Síndrome de apneas-hipopneas durante el sueño en obesos y no obesos: características clínicas, polisomnográficas y metabólicas / Sleep apnoea-hypopnoea syndrome in the obese and non-obese: clinical, polysomnographical and clinical characteristics

Introducción:El síndrome de apneas-hipopneas del sueño (SAHS) y la obesidad infantil son dos entidades con alta prevalencia que constituyen un problema de salud pública.Objetivo: Analizar la interacción entre ambas, comparando grupos de niños que presentaban o no ambas condiciones.Pacientes y metodología: Estudio prospectivo en niños (3-14 años), remitidos a la «Unidad Multidisciplinar de Sueño» por sospecha de SAHS, entre el 1/11/2015 y el 1/08/2017. Se evaluaron los siguientes parámetros: antropometría, síntomas, tensión arterial, exploración otorrinolaringológica, polisomnografía (PSG nocturna) y estudio analítico.Resultados: Se valoraron 67 niños, 64% no obesos y 36% obesos.Se observó que los obesos tenían más edad (p<0,001), dormían menos horas (p=0,028), realizaban menos ejercicio físico (p=0,029), comían menos en comedor escolar (p=0,009), tenían menor eficiencia del sueño y presentaban valores alterados en el metabolismo hidrocarbonado y lipídico.Los niños que presentaban SAHS tenían menor edad (p=0,010), un mayor porcentaje de somnolencia diurna (p=0,001) y respiración bucal (p=0,006), mayor percentil de tensión arterial diastólica (p=0,019) y menor IGF-1 (p=0,003) que los que no presentaban SAHS.La comparación de los grupos de SAHS no obesos frente SAHS obesos, reveló que los primeros eran de menor edad (p=0,010), roncaban más (p=0,012), tenían mayor severidad del SAHS (IAH 13,1 vs. 5,4, p=0,041) y mayor GOT (p≤0,001) y en el segundo grupo, se objetivó que dormían menos horas (p=0,038) y mostraban valores mayores de glucosa (p=0,039), insulina (p<0,001) y HOMA (p<0,001). (AU)

Introduction: Sleep apnoea-hypopnoea syndrome (SAHS) and childhood obesity are la high prevalence conditions that represent a public health challenge.Objective: To analyse the association between both and comparing child groups that had or did not have both conditions.Patients and methods: A prospective study in children (3-14 years), referred to the “Multidisciplinary Sleep Unit” due to suspected SAHS, between 1 November 2015 and 1 August 2017. The following parameters were evaluated: anthropometry, symptoms, blood pressure, ear, nose, and throat examination, polysomnography (nocturnal PSG) and laboratory tests.Results: A total of 67 children were evaluated (64% non-obese and 36% obese.It was observed that the obese were older (P<.001), slept less hours (P=.028), did less physical exercise (P=.029), ate less in the school dining room (P=.009), had la lower sleep efficiency, and had abnormal values in carbohydrate and lipid metabolism.The children with SAHS were younger (P=.010), a high percentage of daytime sleepiness (P=.001), and breathing through the mouth (P=.006), greater percentile of diastolic blood pressure (P=.019) and a lower IGF-1 (P=.003) than those that did not have SAHS. (AU) The comparison of the SAHS non-obese and SAHS obese groups, showed that the first group were younger (P=.010), snored more (P=.012), had a more severe SAHS (IAH 13.1 vs. 5.4, P=.041), and a higher GOT (P<.001). In the second group, they slept less hours P=.038) and showed lower values of glucose (P=.039), insulin (P<.001), and HOMA (P<.001).

Sleep apnoea-hypopnoea syndrome in the obese and non-obese: Clinical, polysomnographical and clinical characteristics.

INTRODUCTION: Sleep apnoea-hypopnoea syndrome (SAHS) and childhood obesity are two high prevalence conditions that represent a public health challenge. OBJECTIVE: To analyse the association between both and comparing child groups that had or did not have both conditions. PATIENTS AND METHODS: A prospective study in children (3-14 years), referred to the "Multidisciplinary Sleep Unit" due to suspected SAHS, between 1 November 2015 and 1 August 2017. The following parameters were evaluated: anthropometry, symptoms, blood pressure, ear, nose, and throat examination, polysomnography (nocturnal PSG) and laboratory tests. RESULTS: A total of 67 children were evaluated (64% non-obese (NOb) and 36% obese (Ob). It was observed that the Ob were older (P < .001), slept less hours (P = .028), did less physical exercise (P = .029), ate less in the school dining room (P = .009), had la lower sleep efficiency, and had abnormal values in carbohydrate and lipid metabolism. The children with SAHS were younger (P = .010), a high percentage of daytime sleepiness (P = .001), and breathing through the mouth (P = .006), greater percentile of diastolic blood pressure (P = .019) and a lower IGF-1 (P = .003) than those that did not have SAHS. The comparison of the SAHS NOb and SAHS Ob groups, showed that the first group were younger (P = .010), snored more (P = .012), had a more severe SAHS (IAH 13.1 vs 5.4, P = .041), and a higher GOT (P < .001). In the second group, they slept less hours P = .038) and showed lower values of glucose (P = .039), insulin (P < .001), and HOMA (P < .001). CONCLUSION: The behaviour of SAHS is different in obese children and non-obese children, with differences in age, clinical characteristics, severity of SAHS, and metabolic changes. The children diagnosed with SAHS were in the higher percentile of diastolic blood pressure. Obesity was associated with worse sleep quality, and changes in carbohydrate and lipid metabolism.

Treatment outcomes of obstructive sleep apnoea in obese community-dwelling children: the NANOS study.

The first line of treatment of obstructive sleep apnoea syndrome (OSAS) in children consists of adenotonsillectomy (T&A). The aim of the present study was to evaluate treatment outcomes of OSAS among obese children recruited from the community.A cross-sectional, prospective, multicentre study of Spanish obese children aged 3-14 years, with four groups available for follow-up: group 1: non-OSAS with no treatment; group 2: dietary treatment; group 3: surgical treatment; and group 4: continuous positive airway pressure treatment.117 obese children (60 boys, 57 girls) with a mean age of 11.3±2.9 years completed the initial (T0) and follow-up (T1) assessments. Their mean body mass index (BMI) at T1 was 27.6±4.7 kg·m(-2), corresponding to a BMI Z-score of 1.34±0.59. Mean respiratory disturbance index (RDI) at follow-up was 3.3±3.9 events·h(-1). Among group 1 children, 21.2% had an RDI ≥3 events·h(-1) at T1, the latter being present in 50% of group 2, and 43.5% in group 3. In the binary logistic regression model, age emerged as a significant risk factor for residual OSAS (odds ratio 1.49, 95% confidence interval 1.01-2.23; p<0.05) in obese children surgically treated, and RDI at T0 as well as an increase in BMI emerged as significant risk factors for persistent OSAS in obese children with dietary treatment (OR 1.82, 95% CI 1.09-3.02 (p<0.03) and OR 8.71, 95% CI 1.24-61.17 (p=0.03)).Age, RDI at diagnosis and obesity are risk factors for relatively unfavourable OSAS treatment outcomes at follow-up.

Reliability of home respiratory polygraphy for the diagnosis of sleep apnea in children.

OBJECTIVE: The objective of this study was to evaluate the diagnostic reliability of home respiratory polygraphy (HRP) in children with a clinical suspicion of OSA-hypopnea syndrome (OSAS). METHODS: A prospective blind evaluation was performed. Children between the ages of 2 to 14 years with clinical suspicion of OSAS who were referred to the Sleep Unit were included. An initial HRP followed by a later date, same night, in-laboratory overnight respiratory polygraphy and polysomnography (PSG) in the sleep laboratory were performed. The apnea-hypopnea index (AHI)-HRP was compared with AHI-PSG, and therapeutic decisions based on AHI-HRP and AHI-PSG were analyzed using intraclass correlation coefficients, Bland-Altman plots, and receiver operator curves (ROCs). RESULTS: Twenty-seven boys and 23 girls, with a mean age of 5.3 ± 2.5 years, were studied, and 66% were diagnosed with OSAS based on a PSG-defined obstructive respiratory disturbance index ≥ 3/h total sleep time. Based on the availability of concurrent HRP-PSG recordings, the optimal AHI-HRP corresponding to the PSG-defined OSAS criterion was established as ≥ 5.6/h The latter exhibited a sensitivity of 90.9% (95% CI, 79.6%-100%) and a specificity of 94.1% (95% CI, 80%-100%). CONCLUSIONS: HRP recordings emerge as a potentially useful and reliable approach for the diagnosis of OSAS in children. However, more research is required for the diagnosis of mild OSAS using HRP in children.

Respiratory polygraphy for follow-up of obstructive sleep apnea in children.

OBJECTIVES: (1) To evaluate the effectiveness of adenotonsillectomy for the treatment of Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) in children. (2) To evaluate the usefulness of respiratory polygraphy (RP) for controlling post-adenotonsillectomy effects. METHODS: The children studied were referred to the Burgos Sleep Unit (SU) with clinical suspicion of OSAHS before undergoing adenotonsillectomy. For all patients, a clinical history was taken and a general physical examination, as well as a specific ear, nose, and throat examination was done. RP before adenotonsillectomy, and seven months afterwards, was also done. OSAHS was diagnosed if the Apnea Hypopnea Index (AHI) was ≥ 4.6. RESULTS: Of the 100 children studied, 68 were male and 32 female, with an age of 4.17 ± 2.05 years. Using RP, 86 of them were diagnosed with OSAHS before undergoing adenotonsillectomy. There was a significant improvement in all clinical and polygraphic variables after adenotonsillectomy. The pre and post surgery AHI index was 11.9 ± 11.0 and 2.6 ± 1.5, respectively, with a significant mean difference (9.4 ± 10.9, p<0.01). The residual OSAHS was 11.6% (CI 95%: 4.3-19%). CONCLUSIONS: Respiratory polygraphy is a useful tool for monitoring the effectiveness of surgical treatment and the detection of residual OSAHS in children with adenotonsillar hypertrophy.

Trastornos respiratorios del sueño en niños. Un problema de salud emergente / No disponible

El Síndrome de Apneas/Hipopneas durante el Sueño (SAHS) en los niños, es el máximo exponente de los Trastornos Respiratorios del Sueño en los niños (TRS) y se asocia con importante morbilidad neurocognitiva, cardiovascular y metabólica, existiendo actualmente evidencias de lesión de órganos diana y daño celular. La obesidad se ha convertido en un importante factor de riesgo en la patofisiología del SAHS infantil. El infradiagnóstico del SAHS en los niños, ha conducido a una preocupación creciente en el abordaje diagnósticoterapéutico integral, así como a la búsqueda de sistemas de diagnóstico más sencillos. El tratamiento de elección es la adenoamigdalectomia, sin embargo, las evidencias actuales hacen necesario la incorporación de tratamientos no quirúrgicos que permitan abordar las formas leves, el SAHS residual y los TRS asociados a síndromes malformativos (AU)

No disponible

[Rhinoscleroma]. / Rinoscleroma.

Rhinoescleroma is a chronic infectious granuloma due to Klebsiella rhinoscleromatis. The nose is involved in all cases with frequent extension to other parts of the airways. Rhinoscleroma is endemic to areas of Africa, South-East Asia, Mexico, Central and South America, and Central and Eastern Europe. In the past, rhinoscleroma was infrequent in the Spanish population but, with current trends in migration, the incidence of rhinoscleroma may be on the rise. Diagnosis is made by direct evidence of bacteria in exudate or nasal biopsy. Differential diagnosis must consider syphilis, midline granuloma and malignancy.

Rinoscleroma / Rhinoscleroma

El rinoscleroma es una enfermedad granulomatosa, crónica, causada por Klebsiella rhinoescleromatis. Afecta fundamentalmente a la nariz, pero puede progresar a toda la vía respiratoria. Es endémica en áreas de África, sureste asiático, México, América Central y Suramérica y Europa del este. En el pasado ha sido infrecuente en la población española, pero con la actual tasa de migración, su incidencia puede encontrarse en alza. El diagnóstico se realiza aislando al germen causal en el exudado o la biopsia. El diagnóstico diferencial debe incluir sífilis, granuloma de la línea media y malignidad (AU)

Rhinoescleroma is a chronic infectious granuloma due to Klebsiella rhinoscleromatis. The nose is involved in all cases with frequent extension to other parts of the airways. Rhinoscleroma is endemic to areas of Africa, South-East Asia, Mexico, Central and South America, and Central and Eastern Europe. In the past, rhinoscleroma was infrequent in the Spanish population but, with current trends in migration, the incidence of rhinoscleroma may be on the rise. Diagnosis is made by direct evidence of bacteria in exudate or nasal biopsy. Differential diagnosis must consider syphilis, midline granuloma and malignancy (AU)

[Retropharyngeal liposarcoma: apropos of a case of apnoeas and hypopnoea during sleep]. / Liposarcoma retrofaríngeo: a propósito de un caso de apneas-hipopneas durante el sueño.

Liposarcomas rarely occur in the head and neck. We report a case of myxoid liposarcoma occurring in the retropharyngeal space in a middle-aged male with clinical symptoms of obstructive sleep apnoea.

Liposarcoma retrofaríngeo: a propósito de un caso de apneas-hipopneas durante el sueño / Retropharyngeal liposarcoma: apropos of a case of apnoeas and hypopnoea during sleep

Los liposarcomas raramente se asientan en la cabeza y cuello. Presentamos un caso de un liposarcoma mixoide retrofaríngeo remitido por presentar un síndrome de apneas-hipopneas obstructivas durante el sueño (AU)

Liposarcomas rarely occur in the head and neck. We report a case of myxoid liposarcoma occurring in the retropharyngeal space in a middle-aged male with clinical symptoms of obstructive sleep apnoea (AU)

[Reliability of respiratory polygraphy for the diagnosis of sleep apnea-hypopnea syndrome in children]. / Fiabilidad de la poligrafía respiratoria para el diagnóstico del síndrome de apneas-hipopneas durante el sueño en niños.

OBJECTIVE: Overnight polysomnography (PSG) is the gold standard diagnostic tool for sleep apnea-hypopnea syndrome (SAHS) in children. The aim of the present study was to evaluate the usefulness of diagnostic respiratory polygraphy in children with clinically suspected SAHS referred to our sleep-disordered breathing clinic. PATIENTS AND METHODS: We studied 53 children referred with clinical suspicion of SAHS; 29 (54.7%) were boys and the mean (SD) age was 6.4 (2.9) years. After a medical history was taken and a physical examination performed, patients underwent respiratory polygraphy (Edentec) simultaneously with overnight PSG in the sleep laboratory. The 2 diagnostic tools were compared using statistical analysis. RESULTS: SAHS was defined by an obstructive apnea-hypopnea index (OAHI) of 3 or more in overnight PSG and a respiratory disturbance index (RDI) of 3 or more in respiratory polygraphy. The rate of diagnostic agreement was 84.9%. The difference between the mean OAHI and RDI values was not significant (0.7 +/- 5.4; P=.34). The intraclass correlation coefficient between the OAHI and RDI was 89.4 (95% confidence interval, 82.4-93.7; P< .001). When receiver operating characteristic curves were calculated for the OAHI cutoff points used for the diagnosis of SAHS (> or =1, > or =3, and > or =5), the best RDI cutoff for all 3 OAHI values considered was found to be 4.6. When age strata were considered, in children 6 years or older the best RDI cutoff for the 3 OAHI values was 2.1. In children younger than 6 years the best RDI cutoff was 3.35 for OAHI > or =1 and 5.85 for OAHI > or =3 and > or =5. CONCLUSIONS: Respiratory polygraphy in the sleep laboratory is a valid method for the diagnosis of SAHS in children.

Fiabilidad de la poligrafía respiratoria para el diagnóstico del síndrome de apneas-hipopneas durante el sueño en niños / Reliability of respiratory polygraphy for the diagnosis of sleep apnea-hypopnea syndrome in children

OBJETIVO: La polisomnografía (PSG) nocturna es la técnica diagnóstica de referencia del síndrome de apneas-hipopneas durante el sueño (SAHS) en niños. El objetivo del estudio ha sido evaluar la utilidad diagnóstica de la poligrafía respiratoria (PR) en niños con sospecha clínica de SAHS remitidos a la Unidad de Trastornos Respiratorios del Sueño. PACIENTES Y MÉTODOS: Se estudió a 53 niños remitidos por sospecha clínica de SAHS (29 varones; 54,7%), con una edad media ± desviación estándar de 6,4 ± 2,9 años. A todos ellos se les realizaron historia clínica, exploración física, PR (Edentec®) y PSG nocturna simultáneamente en el laboratorio de sueño. Se realizó el análisis estadístico para comparar ambas técnicas diagnósticas. RESULTADOS: Definiendo el diagnóstico de SAHS como la presencia de un índice de apneas-hipopneas obstructivas (IAHO) igual o mayor de 3 en la PSG y un índice de eventos respiratorios (IER) de 3 o superior en la PR, la coincidencia diagnóstica fue del 84,9%. La diferencia de medias entre el IAHO y el IER no fue significativa (0,7 ± 5,4; p = 0,34). El coeficiente de correlación intraclase entre el IAHO y el IER fue de de 89,4 (intervalo de confianza del 95%, 82,4-93,7; p < 0,001). Para el diagnóstico de SAHS se consideraron los valores de IAHO iguales o mayores de 1; iguales o mayores de 3, e iguales o mayores de 5. Se calcularon las curvas de eficacia diagnóstica para cada uno de ellos y 4,6 resultó ser el mejor IER para los 3 valores de IAHO considerados. Al analizar por estratos de edad, en niños de 6 años o más el mejor IER obtenido para los 3 valores de IAHO considerados fue 2,1. En niños menores de 6 años se obtuvieron los siguientes valores de IER: 3,35 para IAHO de 1 o superior y 5,85 para IAHO de 3 o mayor y de 5 o superior. CONCLUSIONES: La PR realizada en el laboratorio de sueño es un método válido para el diagnóstico de SAHS en niños

OBJECTIVE: Overnight polysomnography (PSG) is the gold standard diagnostic tool for sleep apnea-hypopnea syndrome (SAHS) in children. The aim of the present study was to evaluate the usefulness of diagnostic respiratory polygraphy in children with clinically suspected SAHS referred to our sleep-disordered breathing clinic. PATIENTS AND METHODS: We studied 53 children referred with clinical suspicion of SAHS; 29 (54.7%) were boys and the mean (SD) age was 6.4 (2.9) years. After a medical history was taken and a physical examination performed, patients underwent respiratory polygraphy (Edentec) simultaneously with overnight PSG in the sleep laboratory. The 2 diagnostic tools were compared using statistical analysis. RESULTS: SAHS was defined by an obstructive apneahypopnea index (OAHI) of 3 or more in overnight PSG and a respiratory disturbance index (RDI) of 3 or more in respiratory polygraphy. The rate of diagnostic agreement was 84.9%. The difference between the mean OAHI and RDI values was not significant (0.7 ± 5.4; P=.34). The intraclass correlation coefficient between the OAHI and RDI was 89.4 (95% confidence interval, 82.4-93.7; P<.001). When receiver operating characteristic curves were calculated for the OAHI cutoff points used for the diagnosis of SAHS (³1, ³3, and ³5), the best RDI cutoff for all 3 OAHI values considered was found to be 4.6. When age strata were considered, in children 6 years or older the best RDI cutoff for the 3 OAHI values was 2.1. In children younger than 6 years the best RDI cutoff was 3.35 for OAHI ³1 and 5.85 for OAHI ³3 and ³5. CONCLUSIONS: Respiratory polygraphy in the sleep laboratory is a valid method for the diagnosis of SAHS in children

Síndrome de apneas e hipopneas durante el sueño en niños / Sleep apnea-hypopnea syndrome in children

Los trastornos respiratorios del sueño, en particular el síndrome de apneas e hipopneas durante el sueño (SAHS), son frecuentes en la población infantil (su prevalencia se ha estimado en un 1-3%) y su causa más frecuente es la hipertrofia adenoamigdalar. Están infradiagnosticados y se asocian a importantes complicaciones, tales como alteraciones del crecimiento, alteraciones cognitivas e incluso, en casos graves, cor pulmonale. La polisomnografía nocturna es la técnica diagnóstica de elección para el diagnóstico del SAHS en los niños, pero en la población infantil es necesario tener en cuenta una serie de consideraciones, como la edad y el entorno adecuado. Además, los criterios diagnósticos del SAHS para adultos no son útiles. El tratamiento de elección en los niños con SAHS es la adenoamigdalectomía, que es curativa en un 70% de los casos (AU)

Sleep disordered breathing in children, especially sleep apnea-hypopnea syndrome (SAHS), is common, affecting 1-3% of the pediatric population. The most frequent cause is adenotonsillar hypertrophy. This disease is under-diagnosed and leads to important complications such as growth alterations, cognitive impairment and even, in severe cases, to cor pulmonale. Nocturnal polysomnography (PSG) is the technique of choice for diagnosing SAHS in children; however, in this population a series of considerations should be taken into account such as the age of the population to be studied and a suitable environment. The diagnostic criteria for SAHS in adults are not useful in children. The treatment of choice in children with SAHS is denotonsillectomy, which is curative in 70% (AU)