parma, Parma, Italy.
Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
Front Neurol. 2024 Jul 5;15:1393272. doi: 10.3389/fneur.2024.1393272. eCollection 2024.
Obstructive sleep apnoea syndrome is a respiratory sleep disorder that affects 1-5% of children. It occurs equally in males and females, with higher incidence in school age and adolescence. OSAS may be caused by several factors, but in children, adenotonsillar hypertrophy, obesity, and maxillo-mandibular deficits are the most common. In general, there is a reduction in the diameter of the airway with reduced airflow. This condition worsens during sleep due to the muscular hypotonia, resulting in apnoeas or hypoventilation. While snoring is the primary symptom, OSAS-related manifestations have a wide spectrum. Some of these symptoms relate to the nocturnal phase, including disturbed sleep, frequent changes of position, apnoeas and oral respiration. Other symptoms concern the daytime hours, such as drowsiness, irritability, inattention, difficulties with learning and memorisation, and poor school performance, especially in patient suffering from overlapping syndromes (e.g., Down syndrome). In some cases, the child's general growth may also be affected. Early diagnosis of this condition is crucial in limiting associated symptoms that can significantly impact a paediatric patient's quality of life, with the potential for the condition to persist into adulthood. Diagnosis involves evaluating several aspects, beginning with a comprehensive anamnesis that includes specific questionnaires, followed by an objective examination. This is followed by instrumental diagnosis, for which polysomnography is considered the gold standard, assessing several parameters, including the apnoea-hypopnoea index (AHI) and oxygen saturation. However, it is not the sole tool for assessing the characteristics of this condition. Other possibilities, such as night-time video recording, nocturnal oximetry, can be chosen when polysomnography is not available and even tested at home, even though with a lower diagnostic accuracy. The treatment of OSAS varies depending on the cause. In children, the most frequent therapies are adenotonsillectomy or orthodontic therapies, specifically maxillary expansion.
阻塞性睡眠呼吸暂停综合征是一种影响1%-5%儿童的睡眠呼吸障碍。男性和女性发病率相同，在学龄期和青春期发病率更高。阻塞性睡眠呼吸暂停综合征可能由多种因素引起，但在儿童中，腺样体扁桃体肥大、肥胖和颌骨发育不全是最常见的原因。一般来说，气道直径减小，气流减少。由于肌肉张力减退，这种情况在睡眠期间会恶化，导致呼吸暂停或通气不足。虽然打鼾是主要症状，但阻塞性睡眠呼吸暂停综合征相关表现范围广泛。其中一些症状与夜间阶段有关，包括睡眠障碍、频繁翻身、呼吸暂停和口呼吸。其他症状则与白天有关，如嗜睡、易怒、注意力不集中、学习和记忆困难以及学业成绩差，尤其是患有重叠综合征（如唐氏综合征）的患者。在某些情况下，儿童的总体生长也可能受到影响。早期诊断这种疾病对于限制可能严重影响儿科患者生活质量的相关症状至关重要，因为这种疾病有可能持续到成年。诊断包括评估几个方面，首先是全面的病史采集，包括特定问卷，然后是客观检查。接下来是仪器诊断，多导睡眠图被认为是评估阻塞性睡眠呼吸暂停综合征的金标准，它可以评估几个参数，包括呼吸暂停低通气指数（AHI）和血氧饱和度。然而，它并不是评估这种疾病特征的唯一工具。当无法进行多导睡眠图检查时，可以选择其他方法，如夜间视频记录、夜间血氧饱和度测定，甚至可以在家中进行测试，尽管诊断准确性较低。阻塞性睡眠呼吸暂停综合征的治疗因病因不同而有所差异。在儿童中，最常见的治疗方法是腺样体扁桃体切除术或正畸治疗，特别是上颌扩弓。
