Looking for a cutoff value for the decongestant test in children suffering with turbinate hypertrophy.

OBJECTIVE: The main causes for objectively confirmed chronic impaired nasal breathing in children are adenoid and turbinate hypertrophy. Turbinate hypertrophy may be addressed by turbinate surgery. However, specialized guidelines include no specific indications for pediatric patients. The decongestant test consists of simulating the effect of turbinate surgery by means of a nasal decongestant. This project, developed by the YO-IFOS rhinology group, aims to establish a cutoff value for the nasal decongestant test with rhinomanometry to select children for turbinate surgery. METHODS: Children between 4 and 15 years of age were included. Cases were consecutively selected from children affected by turbinate hypertrophy undergoing turbinate radiofrequency ablation with or without adenoidectomy. Controls were consecutively selected from a sample of healthy children. All the subjects were examined with anterior active rhinomanometry with and without nasal decongestant. RESULTS: Sample included 72 cases and 24 healthy controls. There was a statistically significant difference in the improvement with the decongestant between cases (57.91%) and controls (15.67%). The ROC curve revealed an area under the curve of 0.97. The highest amount of correctly classified individuals (93.44%) corresponded to the cutoff value of 31.66%. However, the value with the highest specificity and highest Youden's index was the 38.88% improvement in nasal resistance with nasal decongestant. CONCLUSIONS: In conclusion, a preliminary cutoff value for the decongestant test used with rhinomanometry in children has been established. This test could help identify children for turbinate surgery.

Exploración videoendoscópica bajo sueño inducido en niños / Drug-induced sleep endoscopy in children

Este documento pretende ser una guía para los otorrinolaringólogos españoles que deseen realizar endoscopia del sueño inducido por fármacos, normalmente conocida como DISE de sus siglas en inglés drug-induced sleep endoscopy. Las indicaciones, el método de sedación y la valoración de los hallazgos se comentarán para tratar de unificar metodología y criterios

This document is intended as a guide for Spanish ENT specialists who want to perform drug-induced sleep endoscopy. Indications, sedation method and important findings are discussed to unify criteria and methodology

La endoscopia del sueño inducido / Drug-induced sleep endoscopy

Este documento pretende dar a conocer la endoscopia de sueño inducido entre los distintos especialistas que tratan a los pacientes con trastornos respiratorios del sueño y ser una guía para los especialistas que vayan a realizarla de modo que pueda ser reproducible

This document introduces drug-induced sleep endoscopy to the specialist treating sleep breathing disorders and is intended as a guide for those willing to perform the procedure so that it can be reproducible

Surgical versus non-surgical treatment in the Obstructive Sleep Apnea-Hypopnea Syndrome.

INTRODUCTION: The treatment of choice for pediatric OSAHS is surgical. However, its etiopathogenesis is multifactorial and surgery does not always solve it. Therefore, other modalities of treatment are used. The main objective of this study is to shed light on the efficacy of surgery compared to other treatments. METHODS AND MATERIALS: Prospective cohort study with 317 children ages 1-13 years and apnea-hypopnea index (AHI) ≥3/h with no previous treatment. The treatment was organised into 3 categories: surgical (n = 201), medical (n = 75) and observation (n = 41). Quality of life and sleep was assessed by two validated questionnaires (PSQ & Esteller et al.) The upper airway was explored, and nocturnal polysomnography (PSG) performed in every patient. After 12 ± 3 months of treatment was completed, a new PSG and questionnaires were evaluated. RESULTS: The surgical group improved significantly both subjectively and objectively. Mean AHI decreased from 7.95/h to 2.57/h and T 90 (time spent with arterial oxygen saturation <90%) from 0.49 to 0. AHI of the medical group decreased only from 5.09/h to 4.9/h. Subjective parameters improved less than in the surgical group. Persistence after surgery was 31%, 50% following medical treatment, and after observation 75%. There were no differences in age and BMI between groups. Age or obesity showed no relationship with treatment success or failure. CONCLUSIONS: The best results were achieved in surgically treated children. However, 31% of those operated had OSAHS persistence, which means a combination of treatments may be the most appropriate strategy.

Drug-induced sleep endoscopy. / La endoscopia del sueño inducido.

This document introduces drug-induced sleep endoscopy to the specialist treating sleep breathing disorders and is intended as a guide for those willing to perform the procedure so that it can be reproducible.

Drug-induced sleep endoscopy in children. / Exploración videoendoscópica bajo sueño inducido en niños.

This document is intended as a guide for Spanish ENT specialists who want to perform drug-induced sleep endoscopy. Indications, sedation method and important findings are discussed to unify criteria and methodology.

Normative data on angular vestibulo-ocular responses in the yaw axis measured using the video head impulse test.

OBJECTIVE: To analyze vestibulo-ocular responses using the video head impulse test in the yaw axis. STUDY DESIGN: Prospective. SETTING: Tertiary and university hospital. PATIENTS: Two hundred twelve healthy subjects with no history of vestibular or neurologic impairment. INTERVENTION: Video head impulse test in the lateral semicircular canal plane. MAIN OUTCOME MEASURES: Vestibulo-ocular reflex (VOR) gain and appearance of refixation saccades (RSs) considering sex, age, and head impulse velocity and direction. RESULTS: Mean gain was 1.06 ± 0.07, and there were no differences between sexes. For all the impulses (n = 9,654; 4,947 rightward and 4,707 leftward), VOR gain decreased as head impulse velocity increased. When gain was evaluated by age and head velocity, it was steady until age 70 years for higher-velocity impulses and until age 90 years for lower-velocity head impulses. RSs were detected in 52 subjects, occurring after impulses to both sides of the head in 22 of these subjects. The number of subjects with RSs was significantly higher after age 71 years, and velocity was correlated, not with age, but with head impulse velocity. CONCLUSION: VOR gain was stable until age 90 years and thereafter dropped. However, this decrease occurred progressively in younger subjects as head impulse velocity increased, with VOR gain for faster head impulses decreasing significantly in subjects older than 70 years. This finding, in addition to the appearance of RSs, can be explained by the effect of aging on the deterioration of the vestibular system in the semicircular canals.

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

Introducción: La creciente prevalencia de obesidad infantil genera un incremento del riesgo de desarrollar trastornos respiratorios del sueño y puede agravar sus comorbilidades. Objetivo: Estudio prospectivo para evaluar la tasa de obesidad en niños con trastornos respiratorios del sueño y estudiar las eventuales diferencias clínicas y epidemiológicas entre los niños con y sin exceso de peso en un hospital privado del área mediterránea. Método: Se estudian 170 niños entre dos y 10 años con trastorno respiratorio del sueño y un grupo control de 170 niños sanos. En el grupo problema el índice de apnea-hipoapnea medio es de 7,61±6,3. Resultados: La comparación del porcentaje de casos de percentil del índice de masa corporal (IMC) ≥85 (sobrepeso) entre ambos grupos problema y control (44: 25,9% vs 34: 20%) o los de IMC ≥95 (obesidad) (30: 17,6% vs 20: 11,8%) no muestra diferencias estadísticamente significativas. La comparación de las variables clínicas y epidemiológicas en el grupo problema entre los casos con sobrepeso (44/170: 25,9%) y sin sobrepeso (126/170: 74,1%), tampoco muestra diferencias en ninguno de los parámetros analizados. Conclusión: En el ámbito del estudio no se observa que los niños con trastornos respiratorios del sueño presenten mayor tasa de obesidad ni que ésta condicione clínicamente la forma de presentación. Es probable que el tipo de población de este estudio condicione estos resultados y por tanto no debe ser óbice para no estar atentos a la posible asociación de la afección respiratoria y obesidad por sus consecuencias negativas(AU)

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(AU)

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)

[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.

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

Introducción: El creciente interés por los trastornos respiratorios del sueño ha hecho renacer el antiguo debate de si existe una relación causal entre la obstrucción respiratoria alta y las alteraciones en el desarrollo dentofacial. Objetivo: Averiguar el impacto sobre el desarrollo dentofacial de los trastornos respiratorios del sueño en los niños. Método: Estudio prospectivo donde se comparan los análisis dentofaciales de 30 niños diagnosticados de trastorno respiratorio del sueño mediante polisomnografía y un grupo control de 30 niños sanos. Las edades de ambos grupos se sitúan entre los 3 y los 13 años. Resultados: El estudio estadístico mostró diferencias significativas entre ambos grupos en la proporción de niños con paladar estrecho (83% en el grupo problema y 57% en el control; p=0,024) y mordida cruzada (40 y 13%; p=0,020). En la comparación de medidas de ángulos, la única diferencia estadísticamente significativa fue el ángulo de la base del craneo con el plano mandibular: los niños del grupo problema tenían una media de 37,59±5,56 y los del grupo control de 34,41±4,62 (p=0,023). Conclusión: Los niños con trastornos respiratorios del sueño presentan alteraciones en el desarrollo dental y facial condicionadas por la obstrucción de la vía respiratoria alta. Estas alteraciones, crecimiento vertical de la cara, paladar estrecho y alteraciones en la oclusión dentaria, deberían ser tenidas en cuenta en el momento de realizar la indicación de adenoamigdalectomía (AU)

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 (AU)

[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.

Trastornos respiratorios obstructivos del sueño en los niños / No disponible

No disponible

Clínica de los trastornos respiratorios del sueño en los niños / Symptoms of sleep-disordered breathing in children

Considerando que un adulto con síndrome de apnea-hipopnea obstructiva del sueño generalmente se presenta con una historia de obesidad, ronquidos y somnolencia diurna importante, un niño con el mismo problema es más probable que se presente con el peso normal, hipertrofia adenoamigdalar y falta de atención durante las clases de la escuela. Podemos dividir los síntomas del cuadro infantil en los propios del trastorno respiratorio del sueño como los ronquidos, los síntomas de la calidad del sueño como la enuresis, y los síntomas de los trastornos de la conducta y del aprendizaje como la hiperactividad(AU)

Adults with obstructive sleep apnea-hypopnea syndrome typically have a history of obesity, snoring, and prominent daytime somnolence. However, children with this condition are more likely to have normal body weight, adenoid and tonsillar hypertrophy, and inattentiveness during school classes. The symptoms of children with sleep apnea-hypopnea syndrome can be divided into those of sleep-disordered breathing —such as snoring—, symptoms of sleep quality —such as enuresis—, and symptoms of behavior or learning disorders —such as hyperactivity— (AU)

Estrategia terapéutica y tratamiento médico / Therapeutic approach and medical treatment

Las alteraciones que provocan los trastornos respiratorios del sueño (TRS) en los niños, así como sus posibles consecuencias negativas en el futuro sanitario y social, justifican claramente un buen abordaje terapéutico. Para conseguir una estrategia óptima de tratamiento se requiere un correcto conocimiento de las causas que lo provocan y un trabajo de evaluación inicial multidisciplinar. Las nuevas aportaciones sobre la relación de estos trastornos con la inflamación de la vía aérea superior nos abre nuevas alternativas terapéuticas. En este capítulo se revisan las relaciones de los TRS en los niños con la obesidad y sus implicaciones en conseguir un abordaje terapéutico más exitoso. Se revisa, también, la utilidad de los tratamientos médicos con corticoides intranasales y con fármacos que reduzcan el componente inflamatorio de las vías aéreas, sin olvidar el tratamiento de patologías asociadas que pueden agravar estos trastornos(AU)

Changes that produce sleep breathing disorders in children and their possible negative consequences on children's future health and social life provide clear justification for a good therapeutic approach. To achieve an optimal treatment strategy, the causes of the disorder must be identified and an initial interdisciplinary evaluation must be carried out. New contributions on the relationship between these conditions and inflammation of the upper respiratory tract have opened up new therapeutic alternatives. This article discusses the relationship between sleep breathing disorders in children and obesity and the implications for achieving a more successful therapeutic approach. The usefulness of medical treatments using intranasal corticosteroids and drugs that reduce the inflammatory component of the airways is also reviewed, including the treatment of associated abnormalities that can aggravate these disorders(AU)

Técnicas actuales de cirugía adenoamigdalar en los trastornos respiratorios del sueño de los niños / Current techniques in tonsil surgery

En los últimos años, la consolidación de la hipertrofia amigdalar como principal indicación quirúrgica, ha originado la aparición de nuevas técnicas. La mayoría persigue una reducción de su volumen (es la llamada amigdalotomía o reducción amigdalar). Con ello, se consigue disminuir considerablemente tanto la incidencia de hemorragia intra y postoperatoria como la intensidad del dolor. Describiremos el mecanismo, las ventajas y los inconvenientes de las diferentes técnicas, incluyendo la electrodisección con bisturí eléctrico, la reducción con microdebrider, el bisturí armónico (o de ultrasonidos), la radiofrecuencia (con sus distintas variantes) y el láser CO2. Con relación a las técnicas que reducen el volumen amigdalar hay que resaltar que la posibilidad de recidiva de la hipertrofia amigdalar será alta si se elimina menos de un 85% de amígdala. Tampoco es despreciable la posibilidad de infección de los restos amigdalares, sea cual sea la técnica empleada, por lo que no serán válidas en caso de amigdalitis de repetición. Recientemente, también han aparecido alternativas a la adenoidectomía clásica con cucharilla-adenotomo. Consisten en la posibilidad de minimizar el sangrado mediante el uso del microdebrider, de la radiofrecuencia o del aspirador coagulador. También nos referiremos al concepto de adenoidectomía parcial, de preferencia en pacientes con riesgo de insuficiencia velopalatina(AU)

In recent years, consolidation of tonsillar hypertrophy as the principal surgical procedure has led to the emergence of new techniques. Most aim to reduce volume (tonsillectomy or tonsil reduction). These techniques have considerably decreased intra- and postoperative hemorrhages and pain intensity. The present article describes the mechanisms and the advantages and disadvantages of the various techniques, including electro-dissection using electrical scalpels, reduction using a microdebrider, ultrasonic scalpel, radiofrequency (with its different variations) and CO2 laser. When techniques that reduce tonsil volume are used, the possibility of recurrence of the tonsillar hypertrophy is high if less than 85% of the tonsil is removed. There is also a considerable possibility of infection of the remaining tonsils, whichever technique is used, and therefore these techniques are not valid in the case of repetitive tonsillitis. Recently, alternatives to classical adenoidectomy using adenoid curette have also appeared. Bleeding can be minimized by using a microdebrider, radiofrequency or a blood coagulator. We also discuss the concept of partial adenoidectomy, which is preferred in patients at risk of velopharyngeal insufficiency(AU)

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

Introducción: Los dispositivos de avance mandibular se muestran cada vez más útiles en el tratamiento de los trastornos respiratorios del sueño en adultos. En 2008 se inició un estudio prospectivo para adaptar 40 dispositivos sin coste, con el objetivo de evaluar su eficacia en nuestros pacientes. Material y método: Se analiza su aplicación en 40 pacientes adultos con un índice de apnea hipoapnea inferior a 40. La totalidad de los casos referían ronquido, el 52,5% apneas observadas y el 47,5% somnolencia diurna. Resultados: Con un seguimiento mínimo de 6 meses, los casos con ronquido descienden a 59%, la mayoría de intensidad significativamente inferior, los casos con apneas observadas al 8,8% y la somnolencia diurna al 14,7%. La mejoria clínica global se consideró en 31 pacientes (91,2%). El índice de apnea hipoapnea medio pasó a 8,4±9,6 y la mejoría polisomnográfica se objetivó en 25 casos (75%). Un resultado positivo global, que requiere la mejoría tanto subjetiva como objetiva, se obtuvo en 23 pacientes (69,7%). Abadonaron su utilización 2 pacientes en los primeros días y otro caso a los 6 meses. Las compliaciones fueron relativamente frecuentes (58,8% de casos), pero leves. Los niveles de cumplimiento fueron satisfactorios: una media de 6,5±1,1 noches a la semana y 7,4±1,09h por noche. Conclusión: Los dispositivos de avance mandibular son una alternativa terapéutica eficaz para tratar los trastornos respiratorios del sueño. Los niveles de cumplimiento pueden ser satisfactorios si se cuenta con la colaboración de un equipo odontológico experto (AU)

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 (AU)

[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.

[Therapeutic approach and medical treatment]. / Estrategia terapéutica y tratamiento médico.

Changes that produce sleep breathing disorders in children and their possible negative consequences on children's future health and social life provide clear justification for a good therapeutic approach. To achieve an optimal treatment strategy, the causes of the disorder must be identified and an initial interdisciplinary evaluation must be carried out. New contributions on the relationship between these conditions and inflammation of the upper respiratory tract have opened up new therapeutic alternatives. This article discusses the relationship between sleep breathing disorders in children and obesity and the implications for achieving a more successful therapeutic approach. The usefulness of medical treatments using intranasal corticosteroids and drugs that reduce the inflammatory component of the airways is also reviewed, including the treatment of associated abnormalities that can aggravate these disorders.