Trastornos del sueño en niños

Title: Sleep disorder breathing in school-aged children of Lima, Peru Authors' full names and academic affiliations: Walter Astorne, MD 1 Jorge Kawano, MD 1,2 Darwin Vizcarra, MD 1,2 1 Universidad Peruana Cayetano Heredia. 2 Hypnos Instituto del Sueño. Lima, Peru Address: Hypnos Instituto del Sueño, Clinica San Felipe. Lima, Peru. Address correspondence and reprint requests to Dr. Darwin VizcarraEscobar, Clinica San Felipe, Avenida Gregorio Escobedo 650, Jesus Maria Lima, Peru Phone / Fax: (511) 2190235 Email: hypnos@clinicasanfelipe.com

Abstract Approximately 200 words is mandatory at the beginning of each article. Objective or Background: The aim of this study was to investigate the prevalence of sleep disorder breathing in Peruvian school -aged children. Methods: A Spanish versionof the validated Pediatric Sleep Questionnaire was used to asses the prevalence of sleep breathing disorder in 2 elementary schools of Lima Peru. 434 questionnaires were returned and included to the study. Results: The overall prevalence of sleep disorder breathing was 6.81 %. We found a prevalence of 6.22 % in boys and 7.8 % in girls. We found a snoring frequency of 6.54 % in this population.Conclusions: We found an important frequency of pediatric sleep disorder breathing in this population.

Keywords: sleep, disorder, breathing, children, pediatric, peru, hispanic

Introduction Sleep disorder breathing (SBD) are common in pediatric population, but they are usually underdiagnosed (1). SBD includes obstructive sleep apnea and upper airway resistance syndrome. Obstructive sleep apnea(OSA) is characterized by total (apnea) or partial (hipopnea) repetitive episodes of upper airway obstruction that occur during sleep. These events are usually associated with a reduction in blood oxygen saturation and are followed by microarousals while sleeping. Apneas and hipopneas last at least 10 seconds in duration (2). Hemoglobin desaturation disrupts ventilation and normal pattern ofsleep (3). Symptoms associated with this condition are somnolence, snoring and insomnia. Central apneas are common in infants and children, particularly during REM sleep. Traditionally, central apneas in children have been considered significant if they were greater than 20 seconds in length, or if they were associated with desaturation, bradycardia, or arousal. However, central apneas more than 20seconds are commonly seen in normal children, particularly after movement or sighs, and associated transient desaturation is not uncommon. Pediatric OSA is characterized by prolonged partial upper airway obstruction, intermittent complete or partial obstruction (obstructive apnea or hypopnea) or either prolonged or intermittent obstruction that disrupts normal ventilation during sleep, normal sleeppatterns, or both. Children with OSA may demonstrate several breathing patterns during sleep (2). There is an increasing recognition that snoring and others symptoms of sleep disorder breathing are unrecognized in children. In the young child, the signs and symptoms are more subtle and the diagnosis is more difficult. Pediatric population can exhibit agitated arousals, unusual sleep postures, suchas sleeping on the hands and knees and nocturnal enuresis (2,4). Snoring, which is characteristic of adult obstructive sleep apnea syndrome, may not be present in children. Mouth breathing and low weight for age are also common. Hypopnea is the usual pattern of obstruction and there is not difference in gender (2,5). Upper airway resistance syndrome (UARS) is associated with abnormal respiratoryeffort, nasal airflow limitation, absence of obstructive sleep apnea, minimal pulse oxygen fluctuation with oxygen saturation equal or greater than 92%, and frequent nocturnal arousals or reflex brainstem activation (5). UARS can cause diurnal hypersomnia and sometimes clinically significant snoring (6). Daytime fatigue, insomnia and depressive mood are observed as well (7). There is an...