[Long-term persistence of obstructive sleep apnoea-hypopnoea syndrome in children treated with adenotonsillectomy. Analysis of prognostic factors]. / Persistencia a largo plazo del síndrome de la apnea-hipopnea obstructiva del sueño infantil tratada con adenoamigdalectomía. Análisis de factores pronósticos.

INTRODUCTION: Treatment of obstructive sleep apnoea-hypopnoea syndrome in children with adenotonsillectomy is effective but has a moderate rate of persistent disease. OBJECTIVES: To analyse the rate of persistence of sleep apnoea-hypopnoea syndrome in a group of adenotonsillectomy-treated paediatric patients and to assess the possible prognostic factors. METHODS: Prospective study of 80 patients aged between 2 and 13 years who had obstructive sleep apnoea-hypopnoea syndrome, treated with adenotonsillectomy. All patients had been followed up clinically and by polysomnography for 1 year after surgery. We analysed the epidemiological and clinical factors that could negatively affect the outcome of surgery. RESULTS: The median age was 5.25 ± 2.05 years and the mean apnoea-hypopnoea index (AHI) was 8.13 ± 6.06. One year after surgery, all clinical parameters improved significantly and the mean AHI was 2.50. Persistent disease (AHI≥3) was present in 21 of the patients (26.3%). The comparative analysis of clinical and epidemiological factors between the group of non-persistence and persistence did not obtain statistically-significant differences in age, sex, tonsillar size, Friedman degree or severity of preoperative disease. The only significant factor was that patients without persistence were more obese. CONCLUSION: The results of our study about the persistence of obstructive sleep apnoea-hypopnoea syndrome after adenotonsillectomy are significant enough to recommend follow-up with polysomnography, especially in high-risk groups. In the series presented here, we were not able to demonstrate these risk factors. Our results are probably conditioned by the characteristics of the population studied: Low age, low obesity rate and less severe levels of apnoea-hypopnoea index.

[Childhood obesity and sleep-related breathing disorders]. / Obesidad infantil y trastornos respiratorios del sueño.

INTRODUCTION: The increasing prevalence of childhood obesity leads to an increase risk of sleep-disordered breathing and may exacerbate their comorbidities. PURPOSE: To assess the rate of obesity in children with sleep-disordered breathing and to study the possible clinical and epidemiological differences between children with and without overweight in a private hospital in the Mediterranean area. MATERIALS AND METHODS: We prospectively studied 340 children between 2 and 10 years. There were 170 children with sleep-disordered breathing (study group) and 170 healthy children (control group). In the problem group, the apnea-hypopnea index was around 7.61 ± 6.3. RESULTS: The comparison of the percentage of cases with a BMI percentile ≥85 (overweight) between problem and control groups (44: 25.9% vs 34: 20%) or with a BMI ≥95 (obesity) (30: 17.6% vs 20: 11.8%) showed no statistically-significant differences. In addition, the comparison of clinical and epidemiological variables in the problem group, cases with (44/170: 25.9%) and without (126/170: 74.1%) overweight, did not show significant differences in any of the parameters analysed. CONCLUSION: In the population studied, it does not appear that the group of children with sleep breathing disorders presents higher rates of obesity, nor does obesity influence its presentation clinically. These results had probably been influenced by the characteristics of the studied population and therefore should not be an obstacle for being attentive to the possible association of respiratory disease to obesity and its negative consequences.

[Dentofacial development abnormalities in paediatric sleep-related breathing disorders]. / Alteraciones del desarrollo dentofacial en los trastornos respiratorios del sueño infantil.

INTRODUCTION: The recent interest in sleep-related breathing disorders has re-opened the old debate as to whether there is a causal relationship between upper respiratory obstruction and abnormalities in dentofacial development. OBJECTIVE: To establish the impact of dentofacial development on sleep-related breathing disorders in children. METHOD: This is a prospective study in which the dentofacial studies of 30 children, diagnosed with a sleep-related breathing disorder using polysomnography, were compared with a control group of 30 healthy children. The ages of both groups were between 3 and 13 years. RESULTS: The statistical analysis showed significant differences between the groups in the proportion of children with a narrow palate (83% of the problem group and 57% in the control; P=0.024) and cross bite (40% and 13%; P=0.020). On comparing the angles measured, the only statistically-significant difference was the skull base-mandibular plane angle: The problem children group had a mean of 37.59±5.56 and the control group, a mean of 34.41±4.62 (P=0.023). CONCLUSION: Children with sleep-related breathing disorders have abnormalities in facial and dental development caused by upper respiratory obstruction. These anomalies, vertical growth of the face, narrow palate and dental occlusion changes should be taken into account when assessing the indication for a adenotonsillectomy.

[Mandibular advancement devices for the treatment of adult sleep respiratory disorders]. / Dispositivos de avance mandibular para el tratamiento de los trastornos respiratorios del sueño del adulto.

INTRODUCTION: Mandibular advancement devices are being shown to be increasingly useful in the treatment of adult respiratory sleep disorders. A prospective study was started in April 2008 to apply 40 devices free of charge, with the aim of assessing their usefulness in our patients. MATERIAL AND METHODS: The device was applied to 40 patients with an apnoea-hypopnoea index of less than 40. All the cases snored, with 52.5% observed apnoeas and 47.5% diurnal sleepiness. RESULTS: With a minimum follow-up of six months, the cases that snored decreased to 59%, most with a significantly lower intensity; 8.8% of cases had observed apnoeas and 14.7% mentioned diurnal sleepiness. There was an overall clinical improvement in 31 (91.2%) patients. The mean apnoea-hypopnoea index fell to 8.4+/-9.6 and polysomnographic improvement could be seen in 25 (75%) cases. An overall positive result, showing subjective as well as objective improvement, was obtained in 23 (69.7%) patients. Two patients stopped using the device in the first few days and another patient after six months. Complications were relatively common, but always slight. Compliance levels were satisfactory: a mean of 6.5+/-1.1 nights per week and 7.4+/-1.09 days per week. CONCLUSION: Mandibular advancement devices are an effective therapeutic option for the treatment of respiratory sleep disorders. Compliance levels can be satisfactory if working with an expert odontology team.

[Neurocognitive and behavioural abnormalities in paediatric sleep-related breathing disorders]. / Alteraciones neurocognitivas y conductuales en los trastornos respiratorios del sueño infantil.

INTRODUCTION: Behavioural and neurocognitive abnormalities in children may be a consequence of sleep-related breathing disorders. The effectiveness of assessments based on questioning parents is dubious and objective assessment tools are therefore required. AIM: To ascertain the impact of these abnormalities in children with sleep-related breathing disorders and compare the reliability of questioning parents in relation to validated psychological tests. METHOD: A prospective study was performed on 20 children with sleep-related breathing disorders and 20 healthy control children between 3 and 12 years of age. Both groups were subjected to a battery of validated psychological tests. The results of both groups were compared with each other and with the response to clinical questionnaires given to parents in the problem group. RESULTS: More than 75% of the cases in the problem group presented abnormalities with regard to attention, anxiety, memory and spatial structuring. The percentage involvement in all concepts was higher in the problem group. Comparisons of attention (40% of children affected in the control group and 80% in the problem group), memory (50% and 84.2%), and spatial structuring (45% and 75%) were statistically significant. More abnormality was observed in the parameters assessed with psychological tests than the equivalent concept obtained from interviewing the parents. Comparison of abnormal concentration assessed from the questionnaires (40% of children affected) with attention during the psychological test (80%), memory (15% and 84.21%), and delayed language development (10%) compared to spatial structuring (75%) was statistically significant. CONCLUSIONS: A high prevalence of behavioural and neurocognitive abnormalities was observed in children with sleep-related breathing disorders compared to a control group of healthy children. The use of objective assessment such as psychological tests revealed more abnormalities than were expressed by parents in response to clinical interviews.

[Clinical efficacy and polysomnography of adenotonsillectomy in the treatment of sleep-related respiratory disorders in children]. / Efectividad clínica y polisomnográfica de la adenamigdalectomía en el tratamiento de los trastornos respiratorios del sueño en los niños.

INTRODUCTION: If sleep-related breathing disorders in children are not treated quickly, they may be harmful to the child's future development. The best diagnostic test is polysomnography, since clinical assessments alone are not enough. Adenotonsillectomy is the most effective and widespread treatment for such disorders. OBJECTIVE: To assess clinical data on sleep-related breathing disorders, particularly in relation to behaviour and neurocognition, their long-term resolution with surgery and correlation with PSG data. METHOD: Prospective study with 73 children between 3 and 11 years of age, attending a special clinic for sleep-related breathing disorders. A medical history questionnaire was given to the parents, which included questions on the child's sleep patterns, respiratory disorders and behavioural and neurocognitive changes, and a polysomnography was carried out. Cases requiring surgery were monitored after 9 months by means of a further questionnaire and a follow-up polysomnography. RESULTS: Of the 73 children tested, 100 % snore, 87.5 % display objective apnoeas and 89 % suffer from nasal congestion. Drowsiness during the day was reported in only 28 %. Over 50 % of cases report aggressiveness or hyperactivity, while 41 % have concentration difficulties. In 61 of the 73 cases (83.6 %) given a pre-operative polysomnography, the mean apnoea-hypopnoea index was 6.44 (4.44). Postoperative follow-up is available for 44 cases, 29 of them with polysomnography. The resolution of clinical symptoms is highly satisfactory in these cases, but 5 patients (17.2 %) still have an apnoea-hypopnoea index of more than 3. CONCLUSIONS: Adenotonsillectomy is effective in curing the majority of sleep-related respiratory disorder symptoms in children. However, a significant percentage of cases display a persistent polysomnographic change. Long-term postoperative monitoring is recommended in such cases.

[Diagnosis of proximal gastro-oesophageal reflux in patients with rhonchopathy and sleep apnoea]. / Diagnóstico de reflujo gastroesofágico proximal en pacientes con trastornos respiratorios del sueño.

INTRODUCTION: The close relationship between gastro-oesophageal reflux disease and sleep-related breathing disorders allows the consideration of treatment with proton pump inhibitors as a feasible alternative for patients with snoring or mild to moderate sleep apnoea syndrome. Nevertheless, the presence of gastro-oesophageal reflux in the proximal oesophagus must be identified objectively with a double channel oesophageal pH-metry. OBJECTIVE: To identify clinical data allowing the selection of patients most likely to have proximal oesophageal reflux, and, therefore, candidates for oesophageal pH-metry. MATERIAL AND METHOD: Between January 2004 and September 2006, 121 patients were prospectively included. In these patients, a nocturnal polysomnography and a 24 hour double channel pH-metry were performed on the same day. We compared statistically the clinical data, endoscopic examination of the upper airway and the pH-metry results. RESULTS: A good correlation was observed between the presence of symptoms suggesting pharyngo-laryngeal acid reflux and endoscopic examination of this area (P< .009). However, the comparison between clinical data and pH-metry results was not statistically significant. CONCLUSIONS: Clinical symptoms and endoscopic examination alone are not good tools to determine the presence of gastro-oesophageal reflux in the pharynx, in this group of patients. Its presence must be ascertained by a double channel oesophageal pH-metry.