a 9-a Conferință Națională de Pneumologie Pediatrică
Eveniment virtual
Joi, 1 octombrie – Sâmbătă 3 octombrie, 2020

Abstract

FENOTIPURI CLINICE SI STRATEGII DE MANAGEMENT ALE TULBURARILOR RESPIRATORII ASOCIATE SOMNULUI LA COPIL

Sorina Chindris1, Vlad Plesca2, Luminita-Elena Spatariu3, Doina-Anca Plesca4

 

1,3,4 Spital Clinic de Copii “Dr. Victor Gomoiu”, UMF “Carol Davila”, Bucuresti

2 Institut Fonoaudiologie si  chirurgie functionala ORL “Prof.Dr.Hociota”, UMF   “Carol Davila”, Bucuresti

Obiective : Evaluarea caracteristicilor clinice si managementul individualizat al tulburarilor respiratorii din timpul somnului, la pacientii care s-au adresat serviciului de polisomnografie din cadrul Sectiei Clinice Pediatrie a Spitalului Clinic de Copii “Dr. Victor Gomoiu” in perioada 1 martie 2019 – 1 martie 2020.

Metode de evaluare : Au fost monitorizati prin studiu prospectiv pe o perioada de 1 an, un numar de 57 pacienti. Acestia au fost evaluati clinic, paraclinic si s-a aplicat chestionarul de somn pediatric. S-a efectuat studiu de somn folosind polisomnograful Alice6 LDx, program de interpretare SleepwareG3, criterii de scorare AASM VIII4.B.

Rezultate : Din totalul de 57 pacienti cu varste curpinse intre 1-18 ani, evaluati pentru tulburari respiratorii asociate somnului, 30% au prezentat ronhopatii, 7% sindrom de rezistenta in caile respiratorii superioare si 61.4% sindrom de apnee in somn.

            Semnele si simptomele pacientilor s-au asociat, cel mai frecvent, cu fenotip de boala genetica. Din randul copiilor care au efectuat polisomnografie, 31.5% prezinta boli neuromusculare, 15.7% sindrom Prader-Willi, 14% alte boli genetice (mucopolizaharidoza, sindrom Down, acondroplazie, etc). Toti pacientii au fost confirmati pentru boala genetica prin teste moleculare.

            Dintre pacientii cu boli neuromusculare 72.2% au prezentat sindrom de apnee in somn.

            Patologia ORL a fost intalnita la 33.33% din pacienti.

            Obezitatea a fost confirmata la 19.2% din pacienti, mai mult de jumatate dintre acestia au asociat grade variate de apnee.

             Pacientii au primit tratament individualizat. Managementul a constat in masuri de imbunatatire a calitatii somnului (recomandari primite de toti pacientii investigati) asociate cu terapie medicamentoasa (22.8%), interventie chirurgicala in sfera ORL (15.7%) si ventilatie noninvaziva cu presiune continua pozitiva (22.8%).

Concluzii : La copil, privarea cronica de somn secundara tulburarilor respiratorii are consecinte importante pentru sanatate, dezvoltare neuromotorie si pentru atingerea performantelor academice.

                   Diagnosticarea corecta, tratamentul precoce si individualizat, sunt deziderate pentru o evolutie cat mai buna a fiecarui pacient.

Cuvinte-cheie: tulburari respiratorii, somn, copil, fenotip clinic, polisomnografie

 

Objectives: Evaluation of the clinical characteristics and individualized management of respiratory sleep disorders in patients who addressed the polysomnography service within the Children's Clinical Hospital "Dr. Victor Gomoiu” between March 1, 2019 - March 1, 2020.

Matherial and methods: A number of 57 patients were monitored by a prospective study over a period of 1 year. They were evaluated clinically, paraclinically and the pediatric sleep questionnaire was applied. A sleep study was performed using the Alice6 LDx polysomnograph, SleepwareG3 interpretation program, AASM VIII4.B scoring criteria.

Results: Out of 57 patients aged 1-18 years, evaluated for sleep-related respiratory disorders, 30% had ronhopathy, 7% sleep related respiratory arousal and 61.4% sleep apnea syndrome.

Patients' signs and symptoms were most commonly associated with a genetic disorder phenotype. Among children who underwent polysomnography, 31.5% have neuromuscular diseases, 15.7% Prader-Willi syndrome, 14% other genetic diseases (mucopolysaccharidosis, Down syndrome, achondroplasia, etc.). All patients were confirmed for the genetic disease by molecular tests.

Among patients with neuromuscular diseases, 72.2% had sleep apnea syndrome.

ENT pathology was found in 33.33% of patients.

Obesity was confirmed in 19.2% of patients and more than half of them associated varying degrees of apnea.

Patients received individualized treatment. Management consisted in measures for improving sleep quality (recommendations received by all the patients) associated with drug therapy (22.8%), ENT surgery (15.7%) and noninvasive ventilation with continuous positive pressure (22.8%).

Conclusions: In children, chronic sleep deprivation secondary to respiratory sleep disorders has important consequences for health, neuromotor development and for achieving academic performance.

The correct diagnosis, the early and individualized treatment, are desideratum for a better evolution of each patient.

Keywords: respiratory disorders, sleep, child, phenotype, polysomnography


28|sorina@chindris.com
A 9-a Conferință Națională de Pneumologie Pediatrică
Joi, 1 octombrie – Sâmbătă 3 octombrie, 2020

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Email: office@pneumologiepediatrica2020.ro