Professional knowledgeGuidelines for diagnosis and treatment of obstructive sleep apnea hypopnea syndrome in children
Source： Time：2015-10-13 16:22
Two.The common causes of OSAHS in children include the increase in the resistance of the upper airway, the change of the adaptation and the influence of the neural regulation.
1.Nose: a common chronic rhinitis (infectious, allergic), sinusitis, nasal polyps, nasal tumor, deviation of nasal septum and posterior choanal atresia.
2.nasopharyngeal and mouth pharynx: the most common reasons for adenoid hypertrophy, hypertrophy of the body, other reasons for the right tongue hypertrophy, obesity caused by the accumulation of fat, the pharynx and nasal pharyngeal mass, cleft palate and palate.
3.throat and trachea: congenital laryngomalacia, laryngeal web, laryngeal cyst, laryngeal and tracheal neoplasms and tracheal stenosis.
4.Craniofacial malformation: good (Down's comprehensive syndrome and Grouzon syndrome in and cartilage development congruent) of midface development; mandible development department, such as Pierre Robin syndrome (Pierre-Robin syndrome), the mandible facial hypoplasia, shy-Drager syndrome etc.. Others, such as sticky much sugar storage disease type II and type IH (Hunter syndrome, Hurler syndrome), and metabolic diseases such as osteopetrosis etc. were associated with craniofacial structure abnormalities.
5 factors that affect the nervous regulation: the reduction of the whole body muscle tone (Down syndrome, neuromuscular disease), and the use of sedative drugs, etc..
Sleep snoring, mouth breathing, shortness of breath, sweating, enuresis, wake up repeatedly, hyperactivity, even daytime sleepiness can occur. Long mouth breathing can lead to obvious maxillofacial developmental abnormalities, the formation of "adenoid body face" severe cases of cognitive defects, memory decline, learning difficulties, behavioral abnormalities, growth and development, hypertension, pulmonary hypertension, right heart failure and other cardiovascular disease.
Four. Diagnosis and differential diagnosis
1.diagnosis:
Obstructive sleep apnea (sleep apnea OSA obstructive) is a time when the mouth and nose are stopped, but the chest and abdominal breathing still exist.
Hypopnea (hypopnea) is defined as the peak of muzzle flow signal decreased by 50%, and accompanied by more than 0.03 oxygen saturation decreased and (or) awakening.
The time length of the respiratory event was defined as greater than or equal to 2 respiratory cycles.
Obstructive (PSG) /h (polysomnogruphy): apnea index OAI (AHI) was more than 1 times during the night. Oxygen saturation lowest (LAaO2) was lower than 0.92. Meet the above two can be diagnosed OSAHS.
2.diagnostic method:
PSG examination at night is the standard method for diagnosis of sleep apnea. Children without conditions of PSG, according to the history, physical examination, nasopharyngeal lateral X ray to bit radiography, nose throat endoscope, snoring sound recording, video, pulse oximeter, means to assist in the diagnosis of. X-ray lateral or CT is helpful to determine the location of airway obstruction, and the dynamic observation of nasal endoscope can be observed.
The purpose of the PSG inspection is:
The identification of snoring and OSAHS;
To determine the diagnosis of OSAHS;
To evaluate the severity of OSAHS;
The evaluation of operation effect;
The identification of central apnea and hypoventilation;
The correlation between sleep structure assessment and non respiratory sleep disorders (such as nocturnal seizures etc.).
Children's OSHAS disease severity rating scale
Table a children's OSHAS condition judgment basis
AHI or OAI (/h) LSaO2
Mild 1-5 or 0.85-0.94 5-10
Moderate -20 or 0.75-0.84 -10
Severe >20 or <0.75 >10
Note: AHI is a low ventilation index of apnea hypopnea index; OAI is the obstructive apnea index; LSaO2 is the lowest blood oxygen saturation;
3.differential diagnosis:
With simple snoring, obstructive sleep apnea hypopnea syndrome, narcolepsy, laryngospasm, epilepsy and other identification.
1.adenoidectomy and tonsillectomy:
Tonsil, adenoid hypertrophy caused by OSAHS children's adenoid tonsillectomy, feasible. When both the amygdala and the adenoid body are enlarged, the curative effect is limited. The majority of obese children can be effectively treated by adenoidectomy, tonsillectomy. Infant tonsil, adenoid hypertrophy is severe OSAHS, conservative treatment is invalid, should also take operation resection.
The high risk population of the postoperative complications was less than 3 years old, severe OSAHS, pulmonary heart disease, malnutrition, pathological obesity, nerve and muscle tumors, and abnormal cranial facial development. In this regard, it is necessary to have a detailed assessment of the operation, and should be closely monitored.
2.Surgical treatment includes: craniofacial is orthognathic surgery (applicable to the portion of the craniofacial developmental malformation of children), uvula palate pharyngeal angioplasty, inferior turbinate reduction capacity operation, tracheotomy treatment may affect a child's growth, development and quality of life, to be very careful.
Two non operative treatment
1.positive airway pressure CPAP (continuous): OSAHS is still present in the surgical treatment of surgical treatment for the patients with and CPAP, and the selection of patients with non operative treatment is still present. CPAP pressure titration must be done in the sleep lab, and need to be adjusted periodically.
2.Department of oral appliance for operation can or cannot tolerate CPAP in the treatment of mild to moderate, with OSAHS.
3.other treatments:
Treatment of nasal disease: system, standardize the treatment of rhinitis, allergic rhinitis and sinusitis;
Obesity children should lose weight.
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