Excessively crying infants are more common among children of parents with restless legs syndrome / Bebes com choro e agitação excessivos têm mais comumente pais com síndrome de pernas inquietas

OBJECTIVE: We have frequently observed that infants presenting with excessive crying and fussing, or colic at night have parents with Restless Legs Syndrome. Our objective was to determine if these infants are more likely to have parents with Restless Legs Syndrome (Willis-Ekbom Disease). METHODS: We interviewed 67 families with infants and children, in search of a history of excessive crying and fussing during their first four months of life. Their parents were investigated for Restless Legs Syndrome. RESULTS: Among the 134 interviewed parents, 39 (29%) had Restless Legs Syndrome. Among the 96 children, 37 (38%) presented excessive crying and fussing. Of these, 28 (76%) had at least one parent with Restless Legs Syndrome. Among the 59 children without excessive crying and fussing only 14 (24%) had at least one parent with Restless Legs Syndrome. The association between events (children of parents with vs. without Restless Legs Syndrome) was measured by the phi coefficient (0.510), indicating a more than trivial association. The estimated association was 75.7 vs. 27.7, Odds Ratio = 10 at 95% confidence interval, 3.82-26.15). CONCLUSION: Children with excessive crying and fussing were more likely to have at least one parent with Restless Legs Syndrome. The present evidence is insufficient to conclude that infantile excessive crying and fussing is equivalent to a a probable diagnosis of parental Restless Legs Syndrome. However, they provide information as well as the necessary motivation to undertake more extensive studies of infants with excessive crying and fussing.

OBJETIVO: Temos frequentemente observado que infantes que apresentam choro excessivo e agitação ou cólicas noturnas têm pais com Síndrome de Pernas Inquietas. Nosso objetivo foi determinar se estes infantes são mais propensos a terem pais com a Síndrome de Pernas Inquietas. MÉTODOS. Foram entrevistadas 67 famílias com infantes e crianças em busca de uma história de choro excessivo e agitação durante os primeiros 4 meses de vida. Seus pais foram investigadas para Síndrome de Pernas Inquietas. RESULTADOS: Dentre os 134 pais entrevistados, 39 (29%) tinham doença Willis-Ekbom. Entre as 96 crianças avaliadas 37 (38%) apresentaram choro excessivo e agitação. Destas, 28 (76%) apresentaram pelo menos um dos pais com Síndrome de Pernas Inquietas. Entre as 59 crianças sem choro excessivo e agitação, apenas 14 (23, 7%) apresentaram pelo menos um dos pais com a Síndrome de Pernas Inquietas. A associação entre os eventos (crianças de pais com ou sem Síndrome de Pernas Inquietas) foi medida pelo coeficiente phi (0,510), indicando uma associação mais do que trivial. As crianças com choro excessivo e agitação mostraram-se mais propensas a ter pelo menos um dos pais com a doença Willis-Ekbom (75,7 vs. 27,7, “Odds Ratio” = 10, com intervalo de confiança de 95%, 3,82-26,15). CONCLUSÃO: A evidência gerada por este estudo não é suficiente para concluir que o choro infantil excessivo e agitação é equivalente a um diagnóstico provável da doença Willis-Ekbom parental. No entanto, eles fornecem informações, bem como a motivação necessária para empreender estudos mais extensos sobre bebês com choro excessivo e agitação.

Class II correction improves nocturnal breathing in adolescents.

OBJECTIVE: To examine modifications in sleep pattern and in craniofacial morphology of adolescents with mandibular retrognathism. MATERIALS AND METHODS: Sixteen subjects at maximum pubertal growth (12.6 years [±11.5 months]) were selected and treated for 12 months with maxillary expansion and mandibular advancement with a Herbst appliance. Cephalometric radiography and magnetic resonance imaging were obtained prior to and after treatment and were compared using the paired Student's t-test or the nonparametric Wilcoxon rank-sum test. Four polysomnographic recordings were obtained with pressurized nasal cannulae and were analyzed by analysis of variance. RESULTS: The length of the mandible was increased, while the antero-posterior position of the maxilla remained stable. The posterior airway space was increased, the length of the tongue was preserved, and the hyoid bone was moved to a more anterior position. After Herbst treatment, sleep efficiency, sleep latency, rapid eye movement (REM) sleep latency, and percentage of REM sleep remained stable. We did observe a reduction (P < .05) in the relative proportions of stage 1 and stage 3-4 (from 4.30 ± 1.99 to 2.61 ± 1.83 for stage 1 and from 25.78 ± 7.00 to 19.17 ± 7.58 for stages 3-4) as well as an increase (P < .01) in the percentage of stage 2 after treatment (49.03 ± 6.25 to 56.90 ± 6.22). There was a reduction (P < .05) in the number of respiratory effort-related arousals (7.06 ± 5.37 to 1.31 ± 1.45 per hour of sleep) due to an increase (P < .01) in airway volume. CONCLUSIONS: In the short term, the increase in airway space improved nocturnal breathing associated with the correction of mandibular retrognathism.

Polisomnographic findings on children with laryngopathies.

UNLABELLED: Polysomnography is the goldstandard exam for child OSAS. When possible, polysomnography clearly distinguishes between those with isolated primary snoring and patients with sleep apnea (obstructive, central and mixed). The most common cause of OSAS in childhood is adenotonsillar hypertrophy. Laryngomalacia is the most common cause of stridor in childhood, though its physiopathology remains unknown. Among the most prominent theories are immaturity of the cartilaginous framework of the larynx and/or neuromuscular immaturity. OBJECTIVE: Our proposal was to describe polysomnographic findings in children with laryngomalacia or other isolated laryngeal alterations, that is, without other alterations in the upper airways. METHODS: The sample included 29 children with exclusively laryngeal alterations. All of them underwent an otorhinolaryngological exam, nasofibrolaryngoscopy and polysomnography. Information was recorded concerning age, nasofibrolaryngoscopy and polysomnography. For analysis, the children were divided into two groups: those with laryngomalacia and those with other laryngeal diseases. RESULTS: Among the 18 children with a diagnosis of laryngomalacia, 18 had central breathing events, knowing that the majority had showed desaturation of oxihemoglobin and bradycardia. In this same group, 3 children had obstructive events. On the other hand, 11 children with other laryngeal alterations showed no predominance of one type or another of apnea. Of these, 4 had central type breathing events and 2 obstructive type. CONCLUSION: The majority of patients with laryngomalacia showed a central type apnea. Patients with various laryngeal diseases did not present a predominant type of apnea.

Achados polissonográficos em crianças portadoras de laringopatias / Polisomnographic findings on children with laryngopathies

O exame diagnóstico padrão-ouro para SAOS na infância é a polissonografia. Quando pode ser efetuado, a polissonografia separa com clareza portadores de ronco primário de pacientes com apnéia (obstrutiva, central e mista) do sono. A causa mais freqüente da SAOS na infância é a hipertrofia adenoamigdaliana. Laringomalácia é a causa mais comum de estridor na infância, porém sua fisiopatologia permanece desconhecida. Entre as teorias mais aceitas estão a imaturidade do arcabouço cartilaginoso da laringe e/ou a imaturidade neuromuscular. OBJETIVO: Nossa proposta foi descrever os achados polissonográficos de crianças portadoras de laringomalácia e outras alterações laríngeas isoladas, ou seja, sem alterações nas vias aéreas superiores. MÉTODOS: Foram selecionadas 29 crianças portadoras de alterações laríngeas exclusivas. Todas foram submetidas a exame otorrinolaringológico, nasofibrolaringoscopia e polissonografia. Foram tabulados dados relativos à idade, nasofibrolaringoscopia e polissonografia. Para análise, as crianças foram separadas em 2 grupos: portadores de laringomalácia e portadores de outras doenças laríngeas. RESULTADOS: Dentre as 18 crianças com diagnóstico de laringomalácia, 18 apresentaram eventos respiratórios do tipo central, sendo a maioria dos episódios associados à dessaturação de oxigênio e alguns à bradicardia. Nesse mesmo grupo, 3 crianças apresentaram apnéia do tipo obstrutivo. Por outro lado, as 11 crianças portadoras de outras alterações laríngeas não apresentaram predominância entre um tipo ou outro de apnéia, 4 apresentaram eventos respiratórios do tipo central, 2 do tipo obstrutivo. CONCLUSÃO: A maioria dos pacientes acometidos por laringomalácia apresentou eventos respiratórios do tipo central quando avaliados pela polissonografia. Já os pacientes com outras doenças laríngeas não apresentaram predominância entre um tipo ou outro de apnéia.