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                        "tituloSerie" => "Br Med J"
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                        "paginaFinal" => "203"
                      ]
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                        "link" => array:1 [
                          0 => array:2 [
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                          "autores" => array:3 [
                            0 => "N&#46;J&#46; Ali"
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                            2 => "R&#46;J&#46; Stradling"
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                    0 => array:1 [
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                        "tituloSerie" => "Arch Dis Child"
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                        "paginaInicial" => "360"
                        "paginaFinal" => "366"
                        "link" => array:1 [
                          0 => array:2 [
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                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9710274"
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                        "paginaFinal" => "687"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8617076"
                            "web" => "Medline"
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                      "titulo" => "Obstructive sleep apnoea in children undergoing routine tonsillectomy and adenoidectomy"
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                          0 => array:2 [
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                          0 => array:2 [
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Vol. 54. Núm. 1.
Páginas 58-64 (enero 2001)
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Vol. 54. Núm. 1.
Páginas 58-64 (enero 2001)
Acceso a texto completo
Síndrome de apnea obstructiva del sueño en la infancia
Obstructive sleep apnea syndrome in childhood
Visitas
10108
J.R. Villa Asensia,
Autor para correspondencia
jrvilla@nacom.es

Correspondencia: Sección de Neumología. Hospital Infantil Niño Jesús. Avda. Menéndez Pelayo, 65. 28009 Madrid
, J. de Miguel Díezb
a Sección de Neumología. Hospital Infantil Niño Jesús
b Servicio de Neumología. Hospital Universitario de Getafe. Madrid
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El síndrome de apnea obstructiva del sueño (SAOS) es una entidad clínica bien conocida en los adultos pero que ha sido menos estudiada, hasta ahora, en la edad pediátrica. Diferentes estudios han mostrado que el SAOS infantil tiene una alta prevalencia (entre el 1 y el 3%) y que sus consecuencias pueden ser importantes. Existen diversos factores predisponentes para padecer SAOS durante la infancia como la hipertrofia adenoamigdalar, enfermedades neuromusculares o síndromes como el de Down o Pierre Robin. El diagnóstico definitivo se realiza por polisomnografía y resultan de indudable utilidad otros métodos como los registros cardiorrespiratorios o la pulsioximetría nocturna cuando se utilizan de forma adecuada. La adenoamigdalectomía desempeña un papel primordial en su tratamiento. La presión positiva continua en la vía respiratoria (CPAP) nasal puede ser una alternativa en aquellos niños que no responden a la cirugía o en los que tienen alteraciones craneofaciales, y en casos muy seleccionados, la administración de oxígeno nocturno puede ser útil.

Palabras clave:
índrome de apnea obstructiva del sueño
Polisomnografía
Pulsioximetría
Adenoidectomía
Amigdalectomía
CPAP
Oxígeno

Obstructive sleep apnea syndrome (OSAS) is a wellknown clinical entity in adults but until now it has been less well-studied in children. Several studies have shown that the prevalence of pediatric OSAS is high (between 1% and 3%) and its consequences can be serious. Major risk factors for OSAS in children include adeno-tonsillar hypertrophy, neuromuscular disease and syndromes such as Down's or Pierre-Robin's syndrome. Definitive diagnosis is by nocturnal polysomnography while other methods such as cardio-respiratory records and nocturnal pulse oximetry are undoubtedly useful. Adenotonsillectomy plays a major role in the treatment of OSAS. Nasal continuous positive airway pressure is an alternative in children who show poor response to surgical treatment or in those with craniofacial alterations. In a few cases, nocturnal oxygen administration can be useful.

Key words:
leep apnea syndrome
Polysomnography
Pulse oximetry
Child
Adenoidectomy
Tonsillectomy
Continuouspositive airway pressure
Oxygen
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Bibliogrífia
[1.]
W. Hill.
On some causes of backwardness and stupity in children.
Br Med J, (1889), pp. 711-712
[2.]
V.D. Menashe, F. Farrehi, M. Miller.
Hypoventilation and cor pulmonale due to chronic upper airway obstruction.
J Pediatr, 67 (1965), pp. 198-203
[3.]
A.M. Levy, B.S. Tabakin, J.S. Hanson, R.M. Narkewicz.
Hypertrophied adenoids causing pulmonary hypertension and severe congestive heart failure.
N Engl J Med, 277 (1967), pp. 506-511
[4.]
R.T. Brouillette, S.K. Fernbach, C.E. Hunt.
Obstructive sleep apnea in infants and children.
J Pediatr, 100 (1982), pp. 31-40
[5.]
C.E. Hunt, R.T. Brouillette.
Disorders of breathing during sleep.
Disorders of the respiratory tract in children, pp. 1173-1186
[6.]
L.P. Singer, P. Saenger.
Complications of pediatric obstructive sleep apnea.
Otolaryngol Clin North Am, 23 (1990), pp. 665-676
[7.]
C. Guilleminault, A. Tilkian, W. Dement.
The sleep apnea syndromes.
Annu Rev Med, 27 (1976), pp. 465-484
[8.]
C.L. Marcus, K.J. Omlin, D.J. Basinki, S.L. Bailey, A.B. Rachal, WS Von Pechmann, et al.
Normal polysomnographic values for children and adolescents.
Am Rev Respir Dis, 146 (1992), pp. 1235-1239
[9.]
Cardiorespiratory sleep studies in children.
Establishment of normative data and polysomnographic predictors of morbidity. American Thoracic Society.
Am J Respir Crit Care Med, 160 (1999), pp. 1381-1387
[10.]
D.B. Teculescu, I. Caillier, P. Perrin, E. Rebstock, A. Rauch.
Snoring in French preschool children.
Pediatr Pulmonol, 13 (1992), pp. 239-244
[11.]
N.J. Ali, D.J. Pitson, R.J. Stradling.
Snoring, sleep disturbance, and behaviour in 4-5 years olds.
Arch Dis Child, 68 (1993), pp. 360-366
[12.]
T. Gislason, B. Benediktsdottir.
Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. An epidemiologic study of lower limit of prevalence.
Chest, 107 (1995),
[13.]
C. Guilleminault.
Treatments in obstructive sleep apnea.
Obstructive sleep apnea syndrome, pp. 99-118
[14.]
C.L. Marcus, A. Hamer, G.M. Loughlin.
Natural history of primary snoring in children.
Pediatr Pulmonol, 26 (1998), pp. 6-11
[15.]
A. Morielli, S. Ladan, F.M. Ducharme, R.T. Brouillette.
Can sleep and wakefulness be distinguised in children by cardiorespiratory and videotape recording?.
Chest, 109 (1996), pp. 680-687
[16.]
C.B. Croft, M.J. Brockbank, A. Wright, A.R. Swanston.
Obstructive sleep apnoea in children undergoing routine tonsillectomy and adenoidectomy.
Clin Otolaryngol, 15 (1990), pp. 307-314
[17.]
J.R. Villa, J. De Miguel, A. Vecchi, J. García Pérez, M. Nieto, A. Sequeiros.
Obstructive sleep apnea in patients with Down syndrome.
Eur Respir J, 14 (1999), pp. 443s
[18.]
D. Gozal.
Sleep-disordered breathing and school performance in children.
Pediatrics, 102 (1998), pp. 616-620
[19.]
C.L. Marcus, M.G. Greene, J.L. Carroll.
Blood pressure in children with obstructive sleep apnea.
Am J Respir Crit Care Med, 157 (1998), pp. 1098-1103
[20.]
A. Bar, A. Tarasiuk, Y. Segev, M. Phillip, A. Tal.
The effect of adenotonsillectomy on serum insulin-like growth factor-I and growth in children with obstructive sleep apnea syndrome.
J Pediatr, 135 (1999), pp. 76-80
[21.]
M.G. Greene, J.L. Carroll.
Consequences of sleep-disordered breathing in childhood.
Curr Opin Pulm Med, 3 (1997), pp. 456-463
[22.]
American Thoracic Society Official Statement.
Standards and Indications for Cardiopulmonary Sleep Studies in Children.
Am J Respir Crit Care Med, 153 (1996), pp. 866-878
[23.]
V.M. Lafontaine, F.M. Ducharme, R.T. Brouillette.
Pulse oximetry: accuracy of methods of interpreting graphic summaries.
[24.]
A. Rechtschaffen, A. Kales.
A manual of standarized teminology, techniques and scoring system for sleep stages of human subjects.
[25.]
J. De Miguel, J.R. Villa, J. Blanco, M.A. Neira, A.A. Vecchi.
Utilidad de la pulsioximetría para detectar el síndrome de apnea obstructiva del sueño.
Acta Pediatr Esp, 56 (1998), pp. 557-562
[26.]
R.T. Brouillette, A. Morielli, A. Leimanis, K.A. Waters, R. Luciano, F.M. Ducharme.
Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea.
Pediatrics, 105 (2000), pp. 405-412
[27.]
Y. Sivan, A. Kornecki, T. Schonfeld.
Screening obstructive sleep apnoea syndrome by home videotape recording in children.
Eur Respir J, 9 (1996), pp. 2127-2131
[28.]
R.T. Brouillette, S.V. Jacob, K.A. Waters, A. Morielli, M. Mograss, F.M. Ducharme.
Cardiorespiratory sleep studies for children can often be performed in the home.
Sleep, 19 (1996), pp. S278-S280
[29.]
J.R. Villa, J. De Miguel, A. Vecchi, F. Romero, R. Muñoz Codoceo, M. Bartolomé, et al.
Evaluación clínica y polisomnográfica de niños con SAOS antes y después de la adenoamigdalectomía.
Acta Pediatr Esp, 58 (2000), pp. 16-22
[30.]
C.E. Sullivan, F. McNamara, K.A. Waters, M. Harris, F. Everett, C. Seton, et al.
Nasal CPAP: use in the management of infantile apnea.
Sleep, 16 (1993), pp. S108-S111
[31.]
K.A. Waters, F.M. Everett, J.W. Bruderer, C.E. Sullivan.
Obstructive sleep apnea: the use of nasal CPAP in 80 children.
Am J Respir Crit Care Med, 152 (1995), pp. 780-785
[32.]
K.A. Waters, F. Everett, J. Bruderer, F. MacNamara, C.E. Sullivan.
The use of nasal CPAP in children.
Pediatr Pulmonol, (1995), pp. 91-93
[33.]
G. Aljadeff, D. Gozal, S.L. Bailey-Wahl, B. Burrell, T.G. Keens, S.L. Ward.
Effects of overnight supplemental oxygen in obstructive sleep apnea in children.
Am J Respir Crit Care Med, 153 (1996), pp. 51-55
[34.]
C.L. Marcus, J.L. Carroll, O. Bamford, P. Pyzik, G.M. Loughlin.
Supplemental oxygen during sleep in children with sleep-disordered breathing.
Am J Respir Crit Care Med, 152 (1995), pp. 1297-1301
[35.]
R.T. Brouillette, K. Waters.
Oxygen therapy for pediatric obstructive sleep apnea syndrome: how safe? How effective?.
Am J Respir Crit Care Med, 153 (1996), pp. 1-2
Copyright © 2001. Asociación Española de Pediatría
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