《兒童阻塞性睡眠呼吸暫停綜合征診斷治療指南》內容簡(jiǎn)介

    ABSTRACT. This clinical practice guideline, intendedfor use by primary care clinicians, provides recommen-dations for the diagnosis and management of obstructivesleep apnea syndrome （OSAS）。The Section on Pediatric Pulmonology of the AmericanAcademy of Pediatrics selected a subcommittee com-posed of pediatricians and other experts in the fields ofpulmonology and otolaryngology as well as experts fromepidemiology and pediatric practice to develop an evi-dence base of literature on this topic. The resulting evi-dence report was used to formulate recommendations forthe diagnosis and management of childhood OSAS.

    The guideline contains the following recommenda-tions for the diagnosis of OSAS: 1） all children should bescreened for snoring; 2） complex high-risk patientsshould be referred to a specialist; 3） patients with cardio-respiratory failure cannot await elective evaluation; 4）diagnostic evaluation is useful in discriminating be-tween primary snoring and OSAS, the gold standardbeing polysomnography; 5） adenotonsillectomy is thefirst line of treatment for most children, and continuouspositive airway pressure is an option for those who arenot candidates for surgery or do not respond to surgery;6） high-risk patients should be monitored as inpatientspostoperatively; 7） patients should be reevaluated post-operatively to determine whether additional treatment isrequired.

    《兒童阻塞性睡眠呼吸暫停綜合征診斷治療指南》內容預覽

    DEFINITION

    OSAS in children is a “disorder of breathing dur-ing sleep characterized by prolonged partial upperairway obstruction and/or intermittent complete ob-struction （obstructive apnea） that disrupts normalventilation during sleep and normal sleep patterns.”2Symptoms include habitual （nightly） snoring （oftenwith intermittent pauses, snorts, or gasps）， disturbedsleep, and daytime neurobehavioral problems. Day-time sleepiness may occur but is uncommon inyoung children. Complications include neurocogni-tive impairment, behavioral problems, failure tothrive, and cor pulmonale, particularly in severecases. Risk factors include adenotonsillar hypertro-phy, obesity, craniofacial anomalies, and neuromus-cular disorders. Only the first 2 risk factors are dis-cussed in this guideline.OSAS needs to be distinguished from primarysnoring （PS）， which is defined as snoring withoutobstructive apnea, frequent arousals from sleep, orgas exchange abnormalities.3Although PS is usuallyconsidered benign, this has not been well evaluated,because most studies of snoring children did notdiscriminate between PS and OSAS.

    PREVALENCE

    OSAS occurs in children of all ages, from neonatesto adolescents. It is thought to be most common inpreschool-aged children, which is the age when thetonsils and adenoids are the largest in relation to theunderlying airway size.4Three studies have evalu-ated the prevalence of childhood OSAS. These stud-ies did not use conventional polysomnography, used** rather than pediatric polysomnographic crite-ria, or studied only a selected high-risk sample of thepopulation; thus, a definitive epidemiologic studyhas not yet been performed. Despite these limita-tions, the 3 studies showed similar prevalence ratesof approximately 2%.5–7In contrast, PS is more com-mon; habitual snoring occurs in 3% to 12% of pre-school-aged children.5,6,8–10Thus, the clinician needsa method to distinguish OSAS from PS. OSAS occursequally among boys and girls.7One study indicatedthat the prevalence is higher among African Ameri-can individuals than among white individuals.7

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