Regina Terse Trindade Ramos

Prevalência da apneia obstrutiva do sono em crianças e adolescentes portadores da anemia falciforme

OBJECTIVE: To estimate the prevalence of obstructive sleep apnea syndrome (OSAS) in children and adolescents with sickle cell anemia (SCA); to investigate the possible correlation between mean annual hemoglobin level and total sleep time with SpO2 1 was considered indicative of a diagnosis of OSAS. RESULTS: The prevalence of OSAS was 10.6%. We found a negative correlation between mean annual hemoglobin level and total sleep time with SpO2 < 90% (r = µ0.343; p = 0.002), as well as between mean annual hemoglobin level and total sleep time with SpO2 < 80% (r = µ0.270; p = 0.016). There was no association between AHI and painful crisis. CONCLUSIONS: The prevalence of OSAS in this population was high (10.6%). Therefore, it is important to identify signs of OSAS as soon as possible and to determine the mean annual hemoglobin level because of the inverse correlation between that level and the total sleep time with SpO2 < 90% or < 80%.

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.

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.

Associação entre hipertrofia adenotonsilar, tonsilites e crises álgicas na anemia falciforme

OBJETIVOS: Determinar a prevalencia da hipertrofia adenotonsilar obstrutiva em criancas e adolescentes portadores de anemia falciforme; investigar possivel associacao entre presenca de mais de cinco episodios de tonsilite nos ultimos 12 meses e episodios de crise algica no mesmo periodo; e comparar a hemoglobina anual media entre os que apresentam e os que nao apresentam hipertrofia adenotonsilar obstrutiva. METODOS: Trata-se de estudo prospectivo, observacional do tipo corte transversal, com 85 criancas e adolescentes com anemia falciforme. Todos responderam questionario e avaliacao otorrinolaringologica, incluindo endoscopia nasossinusal. Para o diagnostico da hipertrofia adenotonsilar obstrutiva foram adotados os criterios de Brodsky. RESULTADOS: A prevalencia da hipertrofia adenotonsilar obstrutiva foi de 55,3%. A hipertrofia adenotonsilar obstrutiva associou-se a historia de dificuldade para alimentar-se (76,7 versus 23,5%; p = 0,003), presenca de mais de cinco episodios de tonsilites nos ultimos 12 meses (70,6 versus 29,4%; p = 0,021), roncar alto (73,0 versus 27,0%; p = 0,004) e apneia do sono assistida (71,8 versus 28,2%; p = 0,005). Portadores de hipertrofia adenotonsilar obstrutiva apresentaram maior numero de infeccoes das vias aereas superiores (62,5 versus 37,5; p = 0,010). Tambem foi observada associacao entre presenca de mais de cinco episodios de tonsilite nos ultimos 12 meses e episodios de crise algica no mesmo periodo (mediana = 12 versus 2; p = 0,017). Nao houve diferenca significante da hemoglobina anual media entre portadores de hipertrofia adenotonsilar obstrutiva versus hipertrofia adenotonsilar nao-obstrutiva (7,6 versus 8,2 g/dL; p = 0,199). CONCLUSAO: A prevalencia da hipertrofia adenotonsilar obstrutiva foi de 55,3% em criancas e adolescentes com anemia falciforme. A presenca de mais de cinco episodios de tonsilite nos ultimos 12 meses associaram-se com episodios de crise algica no mesmo periodo; e nao houve diferenca quanto ao valor da hemoglobina anual media entre os que apresentaram e os que nao apresentaram hipertrofia adenotonsilar obstrutiva.

Association between adenotonsillar hypertrophy, tonsillitis and painful crises in sickle cell disease.

OBJECTIVES To determine the prevalence of obstructive adenotonsillar hypertrophy in children and adolescents with sickle cell anemia; to investigate possible association between the presence of more than five episodes of tonsillitis in the last 12 months and episodes of painful crises in the same period; and to compare the mean annual hemoglobin level in children and adolescents with and without obstructive adenotonsillar hypertrophy. METHODS Prospective, observational, cross-sectional study involving 85 children and adolescents with sickle cell anemia. All patients answered a questionnaire and underwent a standard otolaryngology examination, including endoscopic endonasal approach. The diagnosis of obstructive adenotonsillar hypertrophy was made according to the Brodsky scale. RESULTS The prevalence of obstructive adenotonsillar hypertrophy was 55.3%. Obstructive adenotonsillar hypertrophy was associated with history of difficulty in eating (76.7 vs. 23.5%, p = 0.003), presence of more than five episodes of tonsillitis in the last 12 months (70.6 vs. 29.4%, p = 0.021), loud snoring (73.0 vs. 27.0%, p = 0.004), and sleep apnea (71.8 vs. 28.2%, p = 0.005). Patients with obstructive adenotonsillar hypertrophy had more episodes of recurrent upper airway tract infection (62.5 vs. 37.5; p = 0.010). The presence of more than five episodes of tonsillitis in the last 12 months was associated with episodes of painful crises (median = 12 vs. 2, p = 0.017). There was no significant difference between mean annual hemoglobin levels of patients with obstructive adenotonsilar hypertrophy vs. nonobstructive adenotonsillar hypertrophy: 7.6 vs. 8.2 g/dL, p = 0.199. CONCLUSIONS The prevalence of obstructive adenotonsillar hypertrophy was 55.3% in children and adolescents with sickle cell anemia; the presence of more than five episodes of tonsillitis in the last 12 months was associated with episodes of painful crises in the same period; and there was no difference in the mean annual hemoglobin value among those with or without obstructive adenotonsillar hypertrophy.

Factors associated with Group A Streptococcus emm type diversification in a large urban setting in Brazil: a cross-sectional study

BackgroundGroup A Streptococcus (GAS) strain diversity varies across different regions of the world, according to low versus high-income countries. These differences may be related to geographic, environmental, socioeconomic, or host-related factors. However, local factors may also affect strain diversity. We compared the emm types of GAS isolates from children with and without sore throat in one large urban setting in Brazil.MethodsChildren 3-15 years of age were consecutively recruited from slum and non-slum pediatric outpatient clinics between April-October, 2008. Throat cultures were performed and data intake forms were completed. GAS isolates were typed by emm sequencing.ResultsFrom 2194 children, 254 (12%) GAS isolates were obtained. Of 238 GAS isolates that were emm-typed, 61 unique emm types were identified. Simpsons diversity index of the emm types was higher among isolates from slum children [97% (96%-98%)] than those of non-slum children [92% (89%-96%)]. Two emm types (66.0, 12.0) were more frequently isolated from children with sore throat (p < 0.05), and one emm type (27G.0) demonstrated a protective effect.ConclusionsThe emm type diversity from children attending slum clinics resembled the emm diversity of low income countries rather than that of children attending a non-slum clinic in the same city. Local factors, such as crowding, may enhance the frequency of GAS transmission and horizontal gene transfers that contribute to increased strain diversity in the slums. GAS vaccine coverage and control of GAS infections will need to take these local factors and strain differences into consideration.

Nocturnal hypoxemia in children and adolescents with cystic fibrosis

OBJECTIVE: To determine the prevalence of nocturnal hypoxemia and its association with pulmonary function, nutritional status, sleep macrostructure, and obstructive respiratory events during sleep in a population of clinically stable children and adolescents with cystic fibrosis (CF). METHODS: This was a cross-sectional study involving 67 children and adolescents with CF between 2 and 14 years of age. All of the participants underwent polysomnography, and SpO2 was measured by pulse oximetry. We also evaluated the Shwachman-Kulczycki (S-K) scores, spirometry findings, and nutritional status of the patients. RESULTS: The study involved 67 patients. The mean age of the patients was 8 years. The S-K scores differed significantly between the patients with and without nocturnal hypoxemia, which was defined as an SpO2 < 90% for more than 5% of the total sleep time (73.75 ± 6.29 vs. 86.38 ± 8.70; p < 0.01). Nocturnal hypoxemia correlated with the severity of lung disease, FEV1 (rs = −0.42; p = 0.01), FVC (rs = −0.46; p = 0.01), microarousal index (rs = 0.32; p = 0.01), and apnea-hypopnea index (rs = 0.56; p = 0.01). CONCLUSIONS: In this sample of patients with CF and mild-to-moderate lung disease, nocturnal oxygenation correlated with the S-K score, spirometry variables, sleep macrostructure variables, and the apnea-hypopnea index.

Inverse Association between Lancefield Group G Streptococcus Colonization and Sore Throat in Slum and Nonslum Settings in Brazil

ABSTRACT Group G Streptococcus has been implicated as a causative agent of pharyngitis in outbreak situations, but its role in endemic disease remains elusive. We found an unexpected inverse association of Streptococcus dysgalactiae subsp. equisimilis colonization and sore throat in a study of 2,194 children of 3 to 15 years of age in Salvador, Brazil.

Sensorineural hearing loss in children with sickle cell anemia and its association with endothelial dysfunction

ABSTRACT Objectives: To investigate the prevalence of sensorineural hearing loss (SNHL) in children and adolescents with sickle cell anemia (SCA) and its association with endothelial dysfunction (ED). Methods: Fifty-two participants with stable SCA and 44 apparently healthy (AA genotype) participants aged 6–18 years were evaluated for pure tone audiometry and endothelial function using ultrasonographic imaging of the brachial artery to assess flow-mediated dilation (FMD). Laboratory analysis of the lipid profile and C-reactive protein levels was performed. Results: In the SCA group, 15 (28.8%) patients presented with SNHL. The FMD values were reduced in the SCA with SNHL group compared with the SCA without SNHL and healthy groups. Logistic regression analysis showed that FMD was associated with SNHL independent of the lipid profile and SCA characteristics (odds ratio [95% confidence interval] = 0.614 [0.440–0.858]; p = 0.004). Discussion: SNHL is a common complication in SCA; furthermore, this study identified a significant association between ED and SNHL. Damage to the vascular endothelium because of inflammation in SCA reduced blood flow in the inner ear. Thus, this circulatory disorder culminates in vaso-occlusive process and induces auditory disorders, such as SNHL.