medigraphic.com
A partir del año 2010, la Revista Oficial del INER cambió a NCT (Neumología y Cirugía de Tórax)

 Ver actualización

2004, Number 3

<< Back Next >>

Rev Inst Nal Enf Resp Mex 2004; 17 (3)

Complications and risk factors associated to morbidity and mortality in adeno-amygdalectomized pediatric patients with obstructive sleep apnea syndrome.

Lule MMS, Moysen RG, Álvarez GA, Robledo PJC, Narváez PO, Niebla ÁBA

Language: Spanish
References: 31
Page: 173-180
PDF size: 82.38 Kb.


ABSTRACT

Background: It is very important to recognize in pediatric patients with OSAS and adenotonsilar hypertrophy the severity of the apnea/hypoapnea index and SpO2 desaturation during REM sleep, because, in case of surgical intervention, non-pharmacologic medical treatment with CPAP or Bilevel positive pressure ventilation will be necessary prior to surgery to dismiss perioperative complications. Methods: Observational, cohort, longitudinal, descriptive and prospective study. We included 124 children under 15 years of age in postsurgical period, who were admitted to IRCU between June 2000 and August 2001. We applied Fisher’s exact test, Chi square, logistic progression and CI value of 95%. Result: Gender relation was M/F: 2:1, boys being more affected. The youngest patients were 13 months and the oldest 168 months; weight in kilograms was 25±9.9; percentages of associated comorbility were: obesity 26.6%, asthma 8.9% and 3.2% for neurological disorders. OSAS severity percentages were: 62.1% for mild; 21% for moderate and 16.9% for severe. Mean apnea index was 21.6 (SD32.7; min 1.3 max 175/hour). Perioperative complications were: systemic arterial hypertension, 6.5%; weaning failure, 4.8%; strider, wheezing and AMV: 9.7%; in addition, 4% of the patients with SAH needed vasodilatation intravenous therapy and analgesic. Univariate analyses showed strong association of morbidity with obesity (p>0.08), weaning failure in the OR and other trans-operative complications (p<0.002), and comorbility (p<0.017). Conclusions: Postoperative cardiovascular and respiratory complications of adeno-amygdalectomy were common (23%) in these OSAS patients compared to children without OSAS. Comorbility was strongly associated with perioperative complication. Treatment with CPAP or Bilevel positive pressure ventilation before surgical intervention decreased respiratory and cardiovascular complications.


REFERENCES

  1. Osler W. Principles and practice of medicine. Chronic tonsillitis. New York: Appleton; 1982. p. 335-339.

  2. Guilleminau C, Eldrige FL, Simmons FB, Dement WC. Sleep apnea in eight children. Pediatrics 1976;58:23-30.

  3. Carroll JL, Laughlin GM. Obstructive sleep apnea syndrome in infants and children. In: Ferber R, Krynger M, editors. Principles and practice of sleep medicine in the child. Philadelphia: Saunders; 1995. p. 91-163.

  4. American Thoracic Society. Standards and indication for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 1996;153:866-878.

  5. Krieger JD. Sleep apneas in normal older subjects do not worsen their long term morbidity. Sleep Res 1987;16:374.

  6. Carol L, Rosen MD. Obstructive sleep apnea syndrome in children: controversies in diagnosis and treatment. Pediatr Clin North Am 2004;51:153-167.

  7. Eddy A, Bresnits EA, Golderg R, Kasinski RM. Epidemiology of obstructive sleep apnea. Epidemiology Rev 1994;16:210-294.

  8. Ellen SD. FAAP, FACS, tonsillectomy and adenoidectomy. Pediatr Clin North Am 1996;43:1319-1338.

  9. Millman RP. Snoring and apnea. Clin Chest Med 1998;8:253-264.

  10. Lewis P, Singer P. Complications of pediatric obstructive sleep apnea. Otolaryngol Clin North Am 1990;23:665-675.

  11. Hoffstein V, Mateika JH, Mateika S. Snoring and sleep architecture. Am Rev Respir Dis 1991:143:92-96.

  12. Mallory GB, Fisher DH, Jackson R. Sleep associated breathing disorders in morbidly obese children and adolescents. J Pediatric 1989;115:892-897.

  13. Calverley PMA. Impact of sleep on respiration. Eur Respir Monogr 1998;3:9-27.

  14. Leach J, Olson J, Hermann J, Manning S. Polysomnographic and clinical findings in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 1992;118:741-744.

  15. Peter JH, Becker H, Brandenburg U, Cassel W, Conradt R, Hochban W, et al. Investigation and diagnosis of sleep apnea syndrome. Eur Respir Monogr, 1998;3: 106-143.

  16. Ainger LE. Large tonsils and adenoids in small children with cor pulmonale. Br Heart J 1968;30: 356.

  17. Wilkinson AR, McCormick MS, Freeland AP. Electrocardiography signs of pulmonary hypertension in children who snore. Br Med J 1981;282:579.

  18. Hillman BC. Pediatric respiratory disease. Diagnosis and treatment. In: Dyson MC, editor. Obstructive sleep apnea syndrome. Philadelphia:Saunders; 1993. p. 563-574.

  19. Gaultier C. Cardiorespiratory adaptation during sleep in infants and children. Ped Pulmonology 1995;19:105-117.

  20. Brooks LJ, Stepheos BM, Bacevice AM. Adenoid size is related to severity but not the number of episodes of obstructive apnea in children. J Pediatr 1998;132:682-686.

  21. Kunzman LA, Keens TG, Davidson-Ward SL. Incidence of systemic hypertension in children with obstructive sleep apnea syndrome. Am Rev Respir Dis 1990;141:808.

  22. Chowdhuri GS. Upper airway resistance syndrome is a distinct syndrome. Am J Respir Crit Care Med 2000;161:1412-1416.

  23. Hedner J, Grote L. Cardiovascular consequences of obstructive sleep apnea. Eur Respir Monogr 1998;3:227-265.

  24. Miman MC, Kirazli T, Ozyurek R. Doppler echocardiography in adenotonsilar hypertrophy. Int J Pediatr Otorhinolaryngol 2000;16:21-36.

  25. Delang DJ. Imaging of the right heart. In: Harned HS, editor. Pediatric pulmonary heart disease. USA: Little, Brown;1990. p. 107-119.

  26. Redding GJ. Pulmonary hypertension and cor pulmonale in children. In: Hillman BC, editor. Pediatric respiratory disease. Philadelphia:Saunders; 1993. p. 335-354.

  27. Montgomery JN, Watson CB, Mackie AM. Anesthesia for tonsillectomy and adenoidectomy. Otolaryngol Clin North Am 1987;20:326.

  28. Nooman JA. Cor pulmonale. In: Kendig’s, editor. Disorders of the respiratory tract in children. Philadelphia, Pennsylvania:Saunders;1998. p. 826-837.

  29. Levy AM, Tabakin BS, Hnson JS, Narkewicz RM. Hypertrophied adenoids causing pulmonary hypertension and severe congestive heart failure. N Engl J Med 1967;277:506-511.

  30. Marcus CL, Omlin KJ, Basinki DJ, Barley SL, Rachal AB, von Pechmann WS, et al. Normal polysomnographic values for children and adolescents. Am Rev Respir Dis 1992;146:1235-1239.

  31. Waters KA, Everett FM, Bruderer JW, Sullivan CE. The use of nasal CPAP in 80 children. Am J Respir Crit Care Med 1995;152:780-785.




2020     |     www.medigraphic.com