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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">The prevalence of obstructive sleep apnea hypopnea syndrome &#40;OSAHS&#41; in the general pediatric population ranges from 1&#37; to 3&#37;&#46; However&#44; its prevalence in an unselected population of obesity and OSAHS in children diagnosed with the syndrome in a cohort of boys and girls &#40;age range&#44; 2-14 years&#41; referred to the pediatric respiratory medicine outpatient clinic at our hospital for suspected apnea&#44; snoring&#44; or both over the past 5 years&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">The medical history of each patient was recorded and all patients underwent a physical examination&#44; chest and nasal cavities radiography&#44; and 8-channel respiratory polygraphy during sleep&#46; the following variables were evaluated&#58; sex&#44; reason for consultation&#44; source of referral&#44; findings during upper airway examination&#44; age&#44; weight <span class="elsevierStyleItalic">z</span>-score &#40;reflecting how much a finding differs from the mean and in what direction in a normally distributed sample&#41;&#44; height <span class="elsevierStyleItalic">z</span>-score&#44; body mass index &#40;BMI&#41; <span class="elsevierStyleItalic">z</span>-score&#44; number of apneas&#44; number of hypopneas&#44; apnea index&#44; hypopnea index&#44; apnea-hypopnea index &#40;AHI&#41;&#44; oxygen saturation &#40;mean and minimum&#41; measured by pulse oximetry&#44; number of snores&#44; and snore index&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Of the 400 patients studied&#44; 242 &#40;60&#46;5&#37;&#41; were male and 158 &#40;39&#46;5&#37;&#41; female&#46; the mean age was 4&#46;95 years&#46; OSAHS &#40;AHI&#8805;3&#41; was diagnosed in 298 cases &#40;74&#46;5&#37;&#41; and these patients were then studied to determine the relation between OSAHS and obesity&#46; the anthropometric distribution &#40;expressed as mean &#91;SD&#93;&#41; was as follows&#58; weight <span class="elsevierStyleItalic">z</span>-score&#44; 0&#46;37 &#40;1&#46;31&#41;&#59; height <span class="elsevierStyleItalic">z</span>-score&#44; 0&#46;23 &#40;1&#46;19&#41;&#59; BMI&#44; 17&#46;063 kg&#47;m<span class="elsevierStyleSup">2</span> &#40;2&#46;51&#41;&#59; and BMI <span class="elsevierStyleItalic">z</span>-score&#44; 1&#46;39 &#40;1&#46;36&#41;&#46; the respiratory polygraph during sleep recorded an AHI of 6&#46;56 &#40;7&#46;56&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">No differences were observed between the height <span class="elsevierStyleItalic">z</span>-score&#44; weight <span class="elsevierStyleItalic">z</span>-score&#44; BMI <span class="elsevierStyleItalic">z</span>-score&#44; age&#44; and AHI&#46; No association between obesity and OSAHS was found in this series&#46; However&#44; studies of larger&#44; unselected populations are needed to determine if obesity is a risk factor for OSAHS in children&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome de apneas-hipopneas obstructivas durante el sue&#241;o &#40;SAHOS&#41; alcanza una prevalencia del 1-3&#37; en poblaci&#243;n general infantile&#46; Sin embargo&#44; en poblaci&#243;n obesa no preseleccionada la prevalencia es desconocida&#46; Para estudiar la asociaci&#243;n entre SAHOS y obesidad en ni&#241;os diagnosticados de dicho trastorno&#44; hemos analizado a una cohorte de ni&#241;os y ni&#241;as &#40;2-14 a&#241;os&#41; remitidos en los &#250;ltimos 5 a&#241;os a consulta externas de neumolog&#237;a infantile porsospecha de apneas durante el sue&#241;o&#44; ronquido o ambos&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">A los pacientes incluidos se les realizaron anamesis&#44; exploraci&#243;n f&#237;sica&#44; radiograf&#237;a de t&#243;rax y c&#225;vum y poligraf&#237;a respiratoria durante el sue&#241;o con 8 canales&#46; Se analizaron las siguientes variables&#58; sexo&#44; motivo de consulta&#44; procedencia&#44; exploraci&#243;n de la v&#237;a a&#233;rea superior&#44; edad&#44; z-<span class="elsevierStyleItalic">score</span> del peso &#40;cu&#225;nto se desv&#237;a la media de peso y en qu&#233; direcci&#243;n respecto de la media de peso de una distribuci&#243;n normal&#41;&#44; z-<span class="elsevierStyleItalic">score</span> de la talla &#40;cu&#225;nto se desv&#237;a la media de la talla y en qu&#233; direcci&#243;n respecto de la media de la talla de una distribuci&#243;n normal&#41;&#44; z-<span class="elsevierStyleItalic">score</span> del &#237;ndice de masa corporal &#40;IMC&#59; cu&#225;nto se desv&#237;a la media del IMC y en qu&#233; direcci&#243;n respecto de la media del IMC de una distribuci&#243;n normal&#41;&#44; n&#250;mero de apneas&#44; n&#250;mero de hipopneas&#44; &#237;ndice de apneas&#47;h&#44; &#237;ndice de hipopneas&#47;h &#237;ndice de apneas-hipopneas&#47;h &#40;IAH&#47;h&#41;&#44; saturaci&#243;n de ox&#237;geno por pulsioximetr&#237;a &#40;media y m&#237;nima&#41;&#44; n&#250;mero de ronquidos e &#237;ndice de ronquidos&#47;h&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se estudi&#243; a 400 pacientes&#44; con una edad media de 4&#44;95 a&#241;os&#44; de los que 242 eran varones &#40;60&#44;5&#37;&#41; y 158 ni&#241;as &#40;39&#44;5&#37;&#41;&#46; Se diagnostic&#243; de SAHOS &#40;IAH&#47;h &#8805; 3&#41; a 298 &#40;74&#44;5&#37;&#41;&#44; y en &#233;stos se analiz&#243; la relaci&#243;n entre SAHOS y obesidad&#46; La distribuci&#243;n antropom&#233;trica &#40;expresada en media &#177; desviaci&#243;n est&#225;ndar&#41; fue la siguiente&#58; z-peso de 0&#44;37 &#177; 1&#44;31&#59; z-talla de 0&#44;23 &#177; 1&#44;19&#59; IMC de 17&#44;063 &#177; 2&#44;51 kg&#47;m<span class="elsevierStyleSup">2</span>&#44; y z-IMC de 0&#44;39 &#177; 1&#44;36&#46; Los resultados de la poligraf&#237;a respiratoria durante el sue&#241;o mostraron un IAH&#47;h de 6&#44;56 &#177; 7&#44;56&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">No se han encontrado diferencias entre z-talla&#44; z-peso&#44; z-IMC&#44; edad e IAH&#47;h&#46; En esta serie la obesidad no se asocial a SAHOS&#46; Sin embargo&#44; se requieren estudios en poblaciones m&#225;s amplias y no preseleccionadas para evaluar si la obesidad act&#250;a o no como factor de riesgo para desarrollar SAHOS en ni&#241;os&#46;</p>"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.164.1.2008171"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med&#46;"
                        "fecha" => "2001"
                        "volumen" => "164"
                        "paginaInicial" => "16"
                        "paginaFinal" => "30"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11435234"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sleep architecture and respiratory disturbances in children with obstructive sleep apnea"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "DYT Goh"
                            1 => "P Galster"
                            2 => "CL Marcus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.162.2.9908058"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med&#46;"
                        "fecha" => "2000"
                        "volumen" => "162"
                        "paginaInicial" => "682"
                        "paginaFinal" => "686"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10934106"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Curvas y tablas de crecimiento &#40;estudio longitudinal y transversal&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B Sobradillo"
                            1 => "A Aguirre"
                            2 => "U Aresti"
                            3 => "C Bilbao"
                            4 => "C Fern&#225;ndez-Ramos"
                            5 => "A Lizarraga"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Patrones de crecimiento y desarrollo en Espa&#241;a&#46; Atlas de gr&#225;ficas y tablas"
                        "paginaInicial" => "145"
                        "paginaFinal" => "168"
                        "serieFecha" => "2004"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Should children with suspected obstructive sleep apnea syndrome and normal nap sleep studies have overnight sleep studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "MM Saeed"
                            1 => "TG Keens"
                            2 => "MW Stabile"
                            3 => "J Bolokowicz"
                            4 => "SL Davidson Ward"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2000"
                        "volumen" => "118"
                        "paginaInicial" => "360"
                        "paginaFinal" => "365"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10936125"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity and renal transplant outcome&#58; a report of the North American Pediatric Renal Transplant Cooperative Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "CD Hanevold"
                            1 => "PL Ho"
                            2 => "L Talley"
                            3 => "MM Mitsnefes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2004-0289"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2005"
                        "volumen" => "115"
                        "paginaInicial" => "352"
                        "paginaFinal" => "356"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15687444"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting preschooler obesity at birth&#58; the role of maternal obesity in early pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "RC Whitaker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2004"
                        "volumen" => "114"
                        "paginaInicial" => "e29"
                        "paginaFinal" => "e36"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15231970"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obstructive sleep apnea syndrome&#58; differences between children and adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "CL Marcus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Sleep"
                        "fecha" => "2000"
                        "volumen" => "23"
                        "numero" => "Suppl 4"
                        "paginaInicial" => "140"
                        "paginaFinal" => "141"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Childhood obstructive sleep apnea"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S Kotagal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.330.7498.978"
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2005"
                        "volumen" => "330"
                        "paginaInicial" => "978"
                        "paginaFinal" => "979"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15860803"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Caracter&#237;sticas del s&#237;ndrome de apnea obstructiva del sue&#241;o en pacientes con un s&#237;ndrome de Down"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J de Miguel"
                            1 => "JR Villa"
                            2 => "JL &#193;lvarez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol&#46;"
                        "fecha" => "2002"
                        "volumen" => "38"
                        "paginaInicial" => "77"
                        "paginaFinal" => "80"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11844439"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nuevos aspectos patog&#233;nicos en el s&#237;ndrome de apneas e hipopneas durante el sue&#241;o &#40;SAHS&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J Montserrat"
                            1 => "L Hern&#225;ndez"
                            2 => "M Nacher"
                            3 => "F Barbe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol&#46;"
                        "fecha" => "2004"
                        "volumen" => "40"
                        "paginaInicial" => "27"
                        "paginaFinal" => "34"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16137464"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of overweight and obesity in a provincial population of Canadian preschool children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "PM Canning"
                            1 => "ML Courage"
                            2 => "LM Frizzell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "CMAJ"
                        "fecha" => "2004"
                        "volumen" => "171"
                        "paginaInicial" => "240"
                        "paginaFinal" => "242"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15289421"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and trends in overweight among children and adolescents&#44; 1999-2000"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "CL Ogden"
                            1 => "KM Flegal"
                            2 => "MD Carroll"
                            3 => "CL Jonson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA&#46;"
                        "fecha" => "2002"
                        "volumen" => "288"
                        "paginaInicial" => "1728"
                        "paginaFinal" => "1732"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12365956"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Establishing a standard definition for child overweight and obesity worldwide&#58; international survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "TJ Cole"
                            1 => "MC Bellizzi"
                            2 => "KM Flegal"
                            3 => "WH Diets"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2000"
                        "volumen" => "320"
                        "paginaInicial" => "1"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10617503"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of symptoms and risk of sleep apnea in primary care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "NC Netzer"
                            1 => "JJ Hoegel"
                            2 => "D Loube"
                            3 => "CM Netzer"
                            4 => "B Hay"
                            5 => "R &#193;lvarez-Sala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2003"
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                        "paginaInicial" => "1406"
                        "paginaFinal" => "1414"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14555573"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "the genesis of adult sleep apnoea in childhood"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F McNamara"
                            1 => "CE Sullivan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2000"
                        "volumen" => "55"
                        "paginaInicial" => "964"
                        "paginaFinal" => "969"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11050269"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Snoring in 9-15 year-old children&#58; risk factors and clinical relevance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "GM Corbo"
                            1 => "F Forastiere"
                            2 => "N Agabiti"
                            3 => "R Pistelli"
                            4 => "V dell&#39;Orco"
                            5 => "CA Perucci"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2001"
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                        "paginaInicial" => "1149"
                        "paginaFinal" => "1154"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11694695"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Morning levels of C-reactive protein in children with obstructive sleep-disordered breathing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "AG Kaditis"
                            1 => "EI Alexopoulos"
                            2 => "E Kalampouka"
                            3 => "E Kostadima"
                            4 => "A Germenis"
                            5 => "E Zintzaras"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.2412001"
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                        "tituloSerie" => "Am J Respir Crit Care Med&#46;"
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                        "paginaInicial" => "202"
                        "paginaFinal" => "203"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15668301"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Plasma C-reactive protein levels among children with sleep-disordered breathing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R Tauman"
                            1 => "A Ivanenko"
                            2 => "LM O&#39;Brien"
                            3 => "D Gozal"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
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                        "paginaFinal" => "e5e9"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15173538"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Childhood obesity&#44; inflamation and apnea&#46; What is the future for our children&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A Kelly"
                            1 => "CL Marcus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Crit Care Med&#46;"
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                        "paginaInicial" => "282"
                        "paginaFinal" => "286"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of pulmonary function and polysomnography in obese children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "CL Marcus"
                            1 => "S Curtis"
                            2 => "CB Koerner"
                            3 => "A Joffe"
                            4 => "JR Serwint"
                            5 => "GM Loughlin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/(SICI)1099-0496(199603)21:3<176::AID-PPUL5>3.0.CO;2-O"
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                        "tituloSerie" => "Pediatr Pulmonol&#46;"
                        "fecha" => "1996"
                        "volumen" => "21"
                        "paginaInicial" => "176"
                        "paginaFinal" => "183"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8860073"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical features of obstructive sleep apnea hypoventilation syndrome in otherwise healthy children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "CL Rosen"
                          ]
                        ]
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                    ]
                  ]
                  "host" => array:1 [
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                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatr Pulmonol&#46;"
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                        "paginaFinal" => "409"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8649921"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Snoring and atopic disease&#58; a strong association"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "SY Chng"
                            1 => "DY Goh"
                            2 => "XS Wang"
                            3 => "TN Tan"
                            4 => "NB Ong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ppul.20075"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Pulmonol&#46;"
                        "fecha" => "2004"
                        "volumen" => "38"
                        "paginaInicial" => "210"
                        "paginaFinal" => "216"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15274099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Associations of obesity&#44; sleep-disordered breathing and wheezing in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "LG Suilt"
                            1 => "A Storfer-Isser"
                            2 => "CL Rosen"
                            3 => "HL Kirchner"
                            4 => "S Redline"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200403-398OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med&#46;"
                        "fecha" => "2005"
                        "volumen" => "171"
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                        "paginaFinal" => "664"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15591475"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of a cardiorespiratory device versus polysomnography for diagnosis of sleep apnoea"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "JM Calleja"
                            1 => "S Esnaola"
                            2 => "R Rubio"
                            3 => "J Duran"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J&#46;"
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                        "volumen" => "20"
                        "paginaInicial" => "1505"
                        "paginaFinal" => "1510"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12503711"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
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              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#191;Hacia d&#243;nde va el diagn&#243;stico del s&#237;ndrome de apneashipopneas durante el sue&#241;o&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Arch Bronconeumol&#46;"
                        "fecha" => "2005"
                        "volumen" => "41"
                        "paginaInicial" => "645"
                        "paginaFinal" => "648"
                        "link" => array:1 [
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                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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                    0 => array:2 [
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                            1 => "J Mar"
                            2 => "G de la Torre"
                            3 => "R Rubio"
                            4 => "L Guerra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "link" => array:1 [
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              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Respiratory monitoring by means of an unattended device in children with suspected uncomplicated obstructive sleep apnea&#58; a validation study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            2 => "V Castronovo"
                            3 => "L Ferini-Strambi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "paginaFinal" => "607"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12907549"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Home cardiorespiratory sleep study in children&#46; Will it be feasible&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A Amorim"
                            1 => "M Sucena"
                            2 => "JC Winck"
                            3 => "J Almeida"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Pneumol&#46;"
                        "fecha" => "2004"
                        "volumen" => "10"
                        "paginaInicial" => "463"
                        "paginaFinal" => "474"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15735886"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validaci&#243;n de un equipo de poligraf&#237;a respiratoria en el diagn&#243;stico del s&#237;ndrome de apneas durante el sue&#241;o"
                      "autores" => array:1 [
                        0 => array:2 [
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                          "autores" => array:6 [
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                            1 => "L Hern&#225;ndez"
                            2 => "S Asensio"
                            3 => "J S&#225;nchez-Paya"
                            4 => "J Villa"
                            5 => "N Benito"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Bronoconeumol&#46;"
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                        "volumen" => "41"
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                        "paginaFinal" => "77"
                      ]
                    ]
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              "etiqueta" => "33"
              "referencia" => array:1 [
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                    0 => array:2 [
                      "titulo" => "Uso secuencial de la pulsioximetr&#237;a nocturna y la poligraf&#237;a respiratoria &#40;AutoSet&#191;&#41; para el diagn&#243;stico del s&#237;ndrome de apneas-hipopneas durante el sue&#241;o en pacientes con alta sospecha cl&#237;nica"
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                          "autores" => array:3 [
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                            2 => "P Roman"
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                        ]
                      ]
                    ]
                  ]
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Vol. 42. Issue 11.
Pages 583-587 (November 2006)
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Vol. 42. Issue 11.
Pages 583-587 (November 2006)
Original Articles
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Obstructive Sleep Apnea-Hypopnea Syndrome in Children Is Not Associated With Obesity
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Olaia Sardóna,
Corresponding author
osardon@chdo.osakidetza.net

Correspondence: Dra. O. Sardón. Unidad de Neumología Infantil. Hospital Donostia. Avda. Dr. Beguiristain, s/n. 20014 San Sebastián. Guipúzcoa. España
, Eduardo González Pérez-Yarzaa, Ane Aldasoraa, Andrea Bordoya, Javier Minteguia, José Ignacio Emparanzab
a Unidad de Neumología, Servicio de Pediatría, Hospital Donostia, San Sebastián, Guipúzcoa, Spain
b Unidad de Epidemiología Clínica e Investigación, Hospital Donostia, San Sebastián, Guipúzcoa, Spain
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Objective

The prevalence of obstructive sleep apnea hypopnea syndrome (OSAHS) in the general pediatric population ranges from 1% to 3%. However, its prevalence in an unselected population of obesity and OSAHS in children diagnosed with the syndrome in a cohort of boys and girls (age range, 2-14 years) referred to the pediatric respiratory medicine outpatient clinic at our hospital for suspected apnea, snoring, or both over the past 5 years.

Patients and methods

The medical history of each patient was recorded and all patients underwent a physical examination, chest and nasal cavities radiography, and 8-channel respiratory polygraphy during sleep. the following variables were evaluated: sex, reason for consultation, source of referral, findings during upper airway examination, age, weight z-score (reflecting how much a finding differs from the mean and in what direction in a normally distributed sample), height z-score, body mass index (BMI) z-score, number of apneas, number of hypopneas, apnea index, hypopnea index, apnea-hypopnea index (AHI), oxygen saturation (mean and minimum) measured by pulse oximetry, number of snores, and snore index.

Results

Of the 400 patients studied, 242 (60.5%) were male and 158 (39.5%) female. the mean age was 4.95 years. OSAHS (AHI≥3) was diagnosed in 298 cases (74.5%) and these patients were then studied to determine the relation between OSAHS and obesity. the anthropometric distribution (expressed as mean [SD]) was as follows: weight z-score, 0.37 (1.31); height z-score, 0.23 (1.19); BMI, 17.063 kg/m2 (2.51); and BMI z-score, 1.39 (1.36). the respiratory polygraph during sleep recorded an AHI of 6.56 (7.56).

Conclusions

No differences were observed between the height z-score, weight z-score, BMI z-score, age, and AHI. No association between obesity and OSAHS was found in this series. However, studies of larger, unselected populations are needed to determine if obesity is a risk factor for OSAHS in children.

Key words:
Obstructive sleep apnea-hypopnea syndrome
OSAHS
Obstructive apneas
Obesity
Children
Objetivo

El síndrome de apneas-hipopneas obstructivas durante el sueño (SAHOS) alcanza una prevalencia del 1-3% en población general infantile. Sin embargo, en población obesa no preseleccionada la prevalencia es desconocida. Para estudiar la asociación entre SAHOS y obesidad en niños diagnosticados de dicho trastorno, hemos analizado a una cohorte de niños y niñas (2-14 años) remitidos en los últimos 5 años a consulta externas de neumología infantile porsospecha de apneas durante el sueño, ronquido o ambos.

Pacientes y métodos

A los pacientes incluidos se les realizaron anamesis, exploración física, radiografía de tórax y cávum y poligrafía respiratoria durante el sueño con 8 canales. Se analizaron las siguientes variables: sexo, motivo de consulta, procedencia, exploración de la vía aérea superior, edad, z-score del peso (cuánto se desvía la media de peso y en qué dirección respecto de la media de peso de una distribución normal), z-score de la talla (cuánto se desvía la media de la talla y en qué dirección respecto de la media de la talla de una distribución normal), z-score del índice de masa corporal (IMC; cuánto se desvía la media del IMC y en qué dirección respecto de la media del IMC de una distribución normal), número de apneas, número de hipopneas, índice de apneas/h, índice de hipopneas/h índice de apneas-hipopneas/h (IAH/h), saturación de oxígeno por pulsioximetría (media y mínima), número de ronquidos e índice de ronquidos/h.

Resultados

Se estudió a 400 pacientes, con una edad media de 4,95 años, de los que 242 eran varones (60,5%) y 158 niñas (39,5%). Se diagnosticó de SAHOS (IAH/h ≥ 3) a 298 (74,5%), y en éstos se analizó la relación entre SAHOS y obesidad. La distribución antropométrica (expresada en media ± desviación estándar) fue la siguiente: z-peso de 0,37 ± 1,31; z-talla de 0,23 ± 1,19; IMC de 17,063 ± 2,51 kg/m2, y z-IMC de 0,39 ± 1,36. Los resultados de la poligrafía respiratoria durante el sueño mostraron un IAH/h de 6,56 ± 7,56.

Conclusiones

No se han encontrado diferencias entre z-talla, z-peso, z-IMC, edad e IAH/h. En esta serie la obesidad no se asocial a SAHOS. Sin embargo, se requieren estudios en poblaciones más amplias y no preseleccionadas para evaluar si la obesidad actúa o no como factor de riesgo para desarrollar SAHOS en niños.

Palabras clave:
Síndrome de apneas-hipopneas durante el sueño
Apneas obstructivas
Obesidad
Niños
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REFERENCES
[1]
M Schauld, MS Urschitz, PM Urschitz-Duprat, CF Poets.
the German study on sleep-disordered breathing in primary school children: epidemiological approach, representative study sample, and preliminary screening results.
Paediatr Perinat Epidemiol., 18 (2004), pp. 431-440
[2]
B Sobradillo, A Aguirre, U Aresti, C Bilbao, C Fernández-Ramos, A Lizarraga, et al.
Curvas y tablas de crecimiento (estudio longitudinal y transversal).
Patrones de crecimiento y desarrollo en España. Atlas de gráficas y tablas, pp. 145-168
[3]
Documento de consenso nacional sobre el síndrome de apneashipopneas del sueño (SAHS). Grupo Español de Sueño (GES).
Consenso nacional sobre el síndrome de apneas-hipopneas del sueño.
Arch Bronconeumol., 41 (2005), pp. 1-110
[4]
CL Marcus.
Sleep disordered breathing in children.
Am J Respir Crit Care Med., 164 (2001), pp. 16-30
[5]
DYT Goh, P Galster, CL Marcus.
Sleep architecture and respiratory disturbances in children with obstructive sleep apnea.
Am J Respir Crit Care Med., 162 (2000), pp. 682-686
[6]
B Sobradillo, A Aguirre, U Aresti, C Bilbao, C Fernández-Ramos, A Lizarraga, et al.
Curvas y tablas de crecimiento (estudio longitudinal y transversal).
Patrones de crecimiento y desarrollo en España. Atlas de gráficas y tablas, pp. 145-168
[7]
MM Saeed, TG Keens, MW Stabile, J Bolokowicz, SL Davidson Ward.
Should children with suspected obstructive sleep apnea syndrome and normal nap sleep studies have overnight sleep studies.
Chest, 118 (2000), pp. 360-365
[8]
CD Hanevold, PL Ho, L Talley, MM Mitsnefes.
Obesity and renal transplant outcome: a report of the North American Pediatric Renal Transplant Cooperative Study.
Pediatrics, 115 (2005), pp. 352-356
[9]
RC Whitaker.
Predicting preschooler obesity at birth: the role of maternal obesity in early pregnancy.
Pediatrics, 114 (2004), pp. e29-e36
[10]
CL Marcus.
Obstructive sleep apnea syndrome: differences between children and adults.
Sleep, 23 (2000), pp. 140-141
[11]
S Kotagal.
Childhood obstructive sleep apnea.
[12]
J de Miguel, JR Villa, JL Álvarez.
Características del síndrome de apnea obstructiva del sueño en pacientes con un síndrome de Down.
Arch Bronconeumol., 38 (2002), pp. 77-80
[13]
J Montserrat, L Hernández, M Nacher, F Barbe.
Nuevos aspectos patogénicos en el síndrome de apneas e hipopneas durante el sueño (SAHS).
Arch Bronconeumol., 40 (2004), pp. 27-34
[14]
PM Canning, ML Courage, LM Frizzell.
Prevalence of overweight and obesity in a provincial population of Canadian preschool children.
CMAJ, 171 (2004), pp. 240-242
[15]
CL Ogden, KM Flegal, MD Carroll, CL Jonson.
Prevalence and trends in overweight among children and adolescents, 1999-2000.
JAMA., 288 (2002), pp. 1728-1732
[16]
TJ Cole, MC Bellizzi, KM Flegal, WH Diets.
Establishing a standard definition for child overweight and obesity worldwide: international survey.
BMJ, 320 (2000), pp. 1-6
[17]
NC Netzer, JJ Hoegel, D Loube, CM Netzer, B Hay, R Álvarez-Sala, et al.
Prevalence of symptoms and risk of sleep apnea in primary care.
Chest, 124 (2003), pp. 1406-1414
[18]
F McNamara, CE Sullivan.
the genesis of adult sleep apnoea in childhood.
Thorax, 55 (2000), pp. 964-969
[19]
GM Corbo, F Forastiere, N Agabiti, R Pistelli, V dell'Orco, CA Perucci, et al.
Snoring in 9-15 year-old children: risk factors and clinical relevance.
Pediatrics, 108 (2001), pp. 1149-1154
[20]
AG Kaditis, EI Alexopoulos, E Kalampouka, E Kostadima, A Germenis, E Zintzaras, et al.
Morning levels of C-reactive protein in children with obstructive sleep-disordered breathing.
Am J Respir Crit Care Med., 171 (2005), pp. 202-203
[21]
R Tauman, A Ivanenko, LM O'Brien, D Gozal.
Plasma C-reactive protein levels among children with sleep-disordered breathing.
Pediatrics, 113 (2004), pp. e564-e5e9
[22]
A Kelly, CL Marcus.
Childhood obesity, inflamation and apnea. What is the future for our children?.
Am J Crit Care Med., 171 (2005), pp. 282-286
[23]
CL Marcus, S Curtis, CB Koerner, A Joffe, JR Serwint, GM Loughlin.
Evaluation of pulmonary function and polysomnography in obese children and adolescents.
[24]
CL Rosen.
Clinical features of obstructive sleep apnea hypoventilation syndrome in otherwise healthy children.
Pediatr Pulmonol., (1999), pp. 403-409
[25]
SY Chng, DY Goh, XS Wang, TN Tan, NB Ong.
Snoring and atopic disease: a strong association.
Pediatr Pulmonol., 38 (2004), pp. 210-216
[26]
LG Suilt, A Storfer-Isser, CL Rosen, HL Kirchner, S Redline.
Associations of obesity, sleep-disordered breathing and wheezing in children.
Am J Respir Crit Care Med., 171 (2005), pp. 659-664
[27]
JM Calleja, S Esnaola, R Rubio, J Duran.
Comparison of a cardiorespiratory device versus polysomnography for diagnosis of sleep apnoea.
Eur Respir J., 20 (2002), pp. 1505-1510
[28]
J Durán.
¿Hacia dónde va el diagnóstico del síndrome de apneashipopneas durante el sueño?.
Arch Bronconeumol., 41 (2005), pp. 645-648
[29]
J Durán, J Mar, G de la Torre, R Rubio, L Guerra.
El síndrome de apneas-hipopneas durante el sueño en España. Disponibilidad de recursos para su diagnóstico y tratamiento en los hospitales del Estado español.
Arch Bronconeumol., 40 (2004), pp. 259-267
[30]
M Zucconi, G Calori, V Castronovo, L Ferini-Strambi.
Respiratory monitoring by means of an unattended device in children with suspected uncomplicated obstructive sleep apnea: a validation study.
Chest, 124 (2003), pp. 602-607
[31]
A Amorim, M Sucena, JC Winck, J Almeida.
Home cardiorespiratory sleep study in children. Will it be feasible?.
Rev Port Pneumol., 10 (2004), pp. 463-474
[32]
A Candela, L Hernández, S Asensio, J Sánchez-Paya, J Villa, N Benito, et al.
Validación de un equipo de poligrafía respiratoria en el diagnóstico del síndrome de apneas durante el sueño.
Arch Bronoconeumol., 41 (2005), pp. 71-77
[33]
MA Martínez, JJ Soler, P Roman.
Uso secuencial de la pulsioximetría nocturna y la poligrafía respiratoria (AutoSet¿) para el diagnóstico del síndrome de apneas-hipopneas durante el sueño en pacientes con alta sospecha clínica.
Arch Bronconeumol., 39 (2003), pp. 74-80
Copyright © 2006. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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