Anastasia Polytarchou, Angeliki Moudaki, Eli Van de Perck, An Boudewyns, Athanasios G. Kaditis, Stijn Verhulst, Refika Ersu
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引用次数: 0
Abstract
The aim of this review is to summarise evidence that became available after publication of the 2017 European Respiratory Society statement on the diagnosis and management of obstructive sleep apnoea syndrome (OSAS) in 1- to 23-month-old children. The definition of OSAS in the first 2 years of life should probably differ from that applied in children older than 2 years. An obstructive apnoea–hypopnoea index >5 events·h–1 may be normal in neonates, as obstructive and central sleep apnoeas decline in frequency during infancy in otherwise healthy children and those with symptoms of upper airway obstruction. A combination of dynamic and fixed upper airway obstruction is commonly observed in this age group, and drug-induced sleep endoscopy may be useful in selecting the most appropriate surgical intervention. Adenotonsillectomy can improve nocturnal breathing in infants and young toddlers with OSAS, and isolated adenoidectomy can be efficacious particularly in children under 12 months of age. Laryngomalacia is a common cause of OSAS in young children and supraglottoplasty can provide improvement in children with moderate-to-severe upper airway obstruction. Children who are not candidates for surgery or have persistent OSAS post-operatively can be treated with positive airway pressure (PAP). High-flow nasal cannula may be offered to young children with persistent OSAS following surgery, as a bridge until definitive therapy or if they are PAP intolerant. In conclusion, management of OSAS in the first 2 years of life is unique and requires consideration of comorbidities and clinical presentation along with PSG results for treatment decisions, and a multidisciplinary approach to treatment with medical and otolaryngology teams.
本综述旨在总结2017年欧洲呼吸学会关于1至23个月大儿童阻塞性睡眠呼吸暂停综合征(OSAS)诊断和管理的声明发布后的证据。2岁前儿童OSAS的定义可能应不同于2岁以上儿童。阻塞性呼吸暂停–低通气指数>5 事件·h–1在新生儿中可能是正常的,因为在婴儿期,阻塞性和中枢性睡眠呼吸暂停在其他健康儿童和有上气道阻塞症状的儿童中出现的频率会下降。在这个年龄段的儿童中,经常可以观察到动态和固定的上气道阻塞,药物诱导的睡眠内窥镜检查可能有助于选择最合适的手术干预措施。腺样体切除术可改善患有 OSAS 的婴幼儿的夜间呼吸,孤立的腺样体切除术对 12 个月以下的儿童尤其有效。喉头水肿是导致幼儿 OSAS 的常见原因,喉上成形术可以改善中重度上气道阻塞的儿童的病情。不适合手术或术后持续存在 OSAS 的儿童可采用气道正压(PAP)治疗。对于术后出现持续性 OSAS 的幼儿,可以使用高流量鼻插管,作为最终治疗前的过渡,或者如果他们不耐受气道正压治疗。总之,出生后最初 2 年的 OSAS 的治疗是独特的,需要考虑合并症和临床表现以及 PSG 结果来做出治疗决定,并与医疗和耳鼻喉科团队一起采用多学科方法进行治疗。
期刊介绍:
The European Respiratory Review (ERR) is an open-access journal published by the European Respiratory Society (ERS), serving as a vital resource for respiratory professionals by delivering updates on medicine, science, and surgery in the field. ERR features state-of-the-art review articles, editorials, correspondence, and summaries of recent research findings and studies covering a wide range of topics including COPD, asthma, pulmonary hypertension, interstitial lung disease, lung cancer, tuberculosis, and pulmonary infections. Articles are published continuously and compiled into quarterly issues within a single annual volume.