ORIGINAL ARTICLES
Sleep Apnea-Hypopnea Syndrome in a Pediatric Population: Differences Between Children With Tonsillar Hypertrophy and Those With Concomitant Disease
Mónica Llombart
, Eusebi Chiner, Elia Gómez-Merino, Ada Andreu, Esther Pastor, Cristina Senent, Ana Camarasa, Jaime Signes-Costa
Corresponding author
llombart_mon@gva.es
Correspondence: Dra. M. Llombart. Sección de Neumología. Hospital Universitari Sant Joan d'Alacant. Ctra. Alicante-Valencia, s/n. 03550 San Juan de Alicante. Alicante. Espa ña.
Correspondence: Dra. M. Llombart. Sección de Neumología. Hospital Universitari Sant Joan d'Alacant. Ctra. Alicante-Valencia, s/n. 03550 San Juan de Alicante. Alicante. Espa ña.
Unidad de Trastornos de Sueño, Sección de Neumología, Hospital Universitari Sant Joan d'Alacant, San Juan de Alicante, Alicante. Spain
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Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dra. M. Llombart. Sección de Neumología. Hospital Universitari Sant Joan d'Alacant. Ctra. Alicante-Valencia, s/n. 03550 San Juan de Alicante. Alicante. Espa ña." ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-10-09" "fechaAceptado" => "2007-04-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154702" "palabras" => array:5 [ 0 => "Sleep apnea-hypopnea syndrome" 1 => "Children" 2 => "SAHS" 3 => "Diagnosis" 4 => "Treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154703" "palabras" => array:5 [ 0 => "Síndrome de apneas-hipopneas durante el sueño" 1 => "Niños" 2 => "SAHS infantil" 3 => "Diagnóstico" 4 => "Tratamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">OBJECTIVE</span><p class="elsevierStyleSimplePara elsevierViewall">Our aim was to compare clinical and polysomnographic variables in pediatric patients with sleep apnea-hypopnea syndrome (SAHS) secondary to tonsillar hypertrophy with those in patients with concomitant disease.</p> <span class="elsevierStyleSectionTitle">PATIENTS AND METHODS</span><p class="elsevierStyleSimplePara elsevierViewall">We studied 42 children with SAHS (mean [SD] age, 8 [4] years; body mass index [BMI], 19.6 [5.2] kg/m<span class="elsevierStyleSup">2</span>; neck circumference, 29 [4] cm; and BMI percentile, 67 [36]), 26 of whom were otherwise healthy (group A) and 16 of whom had concomitant disease (group B).</p> <span class="elsevierStyleSectionTitle">RESULTS</span><p class="elsevierStyleSimplePara elsevierViewall">A comparison of groups A and B showed no significant differences in age (7.7 [3.9] years vs 8.4 [3.9] years; P=not significant [NS]); sex, BMI (17.6 [4] kg/m<span class="elsevierStyleSup">2</span> vs 20.4 [6] kg/m<span class="elsevierStyleSup">2</span>; P=NS), neck circumference (29.3 [4.7] cm vs 30.7 [3.5] cm; P=NS), or BMI percentile (61 [37] vs 76 [34]; P=NS). Tonsillar hypertrophy was more frequent in group A (P=.02) and craniofacial abnormalities (P=.008), macroglossia (P=.04), and dolichocephalia (P=.04) were more frequent in group B. No significant differences were observed in neurophysiologic variables or in the respiratory disturbance index, although group A presented higher oxygen saturation levels (97 [1.7] vs 95 [2]; P<.007), lower oxygen desaturation index scores (7 [7] vs 15 [10]; P=.007), and a lower cumulative percentage of time with oxygen saturation lower than 90% (2.2 [4] vs 16.4 [4]; P=.01). Twenty-three patients (88.5%) in group A underwent tonsillectomies compared to 7 (44%) patients in group B (P=.003). Seven patients (44%) in group B were treated with continuous positive airway pressure (CPAP) and 2 patients were treated with bilevel positive airway pressure (BiPAP), compared to 1 patient (3.8%) treated with CPAP in group A (P=.003). Three children in group B underwent maxillary surgery. The evolution of clinical and polygraphic variables was more favorable in group A (P=.04).</p> <span class="elsevierStyleSectionTitle">CONCLUSIONS</span><p class="elsevierStyleSimplePara elsevierViewall">Children with SAHS suffer from repeated infections, delayed weight gain, hyperactivity, and neuropsychiatric manifestations. Obesity (associated with concomitant disease) and sleepiness are uncommon. Although most patients require surgery, as many as a third require treatment with CPAP or BiPAP. Furthermore, children with SAHS and concomitant disease show no specific clinical characteristics, although they tend to be more obese, have more craniofacial abnormalities, and greater nocturnal hypoventilation.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">OBJETIVO</span><p class="elsevierStyleSimplePara elsevierViewall">Comparar la expresión clínica y polisomnográfica del síndrome de apneas-hipopneas durante el sueño (SAHS) en niños con hipertrofia amigdalar y enfermedad concomitante.</p> <span class="elsevierStyleSectionTitle">PACIENTES Y MÉTODOS</span><p class="elsevierStyleSimplePara elsevierViewall">Se estudió a 42 niños con SAHS -con una edad media (± desviación estándar) de 8 ± 4 años, índice de masa corporal (IMC) de 19,6 ± 5,2 kg/m<span class="elsevierStyleSup">2</span>, cuello de 29 ± 4 cm y percentil de IMC de 67 ± 36-, 26 sanos (grupo A) y 16 con enfermedad concomitante (grupo B).</p> <span class="elsevierStyleSectionTitle">RESULTADOS</span><p class="elsevierStyleSimplePara elsevierViewall">Al comparar los grupos A y B no se observa-ron diferencias en la edad (7,7 ± 3,9 frente a 8,4 ± 3,9 años; p = no significativa [NS]), el sexo, el IMC (17,6 ± 4 frente a 20,4 ± 6 kg/m<span class="elsevierStyleSup">2</span>; p = NS), el perímetro del cuello (29,3 ± 4,7 frente a 30,7 ± 3,5 cm; p = NS) ni el percentil de IMC (61 ± 37 frente a 76 ± 34; p = NS). En el grupo A fue más frecuente la hipertrofia amigdalar (p = 0,02), y en B, las alteraciones del macizo facial (p = 0,008), macroglosia (p = 0,04) y dolico-cefalia (p = 0,04). No se observaron diferencias en las varia-bles neurofisiológicas ni en el índice de alteración respirato-ria, aunque el grupo A presentó mayor saturación de oxígeno basal (97 ± 1,7 frente a 95 ± 2%; p < 0,007), menor índice de desaturaciones/h (7 ± 7 frente a 15 ± 10; p = 0,007) y menor porcentaje de tiempo de sueño con saturación de oxihemoglobina inferior al 90% (2,2 ± 4 frente a 16,4 ± 4; p = 0,01). Fueron tratados con amigdalectomía 23 pacientes del grupo A (88,5%) frente a 7 (44%) del B (p = 0,003). En el grupo B, 7 pacientes recibieron tratamiento con presión posi-tiva continua de la vía aérea (44%) y 2 con BiPAP®, frente a uno (3,8%) en el grupo A (p = 0,003). Se realizó cirugía ma-xilar a 3 niños del grupo B. La evolución clínica y poligráfica fue más favorable en el grupo A (p = 0,04).</p> <span class="elsevierStyleSectionTitle">CONCLUSIONES</span><p class="elsevierStyleSimplePara elsevierViewall">Los niños con SAHS cursan con infec-ciones de repetición, retraso ponderal, hiperactividad y manifestaciones neuropsíquicas, mientras que son poco fre-cuentes la somnolencia y la obesidad, la cual se asocia a en-fermedad concomitante. Aunque la mayoría necesitará ciru-gía, hasta un tercio precisará tratamiento con presión positiva continua de la vía aérea/BiPAP®. Además, los niños con SAHS y enfermedad concomitante no muestran caracte-rísticas especiales en su expresión clínica, aunque tienden a ser más obesos, con mayores alteraciones del macizo facial y mayor hipoventilación nocturna.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:49 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The occurrence of sleep-disordered breathing among middle-aged adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T Young" 1 => "M Palta" 2 => "J Dempsey" 3 => "J Skatrud" 4 => "S Weber" 5 => "S Badr" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199304293281704" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1993" "volumen" => "328" "paginaInicial" => "1230" "paginaFinal" => "1235" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8464434" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obstructive sleep apnea: implications for cardiac and vascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "AS Shamsuzzaman" 1 => "BJ Gersh" 2 => "VK Somers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.290.14.1906" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2003" "volumen" => "290" "paginaInicial" => "1906" "paginaFinal" => "1914" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14532320" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Síndrome de apnea del sueño y el corazón" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J Terán Santos" 1 => "ML Alonso Álvarez" 2 => "J Cordero Guevara" 3 => "JM Ayuela Azcárate" 4 => "JM Montserrat Canal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2006" "volumen" => "59" "paginaInicial" => "718" "paginaFinal" => "724" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16938214" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The association between sleep apnea and the risk of traffic accidents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J Terán-Santos" 1 => "A Jiménez-Gómez" 2 => "J Cordero-Guevara" 3 => "the Cooperative Group Burgos-Santander" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199903183401104" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1999" "volumen" => "340" "paginaInicial" => "847" "paginaFinal" => "851" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10080847" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cognitive function and behavior of children with adenotonsillar hypertrophy suspected of having obstructive sleep- disordered breathing" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "PM Suratt" 1 => "M Peruggia" 2 => "L D'Andrea" 3 => "R Diamond" 4 => "JT Barth" 5 => "M Nikova" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2006-0173" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2006" "volumen" => "118" "paginaInicial" => "e771" "paginaFinal" => "e781" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16894010" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for sleep-disordered breathing in children. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 4 | 9 |
| 2024 October | 32 | 16 | 48 |
| 2024 September | 35 | 17 | 52 |
| 2024 August | 46 | 36 | 82 |
| 2024 July | 49 | 25 | 74 |
| 2024 June | 54 | 22 | 76 |
| 2024 May | 44 | 31 | 75 |
| 2024 April | 22 | 22 | 44 |
| 2024 March | 21 | 16 | 37 |
| 2024 February | 14 | 20 | 34 |
| 2023 March | 4 | 4 | 8 |
| 2023 February | 15 | 14 | 29 |
| 2023 January | 16 | 28 | 44 |
| 2022 December | 22 | 17 | 39 |
| 2022 November | 19 | 23 | 42 |
| 2022 October | 29 | 32 | 61 |
| 2022 September | 16 | 17 | 33 |
| 2022 August | 22 | 36 | 58 |
| 2022 July | 30 | 43 | 73 |
| 2022 June | 17 | 31 | 48 |
| 2022 May | 16 | 27 | 43 |
| 2022 April | 18 | 31 | 49 |
| 2022 March | 22 | 32 | 54 |
| 2022 February | 15 | 29 | 44 |
| 2022 January | 14 | 36 | 50 |
| 2021 December | 22 | 44 | 66 |
| 2021 November | 20 | 54 | 74 |
| 2021 October | 44 | 44 | 88 |
| 2021 September | 19 | 64 | 83 |
| 2021 August | 14 | 28 | 42 |
| 2021 July | 13 | 18 | 31 |
| 2021 June | 13 | 41 | 54 |
| 2021 May | 26 | 28 | 54 |
| 2021 April | 31 | 58 | 89 |
| 2021 March | 19 | 17 | 36 |
| 2021 February | 10 | 14 | 24 |
| 2021 January | 20 | 14 | 34 |
| 2020 December | 9 | 10 | 19 |
| 2020 November | 41 | 11 | 52 |
| 2020 October | 11 | 3 | 14 |
| 2020 September | 21 | 0 | 21 |
| 2020 August | 62 | 12 | 74 |
| 2020 July | 32 | 15 | 47 |
| 2020 June | 14 | 3 | 17 |
| 2020 May | 27 | 16 | 43 |
| 2020 April | 37 | 15 | 52 |
| 2020 March | 37 | 10 | 47 |
| 2020 February | 48 | 13 | 61 |
| 2020 January | 23 | 14 | 37 |
| 2019 December | 37 | 12 | 49 |
| 2019 November | 20 | 7 | 27 |
| 2019 October | 11 | 4 | 15 |
| 2019 September | 22 | 11 | 33 |
| 2019 August | 13 | 6 | 19 |
| 2019 July | 18 | 27 | 45 |
| 2019 June | 23 | 26 | 49 |
| 2019 May | 19 | 14 | 33 |
| 2019 April | 17 | 35 | 52 |
| 2019 March | 15 | 16 | 31 |
| 2019 February | 11 | 12 | 23 |
| 2019 January | 8 | 12 | 20 |
| 2018 December | 10 | 10 | 20 |
| 2018 November | 15 | 15 | 30 |
| 2018 October | 23 | 23 | 46 |
| 2018 September | 20 | 21 | 41 |
| 2018 May | 5 | 0 | 5 |
| 2018 April | 14 | 6 | 20 |
| 2018 March | 8 | 2 | 10 |
| 2018 February | 3 | 4 | 7 |
| 2018 January | 5 | 4 | 9 |
| 2017 December | 4 | 5 | 9 |
| 2017 November | 1 | 4 | 5 |
| 2017 October | 5 | 5 | 10 |
| 2017 September | 3 | 6 | 9 |
| 2017 August | 5 | 16 | 21 |
| 2017 July | 3 | 5 | 8 |
| 2017 June | 8 | 18 | 26 |
| 2017 May | 5 | 10 | 15 |
| 2017 April | 3 | 15 | 18 |
| 2017 March | 6 | 2 | 8 |
| 2017 February | 3 | 6 | 9 |
| 2017 January | 1 | 3 | 4 |
| 2016 December | 3 | 3 | 6 |
| 2016 November | 5 | 6 | 11 |
| 2016 October | 6 | 6 | 12 |
| 2016 September | 6 | 4 | 10 |
| 2016 August | 9 | 5 | 14 |
| 2016 July | 2 | 3 | 5 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 51 | 9 | 60 |
| 2015 September | 58 | 6 | 64 |
| 2015 August | 42 | 10 | 52 |
| 2015 July | 47 | 12 | 59 |
| 2015 June | 39 | 7 | 46 |
| 2015 May | 55 | 6 | 61 |
| 2015 April | 57 | 9 | 66 |
| 2015 March | 37 | 6 | 43 |
| 2015 February | 37 | 6 | 43 |
| 2015 January | 19 | 2 | 21 |
| 2014 December | 30 | 6 | 36 |
| 2014 November | 38 | 8 | 46 |
| 2014 October | 51 | 9 | 60 |
| 2014 September | 34 | 8 | 42 |
| 2014 August | 48 | 7 | 55 |
| 2014 July | 46 | 8 | 54 |
| 2014 June | 71 | 7 | 78 |
| 2014 May | 75 | 15 | 90 |
| 2014 April | 55 | 7 | 62 |
| 2014 March | 58 | 8 | 66 |
| 2014 February | 60 | 12 | 72 |
| 2014 January | 45 | 9 | 54 |
| 2013 December | 58 | 10 | 68 |
| 2013 November | 33 | 3 | 36 |
| 2013 October | 43 | 10 | 53 |
| 2013 September | 49 | 9 | 58 |
| 2013 August | 41 | 10 | 51 |
| 2013 July | 64 | 11 | 75 |
| 2013 June | 44 | 6 | 50 |
| 2013 May | 43 | 10 | 53 |
| 2013 April | 19 | 8 | 27 |
| 2013 March | 6 | 1 | 7 |
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