Paloma Baiardi Gregório

Evaluation of the upper airway in children and adolescents with cystic fibrosis and obstructive sleep apnea syndrome

OBJECTIVE Obstructive sleep apnea syndrome (OSAS) in cystic fibrosis (CF) patients may be associated with the presence of upper airway obstruction caused by chronic infection and nasal polyposis that may also contribute to OSAS severity. Our objective was to identify the profile of findings in CF and OSAS patients by performing upper airway examinations. METHODOLOGY Observational, cross-sectional study involving 63 children and adolescents between the ages of 2 and 14 with CF. All patients answered a questionnaire and underwent a standard otolaryngology examination, including an endoscopic nasal and nocturnal polysomnography. OSAS diagnosis was confirmed if the obstructive apnea index was >or=1. RESULTS OSAS was identified in 35 (55.6%) patients. The upper airway findings were evaluated using multiple correspondence factorial analysis. The OSAS group presented with overjet >2mm, enlarged pharyngeal pillars, palatine tonsils and pharyngeal tonsils hypertrophy, ogival hard palates and characteristics of chronic rhinosinusitis. CONCLUSION Bone and soft tissue structural alterations of the upper airway and chronic rhinosinusitis were associated with the OSAS group patients.

Sintomas da síndrome de apnéia-hipopnéia obstrutiva do sono em crianças

OBJETIVOS: Investigar os sintomas mais frequentes encontrados em criancas com diagnostico polissonografico de sindrome da apneia-hipopneia obstrutiva do sono (SAHOS). METODOS: Foram avaliadas 38 criancas consecutivamente encaminhadas ao laboratorio do sono com suspeita de SAHOS no periodo de junho de 2003 a dezembro de 2004. Os pacientes foram submetidos a um questionario pre-sono e a polissonografia. RESULTADOS: A idade media foi de 7,8 ± 4 anos (variacao, 2-15 anos), sendo 50% das criancas do sexo masculino. Nao apneicos corresponderam a 7,9% dos pesquisados, disturbio leve obstrutivo do sono ocorreu em 42,1%, moderado em 28,9% e severo em 22,1%. Observou-se maior frequencia de casos severos de apneia entre criancas menores de seis anos (idade pre-escolar). Dentre as criancas com SAHOS, os sintomas mais citados foram ronco e obstrucao nasal, presentes em 74,3 e 72,7% das criancas, respectivamente. Sonolencia excessiva e bruxismo ocorreram em, respectivamente, 29,4 e 34,3% dos casos e doenca do refluxo em apenas 3,1%. Agitacao das pernas e dificuldade para iniciar o sono foram encontradas em, respectivamente, 65 e 33% dos avaliados. Todas as criancas que apresentaram SAHOS de grau severo tinham queixa de ronco e bruxismo. CONCLUSOES: Nossos resultados mostraram que os sintomas mais frequentes em criancas e adolescentes com SAHOS sao ronco e obstrucao nasal. Alem disso, quadros mais graves da SAHOS estao associados a menor faixa etaria.

Síndrome da apnéia e hipopnéia obstrutiva do sono: associação com obesidade, gênero e idade

Obstructive sleep apnea and hypopnea syndrome (OSAHS) has been the focus of extensive research because of its association with neurocognitive and cardiovascular complications. The aim of this study was to evaluate the frequency and association between OSAHS and the class of obesity, gender and age in outpatients referred to a sleep laboratory. We selected 1,595 patients, 71.7% male. Mean ± SD age was 46.7 ± 11.7 years, BMI was 28.1 ± 5.1 kg/m2 and AIH was 13.9 ± 15.5 events/ hour of sleep. The patients were considered apneic when the apnea-hypopnea index (AHI) was > 5 events/hour of sleep; OSAHS was present in: (1) 71.1% of men and 50.3% of women (p 55 years old (p< 0.001). We concluded that OSAHS was directly and strongly associated to the male gender, obesity class and to aging.

Arquitetura do sono e perfil respiratório polissonográfico de crianças e adolescentes com fibrose cística

OBJECTIVES To evaluate sleep architecture in children and adolescents with both cystic fibrosis (CF) and a clinical suspicion of sleep-disordered breathing (SDB), and to identify the respiratory polysomnographic profile of these patients. METHODS Parents or guardians of children with CF filled out a questionnaire designed to assess their clinical and sleep conditions. Children who were identified as having behaviors associated with SDB underwent polysomnography. After polysomnography, patients were grouped according to the obstructive apnea index (AI) obtained (either < 1 or ≥ 1), and a multiple correspondence factor analysis was used to analyze and identify the polysomnographic profile of patients. RESULTS Of the 74 patients who met inclusion criteria for this study, 67 underwent polysomnography, and 38 (56.7%) of the 67 patients showed an AI ≥ 1. Median age was 8 years. The group of patients with an AI ≥ 1 was characterized by total sleep time (TST) during stage 4 and rapid eye movement (REM) stage of sleep < 21 and 13%, respectively, REM sleep latency > 144 minutes, percentage of TST with pulse oxyhemoglobin saturation (SpO2) < 90% higher than 0.28 seconds, and an oxygen desaturation index higher than 0.92. CONCLUSION Results suggest that clinically stable pediatric patients with CF have a high prevalence of SDB and present frequent sleep complaints, significant changes in sleep architecture, and episodes of oxygen desaturation during sleep.OBJECTIVES: To evaluate sleep architecture in children and adolescents with both cystic fibrosis (CF) and a clinical suspicion of sleep-disordered breathing (SDB), and to identify the respiratory polysomnographic profile of these patients. METHODS: Parents or guardians of children with CF filled out a questionnaire designed to assess their clinical and sleep conditions. Children who were identified as having behaviors associated with SDB underwent polysomnography. After polysomnography, patients were grouped according to the obstructive apnea index (AI) obtained (either 1), and a multiple correspondence factor analysis was used to analyze and identify the polysomnographic profile of patients. RESULTS: Of the 74 patients who met inclusion criteria for this study, 67 underwent polysomnography, and 38 (56.7%) of the 67 patients showed an AI > 1. Median age was 8 years. The group of patients with an AI > 1 was characterized by total sleep time (TST) during stage 4 and rapid eye movement (REM) stage of sleep 144 minutes, percentage of TST with pulse oxyhemoglobin saturation (SpO2) < 90% higher than 0.28 seconds, and an oxygen desaturation index higher than 0.92. CONCLUSION: Results suggest that clinically stable pediatric patients with CF have a high prevalence of SDB and present frequent sleep complaints, significant changes in sleep architecture, and episodes of oxygen desaturation during sleep.

OSAS in children: clinical and polysomnographic respiratory profile

UNLABELLED Obstructive sleep apnea and hypopnea syndrome in children (osas) has an estimated prevalence of up to 3% and can be associated with neurocognitive and behavioural abnormalities, and also cardiovascular complications. This study may help pediatricians, who are unaware of the problem, to recognize osas. STUDY DESIGN series of cases. AIM to describe the clinical characteristics and polysomnographic respiratory findings in a population of children with obstructive sleep apnea and hypopnea syndrome referred to the sleep laboratory from january 2002 up to july 2003. METHODS we studied 93 patients between 2 and 10 years of age with polysomnographic diagnosis of obstructive sleep apnea and hypopnea syndrome. Age, gender, racial group and questions about the childrens health and sleep related disorders were evaluated. Apnea-hypopnea index, oxyhemoglobin desaturation, and arousal index were evaluated too. RESULTS males represented 61.3%, With a mean age of 5.2+/-2.1 (Years-old). The complaints that most commonly lead to the exams were snoring in 24.7% And restless sleep in 24.7%. Associated medical conditions frequently reported were allergic rhinitis (98.9%) And adenoid hypertrophy (50.6%). Mild apnea was found in 66%. The mean and sd of spo2 nadir was 89.1+/-3.5% And the mean and sd of the number of arousals was 8.4+/-3.5/Hour of sleep. CONCLUSION the results suggest the possibility that obstructive sleep apnea and hypopnea syndrome should be suspected in children with allergic diseases and adenoid and tonsil hypertrophy with snoring and restless sleep complaints.

Apresentação clínica de pacientes obesos com diagnóstico polissonográfico de apnéia obstrutiva do sono

AIM To evaluate the symptoms of obese patients with polysomnographic diagnosis of obstructive sleep apnea (OSA). METHODS All obese patients (BMI > or =30 kg/m(2)) that accomplished overnight polysomnography in two sleep laboratories in the city of Salvador, BA, Brazil, in the period of July to December of 2004, and had an apnea hypopnea index (AHI) > or =5. The considered symptoms were excessive daytime sleepiness, awakenings during the night and nocturnal choking or gasping. RESULTS 73 patients were included, being 57.5% male, with mean age and BMI of 45.2 years old and 38.0 kg/m(2), respectively. The majority (49.3%) was classified as having severe OSA (AHI > or =30). Data revealed that 19.2% of the patients did not have any symptoms, while 28.8% had one symptom, 30.1% had two and 21.9% had three. There was no statistically significant difference in the severity of OSA between the subjects with and without symptoms. There was a higher prevalence of asymptomatic patients in the subgroup with severe obesity--BMI > or =35 kg/m(2) (30.8% vs. 5.9%; p = 0.007). CONCLUSIONS The polysomnography seems to be a fundamental exam in the evaluation of obese patients due to the elevated prevalence of asymptomatic individuals with OSA in this group, especially the severely obese.