Guía de práctica clínica para el diagnóstico y tratamiento quirúrgico del síndrome de apnea obstructiva del sueño en pacientes de dos a ocho años de edad

  2. Enrique CALVO-BOIZA 1
  3. Ana Cristina MORALES-MARTÍN
  4. Teresa SÁNCHEZ-VÉLEZ 1
  7. DIEGO PÉREZ, Clara
  8. GIL-MELCÓN, María
  10. José Carlos MORÁN-SÁNCHEZ 1
  12. PAZ-SÁNCHEZ, Arturo DE
  13. José Antonio BLANCO-RUEDA 1
  15. Martín Gómez, María Carmen 1
  16. Pablo SANTOS GORJÓN 2
  17. Verísima BARAJAS-SÁNCHEZ 3
  1. 1 Hospital Universitario de Salamanca

    Hospital Universitario de Salamanca

    Salamanca, España


  2. 2 Servicio de Otorrinolaringología. Complejo Asistencial de Ávila
  3. 3 Servicio de Pediatría. Complejo Asistencial de Zamora
Revista ORL

ISSN: 2444-7986 2444-7986

Year of publication: 2019

Volume: 10

Volume: 4

Pages: 279-292

Type: Article

DOI: 10.14201/ORL.20736 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

More publications in: Revista ORL


Introduction and objective: The adenotonsillar hypertrophy is the fundamental cause of childhood obstructive sleep apnea syndrome (OSAS), a frequent pathology that can cause a series of important complications. In certain circumstances, it can be diagnosed without the need of complex tests and treated effectively, with adenotonsillectomy being the choice; since, with the current resources, assuming all the recommendations of the main guidelines are impractical, the number of children that would require referral for diagnostic polysomnography (PSG) and adenotonsillectomy would exceed our capacity. Limiting the guidelines to available means would significantly ignore the health repercussions of childhood OSA, making it difficult to recognize children at risk, as well as being able to offer adequate treatment. Our objective is to establish the recommendations based on the best available scientific evidence to increase, in an efficient way, the diagnosis of pediatric OSAS and to establish the adequate surgical recomendation as well as the safety in the perioperative procedure. Sections: Review of the bibliography of national and international guidelines on the management of childhood OSAS and assessment of own experience derived from clinical practice and prospective follow-up studies of operated patients. Summary of the evidence on childhood OSAS. Resolution of disagreements between scientific evidence and current clinical practice with proposals to minimize them. Recommendations for the diagnostic procedure and the surgical procedure. Perioperative management scheme and post-surgical follow-up. Conclusions: The application of the suggested changes regarding the management of children with suspected OSAS will allow: 1) greater prominence in the process of Primary and Secondary Care provided by general pediatricians to consider adenotonsillectomy; 2) the widespread use of specific questionnaires for the detection of OSAS, nocturnal oximetry and video recording during sleep as assessment tools; and 3) greater availability of complex sleep studies (PSG) to meet international standards for certain conditions.

Bibliographic References

  • 1. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130:576-84.
  • 2. Bixler EO, Vgontzas AN, Lin HM, Liao D, Calhoun S, Vela-Bueno A, et al. Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep. 2009; 32:731-6.
  • 3. Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008; 5:242-52.
  • 4. Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome American Academy of Pediatrics. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109:704-12.
  • 5. Raghavendran S, Bagry H, Detheux G, Zhang X, Brouillette RT, Brown KA. An anesthetic management protocol to decrease respiratory complications after adenotonsillectomy in children with severe sleep apnea. Anesth Analg. 2010 Apr 1; 110(4):1093-101.
  • 6. Garrido C, Flores CS y Núñez CE. Diferencias anatomofuncionales y endoscópicas entre la vía aérea del niño y la del adulto. Rev Inst Enf Resp Mex. 2007; 20:142-8.
  • 7. Vicente González E, Adiego Leza I, Maltrana García JA, Aznar Facerías E, Ortiz García A. Fisiopatología de los trastornos respiratorios del sueño en los niños. Acta Otorrinolaringol Esp. 2010; 61 (supl1):14-21.
  • 8. Alonso-Álvarez ML, Terán J y Navazo AI. Patología respiratoria en sueño en niños. En: Sociedad Española de Sueño eds. Tratado de Medicina de Sueño. Madrid: Editorial Médica Panamericana; 2015.
  • 9. Lumeng JC and Chervin RD. Epidemiology of pediatric obstructive sleep apnea Proc Am Thorac Soc. 2008; 5:242-52.
  • 10. Grupo de trabajo de la Guía de Práctica Clínica sobre Trastornos del Sueño en la Infancia y Adolescencia en Atención Primaria. Guía de Práctica Clínica sobre Trastornos del Sueño en la Infancia y Adolescencia en Atención Primaria. Plan de Calidad para el Sistema Nacional de Salud del Ministerio de Sanidad, Política Social e Igualdad. Unidad de Evaluación de Tecnologías Sanitarias de la Agencia Laín Entralgo [internet]; 2011[citado 12 Dic 2016]. Guías de Práctica Clínica en el SNS: UETS Nº 2009/8. Disponible en: GPC_489_Trastorno_sue%C3%B1o_infadol_ Lain_Entr_compl.pdf
  • 11. García Fernández E, Ríos LLorente A, Ruiz Chirosa MC, Pascual Lorenzo MJ, Rodríguez M, Morales C. 05AP07-10 Assessment of postoperative management in patient with OSA after tonsillectomy. Eur J Anaesthesiol. 2017; 34 (e-Suppl 55):147-8.
  • 12. Brown KA. Outcome, risk, and error and the child with obstructive sleep apnea. Paediatr Anaesth. 2011 Jul; 21(7):771-80.
  • 13. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al on behalf of the AGREE Next Steps Consortium. AGREE II: Advancing guideline development, reporting and evaluation in healthcare. Can Med Assoc J [Internet]. Dec 2010 (citado 12 ene 2016); 182:E839-42; doi: 10.1503/cmaj.090449 Disponible en español: Spanish-AGREE-II.pdf.
  • 14. Alonso-Álvarez ML, Canet T, Cubell-Alarco M, Estivill E, Fernández-Julián E, Gozal D, et al. Documento de consenso del síndrome de apneas-hipopneas durante el sueño en niños. Arch Bronconeumol. 2011; 47(Supl 4):2-8.
  • 15. Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, and Graham G. Risk factors for sleepdisordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med. 1999; 159(5 Pt 1):1527-32.
  • 16. Guilleminault C. Treatments in obstructive sleep apnea. In: Guilleminault C, Partinen C, editors. Obstructive sleep apnea syndrome. New York: Rave Press; 1990. p. 99-118.
  • 17. Marcus CL, Hamer A, Loughlin GM. Natural history of primary snoring in children. Pediatr Pulmonol. 1998; 26:6-11.
  • 18. Morielli A, Ladan S, Ducharme FM, Brouillette RT. Can sleep and wakefulness be distinguished in children by cardiorespiratory and videotape recordings? Chest. 1996; 109 (3):680-7.
  • 19. Ebert CS Jr., Drake AF. The impact of sleepdisordered breathing on cognition and behavior in children: a review and meta-synthesis of the literature. Otolaryngol Head Neck Surg. 2004; 131:814-26.
  • 20. Fitzgerald NM, Fitzgerald DA. Managing snoring and obstructive sleep apnoea in childhood. J Paediatr Child Health. 2013; 49:800-6.
  • 21. Weinstock TG, Rosen CL, Marcus CL, Garetz S, Mitchell RB, Amin R, et al. Predictors of obstructive sleep apnea severity in adenotonsillectomy candidates. Sleep. 2014; 37:261-9.
  • 22. Kheirandish-Gozal L. What is “abnormal” in pediatric sleep? Respir Care. 2010; 55:1366-76.
  • 23. Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clinic N Am. 1989; 36: 1551-69.
  • 24. Sivan Y, Kornecki A, Schonfeld T. Screening obstructive sleep apnoea syndrome by homevideotape recording in children. Eur Respir J. 1996; 9:2127-31.
  • 25. Brouillette RT, Morielli A, Leimanis A, Waters KA, Luciano R, Ducharme FM. Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Pediatrics. 2000; 105:405-12.
  • 26. Roland PS, Rosenfeld RM, Brooks LJ, Friedman NR, Jones J, Kim TW, et al. Clinical Practice Guideline: Polisomnography for sleep disordered breathin prior to tonsillectomy in children. Otolaringol Head Neck Surg. 2011; 145:S1-S15.
  • 27. American Thoracic Society. Cardiorespiratory sleep studies in children. Establishment of normative data and polysomnographic predictors of morbidity. Am J Respir Crit Care Med. 1999; 160:1381-7.
  • 28. Li AM, Au CT, Ng SK, Abdullah VJ, Ho C, Fok TF, et al. Natural history and predictors for progression of mild childhood obstructive sleep apnoea. Thorax. 2010; 65:27-31.
  • 29. Paediatric Sleep Medicine Clinical Network group. Paediatric Society of New Zealand, “New Zealand Guidelines for the Assessment of SleepDisordered Breathing in Childhood”, Wellington [internet], 2015 [citado 20 dic 2016]. Disponible en: item/2008
  • 30. Thongyam A, Marcus CL, Lockman JL, Cornaglia MA, Caroff A, Gallagher PR, et al. Predictors of perioperative complications in higher risk children after adenotonsillectomy for obstructive sleep apnea: a prospective study. Otolaringol Head Neck Surg. 2014 December; 151(6):1046-54.
  • 31. Sadhasivam S, Davidson A, Crowley M. Anesthesia for tonsillectomy with or without adenoidectomy in children [Internet]. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. 2018 [12 abr 2018;12 may 2018] Disponible en: https://