Fiabilidad de la poligrafía respiratoria para el diagnóstico del síndrome de apneas-hipopneas durante el sueño en niños

Objetivo La polisomnografia (PSG) nocturna es la tecnica diagnostica de referencia del sindrome de apneas-hipopneas durante el sueno (SAHS) en ninos. El objetivo del estudio ha sido evaluar la utilidad diagnostica de la poligrafia respiratoria (PR) en ninos con sospecha clinica de SAHS remitidos a la Unidad de Trastornos Respiratorios del Sueno. Pacientes y metodos Se estudio a 53 ninos remitidos por sospecha clinica de SAHS (29 varones; 54,7%), con una edad media ± desviacion estandar de 6,4 ± 2,9 anos. A todos ellos se les realizaron historia clinica, exploracion fisica, PR (Edentec®) y PSG nocturna simultaneamente en el laboratorio de sueno. Se realizo el analisis estadistico para comparar ambas tecnicas diagnosticas. Resultados Definiendo el diagnostico de SAHS como la presencia de un indice de apneas-hipopneas obstructivas (IAHO) igual o mayor de 3 en la PSG y un indice de eventos respiratorios (IER) de 3 o superior en la PR, la coincidencia diagnostica fue del 84,9%. La diferencia de medias entre el IAHO y el IER no fue significativa (0,7 ± 5,4; p = 0,34). El coeficiente de correlacion intraclase entre el IAHO y el IER fue de de 89,4 (intervalo de confianza del 95%, 82,4-93,7; p  Para el diagnostico de SAHS se consideraron los valores de IAHO iguales o mayores de 1; iguales o mayores de 3, e iguales o mayores de 5. Se calcularon las curvas de eficacia diagnostica para cada uno de ellos y 4,6 resulto ser el mejor IER para los 3 valores de IAHO considerados. Al analizar por estratos de edad, en ninos de 6 anos o mas el mejor IER obtenido para los 3 valores de IAHO considerados fue 2,1. En ninos menores de 6 anos se obtuvieron los siguientes valores de IER: 3,35 para IAHO de 1 o superior y 5,85 para IAHO de 3 o mayor y de 5 o superior. Conclusiones La PR realizada en el laboratorio de sueno es un metodo valido para el diagnostico de SAHS en ninos.

[1]  C. Marcus,et al.  Comparison of nap and overnight polysomnography in children , 1992, Pediatric pulmonology.

[2]  C. Marcus,et al.  Polysomnographic values in children 2–9 years old: Additional data and review of the literature , 2005, Pediatric pulmonology.

[3]  T. Campbell,et al.  Clinical assessment of pediatric obstructive sleep apnea. , 2004, Pediatrics.

[4]  S. Redline,et al.  Cardiorespiratory sleep studies in children: Establishment of normative data and polysomnographic predictors of morbidity , 1999 .

[5]  W. Flemons,et al.  Sleep‐disordered breathing in Duchenne muscular dystrophy: A preliminary study of the role of portable monitoring , 2000 .

[6]  Anubha Jain,et al.  Polysomnographic studies in children undergoing adenoidectomy and/or tonsillectomy , 2002, The Journal of Laryngology & Otology.

[7]  J. Carroll.  Obstructive sleep-disordered breathing in children: new controversies, new directions. , 2003, Clinics in chest medicine.

[8]  A. Hoes,et al.  Evaluation of a new device for home cardiorespiratory recording in children. , 2003, Archives of otolaryngology--head & neck surgery.

[9]  M. Mograss,et al.  Home testing for pediatric obstructive sleep apnea syndrome secondary to adenotonsillar hypertrophy , 1995, Pediatric pulmonology.

[10]  A. Rechtschaffen.  A manual of standardized terminology, techniques and scoring system for sleep of human subjects , 1968 .

[11]  A. Beckett,et al.  AKUFO AND IBARAPA. , 1965, Lancet.

[12]  J M Bland,et al.  Statistical methods for assessing agreement between two methods of clinical measurement , 1986 .

[13]  Schechter.  Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome : Technical report : diagnosis and management of childhood obstructive sleep apnea syndrome , 2002 .

[14]  D. Greenblatt,et al.  The International Classification of Sleep Disorders , 1992 .

[15]  P. Chow,et al.  Childhood sleep‐disordered breathing and its implications for cardiac and vascular diseases , 2005, Journal of paediatrics and child health.

[16]  J. Kelly,et al.  Behavior, neurocognition and quality-of-life in children with sleep-disordered breathing. , 2006, International journal of pediatric otorhinolaryngology.

[17]  A. Rechtschaffen,et al.  A manual of standardized terminology, technique and scoring system for sleep stages of human subjects , 1968 .

[18]  H. Trang,et al.  Use of nasal cannula for detecting sleep apneas and hypopneas in infants and children. , 2002, American journal of respiratory and critical care medicine.

[19]  M. Schechter,et al.  Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. , 2002, Pediatrics.

[20]  Gabriel G. Haddad,et al.  Standards and indications for cardiopulmonary sleep studies in children. American Thoracic Society. , 1996, American journal of respiratory and critical care medicine.

[21]  K. Lushington,et al.  Are sleep problems under-recognised in general practice? , 2004, Archives of Disease in Childhood.

[22]  C. Marcus,et al.  Obstructive hypopneas in children and adolescents: normal values. , 2003, American journal of respiratory and critical care medicine.

[23]  A. Pack,et al.  Indications for positive airway pressure treatment of adult obstructive sleep apnea patients: a consensus statement. , 1999, Chest.

[24]  C. Lamm,et al.  Evaluation of home audiotapes as an abbreviated test for obstructive sleep apnea syndrome (OSAS) in children , 1999, Pediatric pulmonology.

[25]  R. Pelayo,et al.  Increased Behavioral Morbidity in School-Aged Children With Sleep-Disordered Breathing , 2005, Pediatrics.

[26]  C. Guilleminault,et al.  EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. , 1992, Sleep.

[27]  L. Ferini-Strambi,et al.  Respiratory monitoring by means of an unattended device in children with suspected uncomplicated obstructive sleep apnea: a validation study. , 2003, Chest.

[28]  Yakov Sivan,et al.  Normal polysomnographic respiratory values in children and adolescents. , 2004, Chest.

[29]  K. Bonuck,et al.  Growth failure and sleep disordered breathing: a review of the literature. , 2006, International journal of pediatric otorhinolaryngology.

[30]  E. Wolpert.  A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. , 1969 .

[31]  D. Gozal,et al.  Polysomnographic Characteristics in Normal Preschool and Early School-Aged Children , 2006, Pediatrics.

[32]  K. Brown,et al.  Planning adenotonsillectomy in children with obstructive sleep apnea: the role of overnight oximetry. , 2004, Pediatrics.

[33]  J. Farber,et al.  Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. , 2002, Pediatrics.