Ayhan SÖĞÜT, LOKMAN UZUN, Remzi ALTIN, MEHMET BİROL UĞUR

Pediatrik tıkayıcı uyku apnesi sendromu ve habituel horlamanın ayrımında orofarengeal muayene bulgularının tanısal değeri

Amaç: Çocukluk çağı tıkayıcı uyku apnesi sendmmu (TUAS) çocukların yaklaşık % 2'sinde görülen ciddi bir hastalık olup uyku sırasında tekrarlayan kısmi veya tam üst hava yolu tıkanıklığı epizodlan ile karakterizedir. Habituel horlama (HH) çocukların % 7-9'unda görülen sık bir semptomdur. HH'h çocuklarda hipoksemi ve hiperkapni bulunmamasına rağmen, TUAS varlığına işaret eden muayene bulgularının bulunması bu iki durumun klinik ayrımını güçleştirmektedir. Bu çalışmada, habituel horlama ve TUAS'u olan çocukları inceleyerek, bu iki bozukluğun klinik ayrımında orofarengeal muayene bulgularının tanısal değerini araştırdık. Gereç ve Yöntem: Bu çalışmaya her gece horlama şikayeti olan 74 çocuk dahil edildi. Her çocuğun TUAS ile ilişkili semptomlar açısından ayrıntılı anamnezi alındı ve fizik muayenesi yapıldı. Polisomnogra.fi sonuçlarına göre çocuklar TUAS ve habituel horlama gruplarından birine dahil edildi. Uykuda saat başı iki veya daha fazla apne veya hipopne atağı olan çocuklar TUAS olarak sınıflandırıldı. Palatin tonsil, adenoid büyüklüğü ve mallampati skorları her bir evre için iki grup arasında ki-kare testi ile karşılaştırıldı. Bulgular: Olguların 17'si HH ve 57'si TUAS'lı idi. Adenotonsil hipertrofili veya mallampati evresi yüksek olan hastaların TUAS ve HH grupları arasındaki dağılımı açısından istatistiksel olarak anlamlı farklılık saptanmadı (p>0.05). Evre 1 palatin tonsil'büyüklüğü HH grupta TUAS'lı gruba göre sınırda anlamlı olarak daha yüksek oranda bulundu (p = 0.07) Sonuç: Bu çalışmada elde edilen bulgulara göre,sadece evre 1 palatin tonsil büyüklüğü HH grupta TUAS'lı gruba göre sınırda anlamlı olarak daha . yüksele oranda görülmekte olup, orofarengeal muayene bulguları İVAS ve HH'nm kesin ayrımında yeterli olmamakta, her iki grupta da benzer muayene bulguları gözlenmektedir.

Anahtar Kelimeler:

Uyku apne, tıkayıcı, Horlama, Çocuk, Tanı, ayırıcı

Diagnostic value of oropharyngeal examination findings in differentiating pediatric obstructive sleep apnea syndrome from habitual snoring

Objective: Obstructive sleep apnea syndrome (OSAS) in children is a serious disease, estimated to occur in approximately 2% pf children and is characterized by repeated episodes of complete or partial upper airway obstruction during sleep. Habitual snoring (HS) is a common symptom seen in %7-Q of children. Although there is no hypercapnia and hypoxemia in HS, presence of examination findings suggestive of OSAS in HS makes the clinical differentiation of these two conditions a challenging one. In this study we evaluated children with HS and OSAS and assessed the diagnostic value of the findings of oropharyngeal examination in the clinical differentiation of these two disorders. Material and Method: 74 children with every night snoring symptom were included in the study. Detailed history with regard to OSAS symptoms was obtained and physical examinations was performed for each child. Children were classified in either OSAS orHS group according to polysomnography results. Children with more than two spells of apnea or hypopnea per hour of sleep were classified as OSAS. Palatine tonsil and adenoid vegetation sizes and mallampati scores were compared between the two groups for each stage by using chi-square test. Results: There were 17 and 57 children in the HS and OSAS groups, respectively. There wasn't any statistically significant difference between the two groups in terms of adenotonsillary hypertrophy and higher mallampati scores (p>0.05). Stage 1 palatine tonsil size was more frequent in HS group than OSAS group and the difference was close to statistical significance (p-0.07). Conclusion: According to the findings of this study only stage 1 palatine tonsil size was more frequent in HS group than OSAS group with a difference close to statistical significance.- Oropharyngeal . examination findings are not sufficient to distinguish children with HS from those with OSAS and the findings are similar in two groups.

Keywords:

Sleep Apnea, Obstructive, Snoring, Child, Diagnosis, Differential,

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