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      Enfoque Pediátrico para el Estudio de los Trastornos Respiratorios del Sueño Translated title: Pediatric Approach to Sleep Disorders Studies in Children

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          Abstract

          Los Trastornos Respiratorios del Sueño (TRS) pueden generar un impacto en la salud de niños y adolescentes, en un periodo altamente vulnerable para el neurodesarrollo. La anamnesis y examen fisco pueden orientar a su diagnóstico, sin embargo, poseen limitaciones importantes, especialmente en etapas precoces de la enfermedad. En niños con factores de riesgo específicos es necesario tener un alto nivel de sospecha y realizar estudios diagnósticos. Este artículo de revisión tiene como objetivo describir las distintas alternativas diagnósticas, practicables en distintos escenarios clínicos y realizadas durante el sueño o vigilia. Estos métodos diagnósticos pueden ser de utilidad en el reconocimiento y tratamiento precoz de los TRS.

          Translated abstract

          Sleep Disorders can generate significant impact in the health of children and adolescents at a highly vulnerable period for neurodevelopment. A proper history and physical exam can lead the diagnosis, however there are significant limitations especially in the early phases of illness. Children with specific risks require a high level of suspicion, and early diagnostic studies. This review describes various diagnostic alternatives, feasible in different clinical situations, during sleep or wakefulness. These diagnostic studies may be useful in detection and early treatment of Sleep Disorders.

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          Most cited references 59

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          Sleep-disordered breathing in children.

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            Normal polysomnographic values for children and adolescents.

            Although polysomnography is routinely performed to evaluate children and adolescents with sleep-disordered breathing, normal polysomnographic values for the pediatric age group have not yet been established. We therefore performed overnight polysomnography in 50 normal children and adolescents (mean age 9.7 +/- 4.6 SD yr, range 1.1 to 17.4 yr). Of the children 56% were male. Chest wall motion, ECG, oronasal airflow, end-tidal PCO2 (PETCO2), arterial oxygen saturation (SaO2), and electrooculogram were monitored. Children had 0.1 +/- 0.5 (range 0 to 3.1) obstructive apneas per hour of total sleep time, with only 18% of children having any obstructive apneas. No child had obstructive apneas > 10 s in duration. Of the children 30% had central apneas > or = 10 s in duration, and one child had a central apnea associated with SaO2 45 mm Hg) occurred for 7 +/- 19% total sleep time (range 0 to 91%). The SaO2 nadir was 96 +/- 2% (range 89 to 98%), with only one child desaturating below 90% in association with a central apnea. We conclude that polysomnographic results in the pediatric age group differ from those in adults. Recommendations for normal polysomnographic criteria are given.
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              Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea.

              To determine the utility of pulse oximetry for diagnosis of obstructive sleep apnea (OSA) in children. We performed a cross-sectional study of 349 patients referred to a pediatric sleep laboratory for possible OSA. A mixed/obstructive apnea/hypopnea index (MOAHI) greater than or equal to 1 on nocturnal polysomnography (PSG) defined OSA. A sleep laboratory physician read nocturnal oximetry trend and event graphs, blinded to clinical and polysomnographic results. Likelihood ratios were used to determine the change in probability of having OSA before and after oximetry results were known. Of 349 patients, 210 (60%) had OSA as defined polysomnographically. Oximetry trend graphs were classified as positive for OSA in 93 and negative or inconclusive in 256 patients. Of the 93 oximetry results read as positive, PSG confirmed OSA in 90 patients. A positive oximetry trend graph had a likelihood ratio of 19.4, increasing the probability of having OSA from 60% to 97%. The median MOAHI of children with a positive oximetry result was 16.4 (7.5, 30.2). The 3 false-positive oximetry results were all in the subgroup of 92 children who had diagnoses other than adenotonsillar hypertrophy that might have affected breathing during sleep. A negative or inconclusive oximetry result had a likelihood ratio of.58, decreasing the probability of having OSA from 60% to 47%. Interobserver reliability for oximetry readings was very good to excellent (kappa =.80). In the setting of a child suspected of having OSA, a positive nocturnal oximetry trend graph has at least a 97% positive predictive value. Oximetry could: 1) be the definitive diagnostic test for straightforward OSA attributable to adenotonsillar hypertrophy in children older than 12 months of age, or 2) quickly and inexpensively identify children with a history suggesting sleep-disordered breathing who would require PSG to elucidate the type and severity. A negative oximetry result cannot be used to rule out OSA.
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                Author and article information

                Journal
                rcp
                Revista chilena de pediatría
                Rev. chil. pediatr.
                Sociedad Chilena de Pediatría (Santiago, , Chile )
                0370-4106
                October 2010
                : 81
                : 5
                : 445-455
                Affiliations
                orgnameHospital Clínico San Borja Arriarán orgdiv1Servicio de Pediatría orgdiv2Unidad de Niños y Adolescentes con Necesidades Especiales en Salud Chile
                orgnameInstituto Nacional de Rehabilitación orgdiv1Unidad de Cuidados Especiales Chile
                orgnameUniversidad de Chile orgdiv1Facultad de Medicina orgdiv2Departamento de Pediatría y Cirugía Infantil Sur Chile
                orgnameUniversidad de Chile orgdiv1Facultad de Medicina orgdiv2Departamento de Pediatría Campus Centro Chile
                orgnameMinisterio de Salud de Chile orgdiv1Programa Asistencia Ventilatoria No Invasiva Chile
                orgnamePontificia Universidad Católica de Chile orgdiv1Departamento de Pediatría Chile
                Article
                S0370-41062010000500009 S0370-4106(10)08100509
                10.4067/S0370-41062010000500009

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 35, Pages: 11
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