Obstructive sleep apnea syndrome in children: Epidemiology, pathophysiology, diagnosis and sequelae.
Obstructive sleep apnea syndrome in children: Epidemiology, pathophysiology, diagnosis and sequelae.
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DOI：
10.3345/kjp.2010.53.10.863
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发表时间：
2010-10-01
影响因子：
--
通讯作者：
Chae, Kyu Young
中科院分区：
文献类型：
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作者：
Chang, Sun Jung;Chae, Kyu Young
儿童阻塞性睡眠呼吸暂停综合征（OSAS）的患病率约为3%。腺样体扁桃体肥大是儿童阻塞性睡眠呼吸暂停综合征最常见的病因，肥胖、低张性神经肌肉疾病和颅面畸形是其他主要的危险因素。打鼾是OSAS儿童最常见的主诉，但临床表现因年龄而异。不安的睡眠伴随着频繁的姿势变化、过度出汗或异常的睡眠姿势，如颈部过度伸展或异常的俯卧位，可能提示睡眠呼吸障碍。夜惊、梦游和遗尿症在慢波睡眠期间经常与睡眠呼吸障碍有关。白天过度嗜睡在年龄较大的儿童中变得明显，而多动症或注意力不集中通常在年幼的儿童中占主导地位。早晨头痛和食欲不振也可能存在。由于儿童的皮层觉醒阈值较高，觉醒不容易发展，他们的睡眠结构通常比成人更保守。未经治疗的儿童OSAS可能导致各种问题，如认知缺陷，注意力缺陷/多动障碍，学业成绩差和情绪不稳定。轻度肺动脉高压并不少见。很少，心血管并发症，如肺心病，心力衰竭，全身性高血压可能会在未经治疗的情况下发展。不能茁壮成长和发育迟缓是OSAS患儿的严重问题。儿童OSAS的诊断应基于打鼾、相关睡眠中断史、上气道狭窄或塌陷部分的发现，并经多导睡眠图证实。儿童OSAS的早期诊断对于通过适当的干预预防并发症至关重要。
The prevalence of pediatric obstructive sleep apnea syndrome (OSAS) is approximately 3% in children. Adenotonsillar hypertrophy is the most common cause of OSAS in children, and obesity, hypotonic neuromuscular diseases, and craniofacial anomalies are other major risk factors. Snoring is the most common presenting complaint in children with OSAS, but the clinical presentation varies according to age. Agitated sleep with frequent postural changes, excessive sweating, or abnormal sleep positions such as hyperextension of neck or abnormal prone position may suggest a sleep-disordered breathing. Night terror, sleepwalking, and enuresis are frequently associated, during slow-wave sleep, with sleep-disordered breathing. Excessive daytime sleepiness becomes apparent in older children, whereas hyperactivity or inattention is usually predominant in younger children. Morning headache and poor appetite may also be present. As the cortical arousal threshold is higher in children, arousals are not easily developed and their sleep architectures are usually more conserved than those of adults. Untreated OSAS in children may result in various problems such as cognitive deficits, attention deficit/hyperactivity disorder, poor academic achievement, and emotional instability. Mild pulmonary hypertension is not uncommon. Rarely, cardiovascular complications such as cor pulmonale, heart failure, and systemic hypertension may develop in untreated cases. Failure to thrive and delayed development are serious problems in younger children with OSAS. Diagnosis of pediatric OSAS should be based on snoring, relevant history of sleep disruption, findings of any narrow or collapsible portions of upper airway, and confirmed by polysomnography. Early diagnosis of pediatric OSAS is critical to prevent complications with appropriate interventions.