Tonsillar Hyperplasia in Children: A Cause of Obstructive Sleep Apneas, CO2 Retention, and Retarded Growth

Lind, Magnus G.; Lundell, Bo

doi:10.1001/archotol.1982.00790580044015

Cited by 106 publications

(42 citation statements)

References 37 publications

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“…(6,16) Stunted growth (weight and height) is most commonly observed in children with OSAHS, who experience an increase in the rate of growth after undergoing tonsillectomy. (25) Decreased production of the growth hormone during fragmented sleep and increased respiratory effort can contribute to the deficit in the growth of these children, (5) as well as to the cardiovascular alterations including pulmonary hypertension and right ventricle dysfunction, which can be potentially avoided by surgically removing the adenoid and tonsillar tissue. The true prevalence of these alterations is as yet unknown.…”

Section: Resultsmentioning

confidence: 99%

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

Gregório¹,

Athanazio

Bitencourt

et al. 2008

J. bras. pneumol.

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OBJETIVOS: Investigar os sintomas mais freqüentes encontrados em crianças com diagnóstico polissonográfico de síndrome da apnéia-hipopnéia obstrutiva do sono (SAHOS). MÉTODOS: Foram avaliadas 38 crianças consecutivamente encaminhadas ao laboratório do sono com suspeita de SAHOS no período de junho de 2003 a dezembro de 2004. Os pacientes foram submetidos a um questionário pré-sono e a polissonografia. RESULTADOS: A idade média foi de 7,8 ± 4 anos (variação, 2-15 anos), sendo 50% das crianças do sexo masculino. Não apnéicos corresponderam a 7,9% dos pesquisados, distúrbio leve obstrutivo do sono ocorreu em 42,1%, moderado em 28,9% e severo em 22,1%. Observou-se maior freqüência de casos severos de apnéia entre crianças menores de seis anos (idade pré-escolar). Dentre as crianças com SAHOS, os sintomas mais citados foram ronco e obstrução nasal, presentes em 74,3 e 72,7% das crianças, respectivamente. Sonolência excessiva e bruxismo ocorreram em, respectivamente, 29,4 e 34,3% dos casos e doença do refluxo em apenas 3,1%. Agitação das pernas e dificuldade para iniciar o sono foram encontradas em, respectivamente, 65 e 33% dos avaliados. Todas as crianças que apresentaram SAHOS de grau severo tinham queixa de ronco e bruxismo. CONCLUSÕES: Nossos resultados mostraram que os sintomas mais freqüentes em crianças e adolescentes com SAHOS são ronco e obstrução nasal. Além disso, quadros mais graves da SAHOS estão associados à menor faixa etária.

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Section: Resultsmentioning

confidence: 99%

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

Gregório¹,

Athanazio

Bitencourt

et al. 2008

J. bras. pneumol.

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“…10 Growth velocity increases after adenotonsillectomy. 11 The hypothesized etiology for failure to thrive is increased work of breathing, with subsequent increase in baseline caloric expenditure.…”

Section: Historymentioning

confidence: 98%

Clinical Manifestations

Zhang

2013

Radiology of Influenza a (H1N1)

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“…4 On observation, there is continued chest and abdominal motion in the absence of airflow during sleep. In contrast to the common pathophysiologic mechanism of adenotonsillar hypertrophy contributing to OSA, 5 individuals with neuromuscular disease may also have weakness of the pharyngeal dilator muscles in the upper airway, which contribute to increased upper airway resistance during sleep because these muscles are required to maintain airway patency. 6 This becomes most evident in rapid eye movement (REM) sleep, 6 when these muscles are atonic.…”

Section: Obstructive Sleep Apneamentioning

confidence: 99%

Assessment of Sleep-Disordered Breathing in Pediatric Neuromuscular Diseases

Katz

2009

Pediatrics

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This is a summary of the presentation on the assessment of sleep-disordered breathing in pediatric neuromuscular diseases, presented as part of the program on pulmonary management of pediatric patients with neuromuscular disorders at the 30th annual Carrell-Krusen Neuromuscular Symposium on February 20, 2008. Pediatrics 2009123:S222-S225 S LEEP-ASSOCIATED RESPIRATORY DISORDERS are a major cause of morbidity and mortality in children with neuromuscular disease. They have a prevalence of Ͼ40%, 1 a 10-fold greater occurrence than in the general population. 2 Gas-exchange abnormalities and disrupted sleep architecture may occur in Ͼ80% of patients with neuromuscular disease. 3 Neuromuscular weakness can result in 2 different types of nocturnal respiratory problems: obstructive sleep apnea (OSA) and nocturnal hypoventilation. Both will be defined here, and pathophysiology specific to neuromuscular disease will be reviewed. The challenges of diagnosis of these conditions and the tools available to evaluate their presence will be explored. OBSTRUCTIVE SLEEP APNEAOSA is defined as partial or complete upper airway obstruction during sleep, associated with at least 1 of the following: (1) sleep disruption; (2) hypoxemia; (3) hypercapnia; or (4) daytime symptoms. 4 On observation, there is continued chest and abdominal motion in the absence of airflow during sleep. In contrast to the common pathophysiologic mechanism of adenotonsillar hypertrophy contributing to OSA, 5 individuals with neuromuscular disease may also have weakness of the pharyngeal dilator muscles in the upper airway, which contribute to increased upper airway resistance during sleep because these muscles are required to maintain airway patency. 6 This becomes most evident in rapid eye movement (REM) sleep, 6 when these muscles are atonic. In addition, OSA may be compounded by the presence of obesity or upper airway abnormalities including retrognathia and macroglossia, which are also risk factors for OSA that contribute to a reduced airway diameter.In neuromuscular disease, the presence of OSA often precedes the development of nocturnal hypoventilation. One retrospective study that studied the presentation of sleep-disordered breathing (SDB) in Duchenne muscular dystrophy evaluated 34 subjects, of whom 32 had polysomnography; 64% had symptoms of SDB, including daytime lethargy, headache or somnolence, and/or nighttime snoring or sleep disturbance. Interestingly, the presence or absence of symptoms did not predict SDB. 7 In addition, the presence of OSA was detected in this group during the first decade of life, as compared with nocturnal hypoventilation, which appeared in the second decade. NOCTURNAL HYPOVENTILATIONIn all individuals, there is a relative hypoventilation that occurs during sleep as a result of blunting of the hypoxic and hypercapnic drive to breathe. Therefore, there is a 25% reduction in tidal volume, a rise in arterial partial pressure of carbon dioxide of 3 to 4 mm Hg, and a reduction in arterial partial pressure of oxygen of...

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Tonsillar Hyperplasia in Children: A Cause of Obstructive Sleep Apneas, CO2 Retention, and Retarded Growth

Cited by 106 publications

References 37 publications

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

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

Clinical Manifestations

Assessment of Sleep-Disordered Breathing in Pediatric Neuromuscular Diseases

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