2010, Número 1
<< Anterior Siguiente >>
Neumol Cir Torax 2010; 69 (1)
Fisiopatología del síndrome de apneas-hipopneas durante el sueño en niños
Torre-Bouscoulet L, Arredondo BF, Carrillo-Alduenda JL, Reyes-Zúñiga M, Vázquez-García JC, Castorena-Maldonado A
Idioma: Español
Referencias bibliográficas: 51
Paginas: 31-38
Archivo PDF: 250.47 Kb.
RESUMEN
El síndrome de apneas-hipopneas durante el sueño (SAHS) afecta al 1% de la población pediátrica y se asocia de manera independiente a déficit en las funciones neurocognoscitivas y conductuales, elevado riesgo cardiovascular y trastornos del metabolismo de la glucosa. La desproporción entre el tamaño de la vía aérea y el crecimiento del tejido linfoide contribuye a la aparición del SAHS; sin embargo, el conocimiento actual de la fisiología de la faringe durante el sueño ha ayudado a esclarecer la razón por la que el crecimiento de amígdalas y adenoides no es,
per se, suficiente para causar SAHS en la mayoría de los casos. La adecuada función de los músculos dilatadores de la faringe es una vía adaptativa neuromuscular que permite mantener permeable la vía aérea superior en diferentes circunstancias, incluyendo la exagerada presión negativa impuesta por el tejido linfoide. La mal función de dicha vía adaptativa es el centro de la fisiopatología del SAHS en niños. Otros factores involucrados en la fisiopatología del SAHS en niños son la obesidad y las malformaciones craneofaciales. En este artículo se revisan los mecanismos fisiopatológicos del SAHS en niños.
REFERENCIAS (EN ESTE ARTÍCULO)
American Academy of Sleep Medicine. International classification of sleep disorders. 2nd ed. Westchester, Illinois: American Academy of Sleep Medicine; 2005.
Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002;165:1217-1239.
Halbower AC, Degaonkar M, Barker PB, et ál. Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury. PLoS Med 2006;3:e301.
Bhattacharjee R, Kheirandish-Gozal L, Pillar G, Gozal D. Cardiovascular complications of obstructive sleep apnea syndrome: evidence from children. Prog Cardiovasc Dis 2009;51:416-433.
Gozal D, Capdevila OS, Kheirandish-Gozal L. Metabolic alterations and systemic inflammation in obstructive sleep apnea among nonobese and obese prepubertal children. Am J Respir Crit Care Med 2008;177:1142-1149.
Goodwin JL, Babar SI, Kaemingk KL, et ál. Symptoms related to sleep-disordered breathing in white and Hispanic children: the Tucson Children’s Assessment of Sleep Apnea Study. Chest 2003;124:196-203.
Ng DK, Kwok KL, Cheung JM, et ál. Prevalence of sleep problems in Hong Kong primary school children: a community-based telephone survey. Chest 2005;128:1315-1323.
Rosen CL, Larkin EK, Kirchner HL, et ál. Prevalence and risk factors for sleep-disordered breathing in 8- to 11-year-old children: association with race and prematurity. J Pediatr 2003;142:383-389
Spruyt K, O’Brien LM, Cluydts R, Verleye GB, Ferri R. Odds, prevalence and predictors of sleep problems in school-age normal children. J Sleep Res 2005;14:163-176.
Brunetti L, Rana S, Lospalluti ML, et ál. Prevalence of obstructive sleep apnea syndrome in a cohort of 1,207 children of southern Italy. Chest 2001;120:1930-1935.
Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G. Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med 1999;159(5 Pt 1):1527-1532.
White DP. Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med 2005;172:1363-1370.
Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Anea Syndrome. American Academy of Pediatrics. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109:704-712.
Castronovo V, Zucconi M, Nosetti L, et ál. Prevalence of habitual snoring and sleep-disordered breathing in preschool-aged children in an Italian community. J Pediatr 2003;142:377-382.
Isono S, Shimada A, Utsugi M, Konno A, Nishino T. Comparison of static mechanical properties of the passive pharynx between normal children and children with sleep-disordered breathing. Am J Respir Crit Care Med 1998; 157(4 Pt 1):1204-1212.
Marcus CL. Pathophysiology of childhood obstructive sleep apnea: current concepts. Respir Physiol 2000;119:143-154.
Caleco M, Zuloaga S, Pérez-Padilla JR, Vázquez JC. Prevalence of snoring and obstructive sleep apnea syndrome in preschool children from Mexico City. Am J Respir Crit Care Med 2001;163:A300.
Arens R, McDonough JM, Costarino AT, et ál. Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2001;164:698-703.
Laurikainen E, Erkinjuntti M, Alihanka J, Rikalainean H, Suonpää. Radiological parameters of the bony nasopharynx and the adenotonsillar size compared with sleep apnea episodes in children. Int J Pediatr Otorhinolaryngol 1987;12:303-310.
Suen JS, Arnold JE, Brooks LJ. Adenotonsillectomy for treatment of obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg 1995;121:525-530.
Marcus CL, Katz ES, Lutz J, Black CA, Galster P, Carson KA. Upper airway dynamic responses in children with the obstructive sleep apnea syndrome. Pediatr Res 2005;57:99-107.
Dayyat E, Kheirandish-Gozal L, Sans Capdevila O, Maarafeya MM, Gozal D. Obstructive sleep apnea in children: relative contributions of body mass index and adenotonsillar hypertrophy. Chest 2009;136:137-144.
Schwab RJ, Gupta KB, Gefter WB, Metzger LJ, Hoffman EA, Pack AL. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med 1995;152(5 Pt 1):1673-1689.
Fogel RB, Trinder J, Malhotra A, et ál. Within-breath control of genioglossal muscle activation in humans: effect of sleep-wake state. J Physiol 2003;550(Pt 3):899-910.
Mezzanotte WS, Tangel DJ, White DP. Influence of sleep onset on upper-airway muscle activity in apnea patients versus normal controls. Am J Respir Crit Care Med 1996;153(6 Pt 1):1880-1887.
Iber C, Ancoli-Israel S, Chesson A, Quan SF for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events. Rules, Terminology and Technical Specifications. Westchester, Illinois: American Academy of Sleep Medicine; 2007.
Weiner D, Mitra J, Salamone J, Cherniack NS. Effect of chemical stimuli on nerves supplying upper airway muscles. J Appl Physiol 1982;52:530-536.
Aronson RM, Onal E, Carley DW, Lopata M. Upper airway and respiratory muscle responses to continuous negative airway pressure. J Appl Physiol 1989;66:1373-1382.
Katz ES, Marcus CL, White DP. Influence of airway pressure on genioglossus activity during sleep in normal children. Am J Respir Crit Care Med 2006;173:902-909.
Marcus CL, Fernandes Do Prado LB, Lutz J, et ál. Developmental changes in upper airway dynamics. J Appl Physiol 2004;97:98-108.
Bandla P, Huang J, Karamessinis L, et ál. Puberty and upper airway dynamics during sleep. Sleep 2008;31:534-541.
Marcus CL, McColley SA, Carroll JL, Loughlin GM, Smith PL, Schwartz AR. Upper airway collapsibility in children with obstructive sleep apnea syndrome. J Appl Physiol 1994;77:918-924.
Kimoff RJ, Sforza E, Champagne V, Ofiara L, Gendron D. Upper airway sensation in snoring and obstructive sleep apnea. Am J Respir Crit Care Med 2001;164:250-255.
Arens R, Marcus CL. Pathophysiology of upper airway obstruction: a developmental perspective. Sleep 2004;27:997-1019.
Strohl KP, Redline S. Nasal CPAP therapy, upper airway muscle activation, and obstructive sleep apnea. Am Rev Respir Dis 1986;134:555-558.
Collard P, Dury M, Delguste P, Aubert G, Rodenstein DO. Movement arousals and sleep-related disordered breathing in adults. Am J Respir Crit Care Med 1996;154(2 Pt 1):454-459.
McNamara F, Issa FG, Sullivan CE. Arousal pattern following central and obstructive breathing abnormalities in infants and children. J Appl Physiol 1996;81:2651-2657.
Standards and indications for cardiopulmonary sleep studies in children. American Thoracic Society. Am J Respir Crit Care Med 1996;153:866-878.
Cherniack NS, Longobardo GS. Mathematical models of periodic breathing and their usefulness in understanding cardiovascular and respiratory disorders. Exp Physiol 2006;91:295-305.
Ievers-Landis CE, Redline S. Pediatric sleep apnea: implications of the epidemic of childhood overweight. Am J Respir Crit Care Med 2007;175:436-441.
Olaiz-Fernández G, Rivera-Dommarco J, Shamah-Levy T, et ál. Encuesta Nacional de Salud y Nutrición 2006. Cuernavaca, México: Instituto Nacional de Salud Pública; 2006.
Wing YK, Hui SH, Pak WM, et ál. A controlled study of sleep related disordered breathing in obese children. Arch Dis Child 2003;88:1043-1047.
Agras WS, Hammer LD, McNicholas F, Kraemer HC. Risk factors for childhood overweight: a prospective study from birth to 9.5 years. J Pediatr 2004;145:20-25.
Lumeng JC, Gannon K, Cabral HJ, Frank DA, Zuckerman B, et ál. Association between clinically meaningful behavior problems and overweight in children. Pediatrics 2003;112:1138-1145.
von Kries R, Toschke AM, Wurmser H, Sauerwald T, Koletzko B. Reduced risk for overweight and obesity in 5- and 6-y-old children by duration of sleep--a cross-sectional study. Int J Obes Relat Metab Disord 2002;26:710-716.
Sulit LG, Storfer-Isser A, Rosen CL, Kirchner HL, Redline S. Associations of obesity, sleep-disordered breathing, and wheezing in children. Am J Respir Crit Care Med 2005;171:659-664.
Shine NP, Lannigan FJ, Coates HL, Wilson A. Adenotonsillectomy for obstructive sleep apnea in obese children: effects on respiratory parameters and clinical outcome. Arch Otolaryngol Head Neck Surg 2006;132:1123-1127.
Kheirandish L, Goldbart AD, Gozal D. Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics 2006;117:e61-66.
Mitchell RB. Adenotonsillectomy for obstructive sleep apnea in children: outcome evaluated by pre- and postoperative polysomnography. Laryngoscope 2007;117:1844-1854.
Tauman R, Gulliver TE, Krishna J, et ál. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr 2006;149:803-808.
Costa DJ, Mitchell R. Adenotonsillectomy for obstructive sleep apnea in obese children: a meta-analysis. Otolaryngol Head Neck Surg 2009;140:455-460.