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Klin Padiatr 2011; 223(07): 424-429
DOI: 10.1055/s-0031-1297972
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und Therapie des obstruktiven Schlafapnoe-Syndroms bei Kindern mit syndromalen Kraniosynostosen

Diagnosis and Therapy of Obstructive Sleep Apnea Syndrome in Children with Premature Craniosynostosis Syndromes
A. Hein
1   Kinderklinik, Universitätsklinikum Würzburg
,
T. Schweitzer
2   Pädiatrische Neurochirurgie, Universitätsklinikum Würzburg
,
H.-M. Straßburg
1   Kinderklinik, Universitätsklinikum Würzburg
,
M. Wurm
› Author Affiliations
Further Information

Publication History

Publication Date:
30 November 2011 (online)

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Zusammenfassung

Hintergrund:

Atmungsstörungen im Schlaf sind häufig bei Kindern mit syndromalen Kraniosy­nostosen, da die Mittelgesichtshypoplasie zur Einengung der Atemwege führen kann.

Patienten und Methoden:

Bei 24 Kindern wurden 68 Polysomnografien vorgenommen, um Aussagen über die Art der schlafbezogenen Apnoen machen zu können. Bei 9 Patienten wurden Verlaufsuntersuchungen nach Therapie durchgeführt.

Ergebnisse:

Bei 4 Patienten fand sich ein schweres, bei 8 ein mäßiges und bei 11 ein mildes ob­struktives Schlaf-Apnoe-Syndrom (OSAS), nur ein Kind hatte kein OSAS. Kinder mit Crouzon-Syndrom hatten überwiegend (9/14) ein mittel- bis schwergradiges OSAS, Kinder mit Apert-Syndrom mehrheitlich keine/eine leichte Atmungsstörung (6/7). Neben obstruktiven Ereignissen war auch die Zahl der zentralen Apnoen erhöht. Die Schlafarchitektur war nicht wesentlich beeinträchtigt bei deutlicher Häufung der respiratorischen Ereignisse im REM-Schlaf. Nasaler CPAP, BiPAP und Adenotonsillektomien führten zu einer Besserung der respiratorischen Parameter.

Schlussfolgerung:

Die Pulsoximetrie kann aufgrund der Korrelation von Entsättigungsindex und OSAS-Schwere zum Screening dienen. Wegen der Dynamik der Erkrankung sind engmaschige Kontrollen notwendig. Zur Erweiterung oder Anpassung der Therapie wird ein Algorithmus vorgestellt.

Abstract

Introduction:

Sleep related breathing disorders are a common symptom in children with craniosynostosis syndromes, as upper airways may be narrowed by midfacial hypoplasia.

Patients and methods:

To better characterize the sleep related apneas, 24 children with syndromal craniofacial dysplasia underwent 68 poly­somnographies. 9 patients had reexaminations after therapeutic procedures.

Results:

4 patients had severe obstructive sleep apnea syndrom (OSAS), 8 patients had moderate and 11 patients mild obstructive sleep apnea respectivly. Only one child had no obstructive sleep apnea. Children with Morbus Crouzon tended to have moderate to severe breathing disorders (9/14) whereas Apert patients mostly had no or light breathing disorders (6/7). Number of central apneas was increased as well. Sleep architecture was not significantly impaired. Apneas were more frequent during REM-sleep. Nasal CPAP, BiPAP and adenotonsillectomy improved respiratory parameters.

Conclusion:

Pulse oxymetry can be used as a screening method because of the good correla­tion of oxygen desaturation index with severity of OSAS. Frequent examinations and, if necessary, adaptation of therapy is indicated as OSAS in ­these children may be rapidly changing. We suggest a guideline for diagnostics and therapy.

Schlüsselwörter

Crouzon - Apert - OSAS - Schlafapnoe - syndromale prämature Kraniosynostosen - Kinder

Key words

Crouzon - Apert - OSAS - sleep apnea - syndromic premature ­craniosynostosis - children
 

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