Quality of life in children with sleep-disordered breathing

Abstract

Introduction: Children may present sleep-disordered breathing (SDB) that includes primary snoring (PS) and obstructive sleep apnea syndrome (OSAS). The golden-standard for diagnosis is polysomnography (PSG), and the main cause is adenotonsillar hypertrophy. Adenotonsillectomy is the most appropriate treatment. SDB leads to innumerable complications and impacts on quality of life (QOL), and to evaluate it, the use of questionnaires with answers from parents or caregivers is necessary. Objectives: To evaluate QOL in children with SDB, to compare the QOL of children with OSAS and PS, and to identify which areas of OSA-18 are mostly affected. Methods: Cross-sectional study with consecutive sampling of spontaneous demand in children with history of snoring and or apnea, with hyperplasia of tonsils or adenoids at physical examination. The obstruction degree of tonsils was identified by Brodsky's classification, pharyngeal tonsil (adenoid) was measured by fiberoptic nasal endoscopy and QOL by OSA-18 questionnaire. PSG was used to diagnose OSAS and PS according to apnea index (AI) and apnea-hypopnea index (AHI) and were calculated by dividing the number of apneas or hypopneas by the hours of sleep. Results: Fifty-nine children participated in this study with mean age of 6.7±2.26 years-old. The mean score of the OSA-18 was 77.9±13.22 and the areas were: caregiver concerns (21.8±4.25), sleep disturbance (18.8±5.19), and physical suffering (17.3±5.0). The impact was low in 6 children (10.2%), moderate in 33 (55.9%), and high in 20 (33.9%). PS was found in 44 children (74.6%), OSAS in 15 (25.6%) and degrees were: mild in 6 (10.2%), moderate in 1 (1.7%), and severe in 8 (13.6%). OSAS had most affected physical suffering area than PS (p=0.04). There was a lack of correlation between the OSA-18 score and the degree of pharyngeal obstruction (r=0.18; p=0.17) and obstructive tonsils (r=0.04; p=0.74). There was no difference between OSA-18 scores and the groups PS, OSAS mild, moderate, and severe (p=0.07). The AI (r=0.22; p=0.08) and AHI (r=0.14; p=0.26) were not correlated with OSA-18. Conclusions: SDB caused moderate to marked impact in the QOL and the most affected areas were caregiver concerns, sleep disturbance, and physical suffering. Those affected by OSAS had higher score in the field of physical distress than PS. OSA-18 did not correlate with PS, OSAS, AI, and AIH.

Correlação entre o perfil do sono e o comportamento em indivíduos com transtorno específico da aprendizagem

“…SBD symptoms in the SLD corroborate the hypothesis reported in previous studies that changes in the respiratory pattern can lead to nocturnal sleep fragmentation -altering its cycle, and affect language development and academic performance (26,27) . Regarding behavior analysis, the present study showed high prevalence of altered behaviors in the SLD, with emphasis on attention problems.…”

Qualidade do sono das crianças internadas com síndrome do respirador bucal

“…Estudo de corte, realizado com 59 crianças de 3 a 12 anos de baixa condição social. Avaliou a qualidade de vida de crianças com distúrbios respiratórios do sono, comparou com crianças com síndrome da apneia obstrutiva do sono e ronco primário e identificou quais domínios do questionário da qualidade de vida estão mais comprometidos; 74,6 % apresentaram ronco primário, sendo a perturbação do sono(18,8 ± 5,19) um dos domínios mais afetados(19).O problema sentir muito calor uma a duas vezes/ semana, apontado como problema por pais e/ou responsáveis de 26,3 % das crianças com sono ruim e de 5,3 % com sono muito ruim (referência que relatou o distúrbio do sono na abordagem pediátrica), leva à recomendação de que hábitos saudáveis de sono devam iniciar-se logo nos primeiros meses de vida (3º ao 4º mês) e continuar por toda a vida, a fim de prevenir os distúrbios comportamentais do sono. Assim, enfatiza que a criança deva dormir em ambiente calmo, com pouca luz, sem ruídos e com temperatura agradável(18,20).…”

The effect of adenotonsillar hypertrophy and other obstructive diseases on sleep disorders in children

“…Besides allergic rhinitis, infectious diseases and hypertrophy of adenoid and tonsillar tissues are also conditions that affect sleep disorders. 2 Allergic rhinitis has also effect on adenotonsillar hypertrophy. 3 , 4 Tonsillar hypertrophy has a great role in obstructing upper airway, and consequently in sleep disorders.…”