[Severe obstructive sleep apnea syndrome in a toddler]. / Síndrome de apnea obstructiva del sueño infantil de presentación grave.

We report the case of a 3-year-old boy who had experienced intense snoring, frequent awakenings, intense respiratory effort during sleep, and delayed growth starting at the age of 15 months. He underwent adenoidectomy at 18 months. Symptoms initially improved but reappeared 3 months after surgery. He underwent a second adenoidectomy, this time with tonsillectomy, but there was no significant clinical improvement. Polysomnography revealed severe sleep apnea-hypopnea with an apnea-hypopnea index of 45. Continuous positive airway pressure improved sleep quality, although some symptoms, mainly snoring, persisted. A third adenoidectomy was necessary to normalize his breathing pattern during sleep.

Síndrome de apnea obstructiva del sueño infantil de presentación grave / Severe obstructive sleep apnea syndrome in a toddler

Describimos el caso de un paciente varón de 3 años de edad, que desde los 15 meses presentaba un cuadro clínico consistente en ronquidos intensos, despertares frecuentes, esfuerzo respiratorio intenso durante el sueño y retraso del desarrollo pondoestatural. Se le practicó una adenoidectomía a los 18 meses de edad, con mejoría inicial de los síntomas, que sin embargo reaparecieron a los 3 meses de la cirugía. Se le realizó una segunda adenoidectomía, acompañada esta vez de amigdalectomía, sin mejoría significativa de la clínica. Se le efectuó una polisomnografía, que resultó diagnóstica de síndrome de apneas-hipopneas durante el sueño de carácter grave, con un índice de apneas-hipopneas de 45. Tras comenzar tratamiento con presión positiva continua de la vía aérea mejoró la calidad del sueño, pero persistieron algunos de los síntomas, fundamentalmente el ronquido. Para normalizar su patrón respiratorio durante el sueño requirió, finalmente, una tercera adenoidectomía

We report the case of a 3-year-old boy who had experienced intense snoring, frequent awakenings, intense respiratory effort during sleep, and delayed growth starting at the age of 15 months. He underwent adenoidectomy at 18 months. Symptoms initially improved but reappeared 3 months after surgery. He underwent a second adenoidectomy, this time with tonsillectomy, but there was no significant clinical improvement. Polysomnography revealed severe sleep apnea-hypopnea with an apnea­hypopnea index of 45. Continuous positive airway pressure improved sleep quality, although some symptoms, mainly snoring, persisted. A third adenoidectomy was necessary to normalize his breathing pattern during sleep

[Resources and delays in the diagnosis of sleep apnea-hypopnea syndrome]. / Recursos y demoras en el diagnóstico del síndrome de apneas-hipopneas durante el sueño (SAHS).

OBJECTIVE: The demand for consultations and diagnostic studies for sleep apnea-hypopnea syndrome (SAHS) has increased, and this has led to considerable delays. We therefore need an updated evaluation of the diagnostic situation to serve as a management tool for specialists and health care administrations responsible for solving the problem. The objective of the present study was to carry out a descriptive analysis of the situation regarding the diagnosis of SAHS in Spanish hospitals. METHODS: We undertook a descriptive cross-sectional observational study. Public and private hospitals listed in the Ministry of Health's 2005 catalog of health care institutions were contacted, and those that routinely evaluate patients for SAHS were included in the study. The person in charge of each hospital filled in a questionnaire concerning the availability of resources and waiting periods for diagnosis. RESULTS: Of the 741 hospitals we contacted, 217 routinely evaluated patients for SAHS. In 88% of these, respiratory polygraphy (RP) (n=168) or polysomnography (PSG) (n=97) was available. The mean waiting period was 61 days for consultation and 224 days for RP. The mean number of RP systems was 0.99 per 100,000 inhabitants, while the recommended number is 3 per 100,000 inhabitants. The mean waiting period for PSG was 166 days. The mean number of PSG beds was 0.49 per 100,000 inhabitants, while the recommended number is 1 per 100,000. CONCLUSIONS: We observed a marked inadequacy of resources that has led to unacceptable waiting periods. While there has been a favorable change in the situation regarding SAHS diagnosis compared to previous studies, there is still room for improvement and it is urgent that healt hcare authorities allocate more resources to this public health problem.

Recursos y demoras en el diagnóstico del síndrome de apneas-hipopneas durante el sueño (SAHS) / Resources and delays in the diagnosis of sleep apnea-hypopnea syndrome

Objetivo: La demanda de consultas y estudios diagnósticos del síndrome de apneas-hipopneas durante el sueño (SAHS) se ha incrementado, lo que ha llevado a importantes demoras. Por tanto, es precisa una evaluación actualizada de la situación del diagnóstico que sirva como herramienta de gestión a especialistas y las administraciones sanitarias que tienen la responsabilidad de solventar el problema. El objetivo del presente estudio ha sido realizar un análisis descriptivo de la situación del diagnóstico del SAHS en los hospitales españoles. Métodos: Se ha realizado un estudio descriptivo, observacional y transversal. Se estableció contacto con los centros públicos y privados incluidos en el catálogo de instituciones sanitarias del Ministerio de Sanidad de 2005. Se incluyeron aquellos que evaluaban habitualmente a pacientes con SAHS. El responsable de cada centro rellenó un cuestionario sobre disponibilidad de recursos y demoras para el diagnóstico. Resultados: De los 741 centros con los que se estableció contacto, 217 evaluaban habitualmente a pacientes con SAHS. El 88% disponía de poligrafía respiratoria (PR) (n = 168) o polisomnografía (PSG) (n = 97). La demora media en consulta fue de 61 días, y la demora media para realizar PR, de 224 días. La media de equipos de PR fue de 0,99/100.000 habitantes, cuando lo recomendable es 3/100.000. La demora media para PSG fue de 166 días. La media de camas de PSG fue de 0,49/100.000 habitantes y lo recomendable es 1/100.000. Conclusiones: Se observa una notable deficiencia de recursos que lleva a inaceptables listas de espera. Aunque la situación del diagnóstico de SAHS ha cambiado favorablemente con respecto a estudios previos, sigue siendo mejorable y es imprescindible que las autoridades sanitarias dediquen más recursos a este problema de salud pública

Objective: The demand for consultations and diagnostic studies for sleep apnea-hypopnea syndrome (SAHS) has increased, and this has led to considerable delays. We therefore need an updated evaluation of the diagnostic situation to serve as a management tool for specialists and health care administrations responsible for solving the problem. The objective of the present study was to carry out a descriptive analysis of the situation regarding the diagnosis of SAHS in Spanish hospitals. Methods: We undertook a descriptive cross-sectional observational study. Public and private hospitals listed in the Ministry of Health's 2005 catalog of health care institutions were contacted, and those that routinely evaluate patients for SAHS were included in the study. The person in charge of each hospital filled in a questionnaire concerning the availability of resources and waiting periods for diagnosis. Results: Of the 741 hospitals we contacted, 217 routinely evaluated patients for SAHS. In 88% of these, respiratory polygraphy (RP) (n=168) or polysomnography (PSG) (n=97) was available. The mean waiting period was 61 days for consultation and 224 days for RP. The mean number of RP systems was 0.99 per 100 000 inhabitants, while the recommended number is 3 per 100 000 inhabitants. The mean waiting period for PSG was 166 days. The mean number of PSG beds was 0.49 per 100 000 inhabitants, while the recommended number is 1 per 100 000. Conclusions: We observed a marked inadequacy of resources that has led to unacceptable waiting periods. While there has been a favorable change in the situation regarding SAHS diagnosis compared to previous studies, there is still room for improvement and it is urgent that healt hcare authorities allocate more resources to this public health problem

Effect of snoring and obstructive respiratory events on sleep architecture in adolescents.

OBJECTIVE: To evaluate the effect of snoring and obstructive respiratory events on the distribution of sleep stages and arousals in a nonselected group of adolescents from the general population. DESIGN: Cross-sectional study. SETTING: Randomly selected secondary schools in Seville, Spain. Patients A general population sample of 43 adolescents (mean [SD] age, 13.6 [1.77] years). INTERVENTIONS: A questionnaire for the investigation of sleep-related breathing disorders was administered. Symptoms were evaluated according to a 4-point frequency scale. Snorers answered "sometimes" or "often" to the question about snoring, and nonsnorers answered "never" or "rarely." All subjects underwent standard polysomnography at the sleep laboratory. RESULTS: Twenty-eight subjects were snorers; 15 were nonsnorers. No statistically significant differences were noted between both groups in the percentages of sleep stages, arousal index, awakenings, or wakefulness during sleep. Snorers showed a significantly higher number of respiratory arousals than nonsnorers (mean [SD], 1.14 [1.5] vs 0.33 [0.6], P<.05). However, neither the apnea-hypopnea index (AHI) nor the oxygen desaturation index correlated with the arousal index. Twelve snorers (27.5%) had an AHI of 2 or more; 13 nonsnorers (30.2%) had an AHI of less than 2. Snorers with some obstructive respiratory events had a significantly higher number of awakenings, a lower percentage of stage 4 sleep, and a higher number of respiratory events compared with nonsnorers. However, the total number of arousals and the arousal index were similar for both groups. Wakefulness during sleep tended to be longer in snorers than in nonsnorers although differences were not significant. The percentage of respiratory events that terminated with an arousal was greater in snorers who had an AHI of 2 or more than in nonsnorers who had an AHI of less than 2 (mean [SD], 8.4% [9.5%] vs 4.9% [11.53%], P<.05). CONCLUSIONS: These data indicate normal sleep architecture in the adolescents. Although snorers as well as adolescents with some polysomnographic abnormality showed a higher number of respiratory arousals than control subjects, most obstructive events did not terminate with a cortical arousal, which may suggest that adolescents share with younger children this mechanism for preserving sleep architecture.