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2 Polish Journal of Otolaryngology

2 2018

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Obstructive sleep disordered breathing in children – an important problem in the light of current European guidelines

100%

Krzeski A. , Burghard M.

nr 5

9-16

Obstructive sleep disordered breathing (SDB) is a common clinical problem. An unrecognized and untreated SDB is a serious threat for an intensively developing organism of a child. The consequences of SDB include cardiovascular and neurological complications, growth disorders and enuresis. Therefore, SDB in children becomes an important subject of many scientific investigations, publications and congresses. In 2015 the European Respiratory Society Task Force published a document concerning the conclusions about the diagnostics and treatment of SDB in children and youth from 2 to 18 years of age (Fig. 1). The scientific data from 362 publications were presented in a condensed form of “seven steps”, very useful in diagnosing and treatment planning (1). The authors underline the limited number of the reliable evidence about SDB: prospective studies, randomized double-blinded studies with placebo. The presented evidence was categorized depending on their quality according to the classification of the American Academy of Neurology (ANN) into classes I – IV. Previously, in 2012, the guidelines of the American Academy of Pediatrics on obstructive sleep apnea syndrome (OSAS) in children with tonsillar hypertrophy and/or obesity were published (2, 3) and they were a valuable diagnostic and therapeutic compendium. The European guidelines discussed in this article result from the progress of knowledge in the recent years, they cover the subject broadly, consider rare and difficult cases and present the spectrum of potential therapeutic actions. The aim of the guidelines is a better recognition of SDB, a systematization of diagnosis and treatment at every stage of medical care, including the causes of this disorder and its complications.

Obstructive sleep apnea in patients scheduled for endarterectomy – preliminary study

80%

Migacz E. , Proczka R. , Krzeski A. , Kukwa W.

nr 4

17-20

Introduction: The association between obstructive sleep apnea and atherosclerosis has been confirmed for a long time, but the pathomechanism is still unknown. The aim of this study was to investigate the prevalence of OSA in patients scheduled for endarterectomy and the influence of this procedure on sleep parameters and sleepiness. Materials and methods: 46 patients scheduled for open carotid endarterectomy were enrolled in the study. Sleep study was carried out and Epworth Sleepiness Scale (ESS) was used preoperatively . In 11 out of 46 patients, sleep study was performed both before and after surgery. Results: The mean age of the group was 69.9 years (± 8.6), 21 patients (45.7%) were female. For 46 patients mean pAHI, ODI, pRDI and %snoring were 16.2 (± SD=15.2), 10.4 (± SD=12.2), 18.9 (± SD=14.9) and 9,9 (± SD=17), respectively. Normal pAHI was noticed in 14 patients (30%), while mild (pAHI 5-15), moderate (pAHI 15-30) and severe (pAHI>30) OSA was observed in 13 (38%), 11 (24%), and 8 (18%) subjects, respectively. The mean ESS score for 27 out of 46 patients was 6.3 (± SD=5.6). The postoperative results of sleep study in 11 patients showed no significant change. Conclusions: This study revealed the prevalence of moderate to severe OSA in 42% of patients scheduled for endarterectomy, while no excessive daytime sleepiness was observed in this group. The results of the study show that patients with carotid atherosclerosis should undergo sleep diagnosis in order to rule out obstructive sleep apnea.