[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.

[Continuous positive airway pressure treatment in sleep-related respiratory disorders in children]. / Tratamiento con presión positiva continua en los trastornos respiratorios del sueño en los niños.

Continuous positive airway pressure (CPAP) is the first choice in the treatment of apnea-hypopnea syndrome in adults and, in recent years, is considered the second option after surgery in children. CPAP is the best option in children if apnea-hypopnea syndrome persists after surgery. For many professionals in the field, the use of CPAP in all ages of children and adolescents is safe, effective and well tolerated. Follow-up visits are required every 6-12 months, since the mask pressure and size requirements will change depending on children's growth and development. The success of the use of CPAP is closely related to children's tolerance of the CPAP mask. Many professionals have described strategies to improve this tolerance. One of these strategies is to use behavioral therapy, which has been shown be effective in increasing tolerance and performance of the CPAP.

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

Introducción: La adenoamigdalectomía (AA) para tratar el síndrome de apnea obstructiva del sueño (SAHOS) infantil es efectiva, pero presenta una moderada tasa de persistencia. Objetivo: Analizar la tasa de persistencia en un grupo de pacientes pediátricos tratados con AA y los posibles factores pronósticos. Metodos: Estudio prospectivo con 80 pacientes, entre dos y 13 años de edad, sometidos a AA por SAHOS. Seguidos clínica y polisomnográficamente a un año de la cirugía. Se analizan los factores epidemiológicos y clínicos que pudieran afectar negativamente el resultado de la cirugía. Resultados: La edad media fue de 5,25±2,05 años y el índice de apnea-hipopnea (IAH) medio de 8,13±6,06. Al año, todos los parámetros clínicos mejoraron significativamente y el IAH medio es 2,50. Presentaron persistencia de enfermedad (IAH ≥3), 21 casos (26,3%). Del análisis comparativo de los factores clínicos y epidemiológicos entre el grupo con y sin persistencia, no se obtuvieron diferencias significativas ni en edad y sexo, ni en talla y grado amigdalar de Friedman ni en la severidad de la enfermedad preoperatorios. Únicamente resultó significativo que los pacientes sin persistencia eran más obesos. Conclusión: Las cifras de persistencia del SAHOS después de AA fueron significativas y aconsejaron seguimiento con polisomnografía, especialmente en los grupos de riesgo. En esta serie no se han podido demostrar estos factores de riesgo. Es probable que los resultados estén condicionados por el tipo de población del estudio: edad baja, bajo porcentaje de obesidad y niveles de IAH menos severos(AU)

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(AU)

Tratamiento con presión positiva continua en los trastornos respiratorios del sueño en los niños / Continuous positive airway pressure treatment in sleep-related respiratory disorders in children

La presión positiva continua (CPAP) es la primera opción en el tratamiento del síndrome de apnea-hipopnea (SAHS) del adulto y, en los últimos años se está considerando la segunda opción tras la cirugía en niños. Es la mejor opción en niños en los que el SAHS persiste a pesar de la intervención quirúrgica. Para muchos autores, el uso de la CPAP en niños y adolescentes es seguro, efectivo y bien tolerado en todas las edades. Es necesario realizar controles frecuentes cada 6–12 meses, pues los requerimientos de presión y talla de la mascarilla cambiarán con el crecimiento y el desarrollo del niño. El éxito en el uso de la CPAP va muy unido a la tolerancia de los niños hacia el mismo. Muchos autores han descrito estrategias para mejorar la tolerancia. Entre ellas, la terapia conductual ha demostrado ser eficaz para aumentar la tolerancia y el cumplimiento a la CPAP(AU)

Continuous positive airway pressure (CPAP) is the first choice in the treatment of apnea-hypopnea syndrome in adults and, in recent years, is considered the second option after surgery in children. CPAP is the best option in children if apnea-hypopnea syndrome persists after surgery. For many professionals in the field, the use of CPAP in all ages of children and adolescents is safe, effective and well tolerated. Follow-up visits are required every 6–12 months, since the mask pressure and size requirements will change depending on children's growth and development. The success of the use of CPAP is closely related to children's tolerance of the CPAP mask. Many professionals have described strategies to improve this tolerance. One of these strategies is to use behavioral therapy, which has been shown be effective in increasing tolerance and performance of the CPAP(AU)

Polisomnografía y otros métodos de registro / Polysomnography and other sleep studies

Para el diagnóstico de la mayoría de alteraciones del sueño en los niños se necesita realizar pruebas complementarias. De estas pruebas complementarias, especialmente cuando se quieren estudiar los trastornos respiratorios del sueño en el niño, destacan la polisomnografía nocturna completa, considerada actualmente la prueba de referencia para el diagnóstico de las alteraciones del sueño. Sin embargo, hay otras pruebas simplificadas que, aunque con menos información y fiabilidad, pueden constituir alternativas diagnósticas aceptables, como son la poligrafía respiratoria y el registro de pulsioximetría. En este artículo se explicarán las principales indicaciones, metodología y ventajas e inconvenientes de las diferentes pruebas de sueño(AU)

Additional tests are needed for an accurate diagnosis of most sleep disorders in children. Of these additional tests, especially when study of sleep breathing disorders in children is required, complete overnight polysomnography is currently considered the gold standard for the diagnosis of sleep disorders. There are, however, other simplified tests, although less informative and reliable, which may be acceptable diagnostic alternatives, such as respiratory polygraphy and pulse oximetry recording. This article will explain the main indications, methodology and advantages and disadvantages of the various sleep tests(AU)

Hábitos de sueño y consumo de tóxicos de los adolescentes / No disponible

No disponible

Efectos de fármacos hipnóticos en el embarazo y la lactancia / Drugs hypnotics in pregnancy and lactation

La utilización de psicofármacos, especialmente hipnóticos y ansiolíticos puede ser necesaria en algunas mujeres gestantes y lactantes. No obstante la escasa información científica existente sobre el tema puede condicionar la correcta administración terapéutica. En parte es totalmente comprensible ya que no se pueden realizar, por cuestiones evidentemente éticas, ensayos clínicos en humanos que nos den alguna información sobre el tema. Lo mejor es conocer que existen algunas de estas sustancias que pueden utilizarse y que el control medico es imprescindible para garantizar la buena alud tanto de la madre como del feto. Por eso hemos creído necesaria la compilación de información acerca de la idoneidad de la administración de estos psicofármacos. Para poder aportar datos científicos contrastados hemos consultado tres organismos que han estudiado y dictado normas sobre estos temas, la FDA (food and drug administration) y la ADEC (australian drug evaluation committee) para el tema de la gestación, y la Escuela Andaluza de Salud Pública, para la lactancia (AU)

The use of psychotropics specially hypnotics and anxiolytics can be necessary in some pregnant and nursing women. Despite the lack of scientific information on the subject it can affect the correct therapeutic administration. The lack of information is understandable due to the impossibility to do, for ethical reasons, clinical tests in humans. The best thing is to know than some of these substances exist that they can be used and that medical control is essential to insure the good health of both the mother and of the fetus. For that reason we have believe necessary an information compilation about the suitability of the administration of these drugs. In order to be able to compare dictated scientific data we have consulted three agencies that have studied and dictated norms on these subjects, the FDA (food and drug administration), the ADEC (Australian Drug Evaluation Committee) in relation to pregnancy and Escuela Andaluza de Salud Pública in relation to breast feeding (AU)