Resumen
Introducción: en Bogotá (2.640 m), se desconoce el comportamiento de la saturación de oxígeno (SpO2) durante el sueño en niños con Síndrome de Apnea-Hipopnea de Sueño (SAHS). Objetivo: describir los diagnósticos polisomnográficos, la SpO2 en vigilia, sueño y durante las apneas-hipopneas en menores de 18 años a 2.640 m. Diseño: estudio analítico, descriptivo de corte transversal. Los PSG se clasificaron en normales, SAHS obstructivo y central con o sin respiración periódica (RP). Se utilizaron medidas de tendencia central y dispersión. Prueba t de Student, chi cuadrado. Resultados: 430 niños, 41.8% femenino. 47.1% (203) < 1 año, de ellos 146 (71.9%) apneas centrales y 22 (11%) apneas obstructivas (p 1 año tuvieron RP (p=0.05). Apneas obstructivas: > 1 año (26.8%) y ≤ 1 año (11%) (p < 0.001). En > 1 año con IAH normal SpO2 > 90% en vigilia y sueño; <1 año SpO2 en NREM y REM (88.8 y 89.6%) (p<0.001). En todos los casos de SAHS hubo una caída (p<0.001) de la SpO2 de vigilia a sueño no REM y REM, desaturación pico durante eventos (78 a 82%). Conclusiones: a 2640 metros sobre el nivel del mar los niños con SAHS presentan desaturación de oxígeno durante el sueño. Las apneas centrales son más frecuentes en ≤ 1 año (71.9%). La RP es un patrón frecuente en menores de 1 año y se asocia a desaturación significativa.
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Kahn A, Franco P, Scaillet S, Groswasser J, Dan B. Development of cardiopulmonary integration and the role of arousability from sleep. Curr Opin Pulm Med. 1997;3(6):440-4. Epub 1997/12/10. https://doi.org/10.1097/00063198-199711000-00010
Kahn A, Dan B, Groswasser J, Franco P, Sottiaux M. Normal sleep architecture in infants and children. J Clin Neurophysiol. 1996;13(3):184-97. Epub 1996/05/01. https://doi.org/10.1097/00004691-199605000-00002
KT. Cardiorespiratory regulation during sleep in infants. Sleep across the age spectrum: Dawn to dusk. International American Thoracic Society Conference. 1999.
Huicho L, Niermeyer S. Cardiopulmonary pathology among children resident at high altitude in Tintaya, Peru: a cross-sectional study. High Alt Med Biol. 2006;7(2):168-79. https://doi.org/10.1089/ham.2006.7.168
Niermeyer S. Cardiopulmonary transition in the high altitude infant. High Alt Med Biol. 2003;4(2):225-39. Epub 2003/07/12. https://doi.org/10.1089/152702903322022820
Yaron M, Niermeyer S, Lindgren KN, Honigman B, Strain JD, Cairns CB. Physiologic response to moderate altitude exposure among infants and young children. High Alt Med Biol. 2003;4(1):53-9. Epub 2003/04/26. https://doi.org/10.1089/152702903321488988
Niermeyer S, Yang P, Shanmina, Drolkar, Zhuang J, Moore LG. Arterial oxygen saturation in Tibetan and Han infants born in Lhasa, Tibet. N Engl J Med. 1995;333(19):1248-52. Epub 1995/11/09. https://doi.org/10.1056/NEJM199511093331903
Niermeyer S, Shaffer EM, Thilo E, Corbin C, Moore LG. Arterial oxygenation and pulmonary arterial pressure in healthy neonates and infants at high altitude. J Pediatr. 1993;123(5):767-72. Epub 1993/11/01. https://doi.org/10.1016/S0022-3476(05)80857-1
Barry PW, Pollard AJ. Altitude illness. BMJ. 2003;326(7395):915-9. Epub 2003/04/26. https://doi.org/10.1136/bmj.326.7395.915
Lozano JM, Duque OR, Buitrago T, Behaine S. Pulse oximetry reference values at high altitude. Arch Dis Child. 1992;67(3):299-301. Epub 1992/03/01. https://doi.org/10.1136/adc.67.3.299
Standards and indications for cardiopulmonary sleep studies in children. American Thoracic Society. Am J Respir Crit Care Med. 1996;153(2):866-78. Epub 1996/02/01. https://doi.org/10.1164/ajrccm.153.2.8564147
Iber C A-IS, Chesson A, and Quan SF for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Westchester, Illinois: 2007.
Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8(5):597-619. Epub 2012/10/16. ttps://doi.org/10.5664/jcsm.2172
Castronovo V, Zucconi M, Nosetti L, Marazzini C, Hensley M, Veglia F, et al. Prevalence of habitual snoring and sleep-disordered breathing in preschool-aged children in an Italian community. J Pediatr. 2003;142(4):377-82. https://doi.org/10.1067/mpd.2003.118
Gislason T, Benediktsdottir B. Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. An epidemiologic study of lower limit of prevalence. Chest. 1995;107(4):963- 6. Epub 1995/04/01. https://doi.org/10.1378/chest.107.4.963
Rosen CL. Clinical features of obstructive sleep apnea hypoventilation syndrome in otherwise healthy children. Pediatr Pulmonol. 1999;27(6):403-9. Epub 1999/06/24. https://doi.org/10.1002/(SICI)1099-0496(199906)27:6<403::AID-PPUL7>3.0.CO;2-8
Gaultier C, Tournier G, Girard F. [Sleep and respiration in infants and children]. Sem Hop. 1982;58(37):2137-9. Epub 1982/10/14.
Rosen CL, Larkin EK, Kirchner HL, Emancipator JL, Bivins SF, Surovec SA, et al. Prevalence and risk factors for sleep-disordered breathing in 8- to 11-year-old children: association with race and prematurity. J Pediatr. 2003;142(4):383-9. Epub 2003/04/25. https://doi.org/10.1067/mpd.2003.28
Rigatto H. Apnea and periodic breathing. Semin Perinatol. 1977;1(4):375-81. Epub 1977/10/01.
Weintraub Z, Cates D, Kwiatkowski K, Al-Hathlol K, Hussain A, Rigatto H. The morphology of periodic breathing in infants and adults. Respir Physiol. 2001;127(2-3):173-84. Epub 2001/08/16. https://doi.org/10.1016/S0034-5687(01)00249-3
Kato I, Franco P, Groswasser J, Kelmanson I, Togari H, Kahn A. Frequency of obstructive and mixed sleep apneas in 1,023 infants. Sleep. 2000;23(4):487-92. Epub 2000/06/30." https://doi.org/10.1093/sleep/23.4.1b