The role of polisomnography in children’s respiratory dysfunction management

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The role of polisomnography in children’s respiratory dysfunction management

Journal Title: ORL.ro - Year 2017, Vol 10, Issue 34

Abstract

Introduction. A common condition, with a prevalence of 1.2 to 5.7%, the obstructive sleep apnea syndrome (OSAS) in children is important in terms of the consequences it has on development, physiology and appropriate function. OSAS in children can cause hyperactive behaviour, attention and learning problems, weight gain issues, hypertension. Any factor that causes excesive narrowing of the pharynx or increases compliance of its walls may further predispose to the occurrence of OSAS. Children with OSAS typically have an anatomical predisposition to airway collapse; maximum airway narrowing corresponds to overlapping areas of the tonsils, the adenoid vegetations and the palate. Genetic and hormonal factors also affect throat compliance and as a result, the risk of OSAS. In this regard, clinical history and physical examination are less relevant prognostic factors and assessement of respiratory function during wakefulness is not helpful to detect gas exchange changes during sleep. Polysomnography (PSG) is a clinical assessment extension that provides important data regarding the respiratory flow, the oxygen saturation, CO2 and respiratory movements during sleep. Material and methods. We present a few cases of patients with sleep apnea episodes observed by parents. In some cases, nocturnal symptoms persisted after surgical adenoidectomy. Performing polysomnography allowed the diagnosis of obstructive sleep apnea syndrome and subsequent therapeutic recommendation. Conclusions. The mechanisms underlying the occurance of OSAS-caused morbidities are likely multifactorial and incompletely elucidated; the activation of the inflammatory pathways by SASO turned out to be an important pathophysiological component in the target organ damage associated with this condition. Sometimes it is possible that adenotonsilectomy is not the best first line treatment. This conclusion does not imply that tonsils or adenoid vegetations is not sometimes the primary mechanism of occurrence of respiratory disorders during sleep in children. It should be seen as an important element in considering alternative therapies. Polysomnography is the investigation of choice in children with suspected OSAS and for the evaluation of apnea/hypopnea residual index after treatment. It is necessary that the equipment and rules of interpretation are appropriate to their age, and the results from polysomnography are integrated with the clinical observation.

Authors and Affiliations

Sorina Dindere, Mihaela Oros, Lucica Baranga, Dan Masariu, Cristina Anghel

Keywords

EP ID EP654988
DOI 10.26416/Orl.34.1.2017.462
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