Guidelines for diagnosis and treatment of obstructive sleep apnea hypopnea syndrome in children

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A definition of children with obstructive sleep apnea hypopnea syndrome (obstructivesleepapneahypopneasyndrom, OSAHS) is refers to some or a

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A definition of children with obstructive sleep apnea hypopnea syndrome (obstructivesleepapneahypopneasyndrom, OSAHS) is refers to some or all of the frequent occurrence of upper airway obstruction during sleep, disrupt the children's normal ventilation and sleep structure and a series of pathophysiological changes caused by.

Two. The common causes of OSAHS in children include the increase of upper airway resistance and the changes of compliance and the influence of neural regulation.

1 nose: chronic rhinitis is common (infectious, allergic), sinusitis, nasal polyps and nasal tumor, nasal septum and choanal atresia.

2 of the nasopharynx and oropharynx: the most common cause with adenoidal hypertrophy, hypertrophy of tonsil, other causes right tongue hypertrophy, accumulation of obesity caused by fat, pharynx and nasopharyngeal neoplasm, cleft palate velopharyngeal obstruction after valve surgery.

3 throat and trachea: congenital laryngomalacia, laryngeal web, laryngeal cyst, laryngeal and tracheal neoplasms and tracheal stenosis.

4 craniofacial malformations: midfacial growth of benign (syndrome, Grouzon syndrome, Down syndrome congruent cartilage development department); mandible development department, such as Pierre Robin syndrome (pierre-robinsyndrome), Mandibulofacial dysostosis and shy-Drager syndrome. Others, such as mucopolysaccharidosis type II and type IH (Hunter syndrome and Hurler syndrome), and metabolic diseases (such as bone sclerosis) abnormalities were associated with craniofacial structure.

5 factors affecting the regulation of nerves: systemic muscle tension reduction (Down syndrome, neuromuscular disorders), the use of sedative drugs, etc..

Three children with OSAHS, clinical manifestations and complications of snoring, mouth breathing, shortness of breath, sweating, repeated wake, enuresis, hyperactivity, excessive daytime sleepiness can occur even. Long-term mouth breathing can cause deformity and obvious maxillofacial development form "adenoid face" serious cases occurred cognitive defects, and memory loss, learning difficulties, behavioral abnormalities, growth retardation, hypertension, pulmonary hypertension, right heart failure and other cardiovascular diseases.

Four, diagnosis and differential diagnosis

1 diagnosis of obstructive sleep apnea (obstructivesleepapneaOSA) refers to sleep when the mouth and nose air flow stopped, but chest and abdominal breathing is still there. Low ventilation (hypopnea) is defined as the muzzle flow signal peak is reduced by 50%, with more than 0.03 oxygen desaturation and (or) awakening. The duration of the respiratory event is defined as greater than or equal to 2 respiratory cycles. Polysomnography (polysomnogruphy, PSG): monitoring of sleep per night in the process of obstructive apnea index (obstructiveapneaindexOAI), equal to 1 times greater than /h or AHI (apnea hypopnea index) was more than 5 abnormal. The lowest arterial oxygen saturation (lowestoxygensaturation, LAaO2) below 0.92 is defined as hypoxemia. Meet the above two can diagnose OSAHS.

2 diagnostic methods: PSG is a standard method for the diagnosis of sleep apnea at night. No conditions of PSG examination in reference to history, physical examination, nasopharyngeal lateral X-ray radiography, endoscopy, nose and throat snoring sound recording, video, pulse oximeter and other means to assist in the diagnosis of. The lateral radiograph of nasopharynx and CT can help to determine the location of airway obstruction, and the nasal endoscope can dynamically observe the upper airway stenosis.

PSG examination: the purpose is to identify snoring and the determination of OSAHS OSAHS; diagnosis; severity evaluation OSAHS; the evaluation of operation effect; the identification of central apnea and hypoventilation; the correlation between sleep structure assessment and non respiratory sleep disorders (such as night seizures etc.).

3 differential diagnosis should be with snoring and obstructive sleep apnea hypopnea syndrome and narcolepsy, laryngospasm, epilepsy and other identification.

Five, the principle of treatment: early diagnosis, early treatment, removal of upper airway obstruction factors, prevention and treatment of complications.

Treatment principles: a surgical treatment of 1 adenoidectomy and tonsillectomy: tonsil and adenoid hypertrophy in children with OSAHS feasible adenoidectomy and tonsillectomy. When the tonsil and adenoid hypertrophy, simple adenoids or simple tonsillectomy limited efficacy. The majority of obese children can be effectively treated by adenoidectomy and tonsillectomy. Infant tonsil, adenoid hypertrophy is severe OSAHS, conservative treatment is invalid, should also take surgical resection. The high risk group of patients with postoperative complications is less than 3 years of age, severe OSAHS, cor pulmonale, malnutrition, pathological obesity, neuromuscular tumors, craniofacial dysplasia. In this regard, must conduct a detailed assessment of preoperative and postoperative close monitoring should include: 2 other surgical treatment of craniofacial orthognathic surgery (for part of craniofacial deformity development in children), uvulopalatopharyngoplasty, inferior turbinate volume reduction surgery, treatment of tracheotomy can affect growth and development and the quality of life of children, should be very cautious.

Two non operative treatment 1 treatment with continuous positive airway pressure (continuouspositiveairwaypressure, CPAP): for surgical contraindication, adenoid tonsil department, adenotonsillectomy remains OSAHS and non operative treatment of children, can choose CPAP treatment. The pressure titration of CPAP must be done in the sleep laboratory and should be adjusted periodically. 2: Department of oral appliance for surgery can or cannot tolerate CPAP in the treatment of mild and moderate OSAHS patients. 3 other methods of treatment: treatment of nasal disease: system, standardize the treatment of rhinitis, allergic rhinitis and sinusitis; the weight loss in obese children.

 

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