Características miofuncionais orofaciais e polissonográficas de crianças com Síndrome de Down e apneia obstrutiva do sono: estudo piloto
Orofacial myofunctional and polysomnographic characteristics of children with Down syndrome and obstructive sleep apnea: a pilot study
Danielle Barreto e Silva; Camila de Castro Corrêa; Silke Anna Theresa Weber
Resumo
Palavras-chave
Abstract
Purpose: To investigate oropharyngeal structures and functions in a pediatric population with Down Syndrome (DS) and obstructive sleep apnea (OSA) and to correlate with the apnea/hypopnea index (AHI) and sleep questionnaires.
Methods: 12 Children with DS and OSA, between the age of 4 and 12 years old, underwent polysomnography (PSG); sleep questionnaires, Pediatric Sleep Questionnaire (PSQ) and Obstructive Sleep Apnea-18 (OSA-18); and speech-language evaluation using the Short Evaluation of Orofacial Myofunctional Protocol (ShOM).
Results: There was a positive correlation between ShoM higher scores and the apneahypopnea index (AHI) and between ShoM and the number of hypopneas. The orofacial myofunctional alterations observed in the studied group were: oral breathing, alteration in lip tonus and competence, tongue posture at rest and in swallowing, and occlusal alteration. There was also an increased risk for OSA according to the sleep questionnaires, as well as the presence of obesity and overweight, but without correlation with the severity of OSA.
Conclusion: All DS children show alterations in orofacial characteristics, higher scores being associated to severe OSA. Orofacial myofunctional evaluation may help to identify different phenotypes in Down syndrome children with Obstructive sleep Apnea, enhancing the need for a multidisciplinary approach.
Keywords
Referências
1 Agarwal Gupta N, Kabra M. Diagnosis and management of Down syndrome. Indian J Pediatr. 2014;81(6):560-7.
2 Kaczorowska N, Kaczorowski K, Laskowska J, Mikulewicz M. Down syndrome as a cause of abnormalities in the craniofacial region: a systematic literature review. Adv Clin Exp Med. 2019;28(11):1587-92.
3 Antonarakis SE, Skotko BG, Rafii MS, Strydom A, Pape SE, Bianchi DW, et al. Down syndrome. Nat Rev Dis Primers. 2020;6(1):9.
4 Lee CF, Lee CH, Hsueh WY, Lin MT, Kang KT. Prevalence of obstructive sleep apnea in children with Down syndrome: a meta-analysis. J Clin Sleep Med. 2018;14(5):867-75.
5 Berry RB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL, et al. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, version 2.2 [Internet]. Darien: American Academy of Sleep Medicine; 2015 [citado em 2023 Maio 26]. Disponível em: www.aasmnet.org
6 Gulotta G, Iannella G, Vicini C, Polimeni A, Greco A, de Vincentiis M, et al. Risk Factors for Obstructive Sleep Apnea Syndrome in Children: state of the Art. Int J Environ Res Public Health. 2019;16(18):3235.
7 Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):242-52.
8 Arens R, Sin S, Nandalike K, Rieder J, Khan UI, Freeman K, et al. Upper airway structure and body fat composition in obese children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2011;183(6):782-7.
9 Tavasoli A, Jalilolghadr S, Lotfi S. Sleep symptoms and polysomnographic patterns of obstructive sleep apnea in obese children. Iran J Child Neurol. 2016;10(1):14-20. PMid:27057182.
10 Stores G, Stores R. Sleep disorders and their clinical significance in children with Down syndrome. Dev Med Child Neurol. 2013;55(2):126-30.
11 Goffinski A, Stanley MA, Shepherd N, Duvall N, Jenkinson SB, Davis C, et al. Obstructive Sleep apnea in young infants with Down syndrome evaluated in a Down syndrome specialty clinic. Am J Med Genet A. 2015;167(2):324-30.
12 Felício CM, Folha GA, Ferreira CL, Medeiros AP. Expanded protocol of orofacial myofunctional evaluation with scores: validity and reliability. Int J Pediatr Otorhinolaryngol. 2010;74(11):1230-9.
13 Corrêa CC, Weber SAT, Evangelisti M, Villa MP. The short evaluation of orofacial myofunctional protocol (ShOM) and the sleep clinical record in pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol. 2020;137:110240.
14 Giannasi LC, Dutra MTS, Tenguan VLS, Mancilha GP, Silva GRC, Fillietaz-Bacigalupo E, et al. Evaluation of the masticatory muscle function, physiological sleep variables, and salivary parameters after electromechanical therapeutic approaches in adult patients with Down syndrome: a randomized controlled clinical trial. Trials. 2019;20(1):215.
15 Martins CAN, Deus MM, Abile IC, Garcia DM, Anselmo-Lima WT, Miura CS, et al. Translation and cross-cultural adaptation of the pediatric sleep questionnaire (PSQ*) into Brazilian Portuguese. Rev Bras Otorrinolaringol. 2022;88(Suppl 1):S63-9. PMid:33972191.
16 Fernandes FMVS, Teles RCVV. Application of the Portuguese version of the obstructive sleep apnea-18 survey to children. Rev Bras Otorrinolaringol. 2013;79(6):720-6. PMid:24474484.
17 Bitners AC, Arens R. Evaluation and management of children with obstructive sleep apnea syndrome. Lung. 2020;198(2):257-70.
18 Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J. 2016;47(1):69-94.
19 Chervin RD, Hedger K, Dillon JE, Pituch KJ. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep: disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med. 2000;1(1):21-32.
20 Villa MP, Sujanska A, Vitelli O, Evangelisti M, Rabasco J, Pietropaoli N, et al. Use of the sleep clinical record in the follow-up of children with obstructive sleep apnea (OSA) after treatment. Sleep Breath. 2016;20(1):321-9.
21 Bertapelli F, Agiovlasitis S, Machado MR, do Val Roso R, Guerra-Junior G. Growth charts for Brazilian children with Down syndrome: birth to 20 years of age. J Epidemiol. 2017;27(6):265-73.
22 Jayaratne YSN, Elsharkawi I, Macklin EA, Voelz L, Weintraub G, Rosen D, et al. The facial morphology in Down syndrome: A 3D comparison of patients with and without obstructive sleep apnea. Am J Med Genet A. 2017;173(11):3013-21.
23 Hanna N, Hanna Y, Blinder H, Bokhaut J, Katz SL. Predictors of sleep disordered breathing in children with Down syndrome: a systematic review and meta-analysis. Eur Respir Rev. 2022;31(164):220026.
24 Hizal M, Satırer O, Polat SE, Tural DA, Ozsezen B, Sunman B, et al. Obstructive sleep apnea in children with Down syndrome: is it possible to predict severe apnea? Eur J Pediatr. 2022;181(2):735-43.
25 Dyken ME, Lin-Dyken DC, Poulton S, Zimmerman MB, Sedars E. Prospective polysomnographic analysis of obstructive sleep apnea in down syndrome. Arch Pediatr Adolesc Med. 2003;157(7):655-60.
26 Bull MJ, Trotter T, Santoro SL, Christensen C, Grout RW. Health supervision for children and adolescents with Down syndrome. Pediatrics. 2022;149(5):e2022057010.
27 Veloso IL, Corrêa CC, Tagliarini JV, Weber SAT. Unsupervised type III polygraphy in children undergoing adenotonsillectomy: a technical and economic report. Sleep Sci. 2021;14(4):370-4.
28 Cavalheiro MG, Corrêa CC, Maximino LP, Weber SAT. Sleep quality in children: questionnaires available in Brazil. Sleep Sci. 2017;10(4):154-60.
29 Panzarella V, Giuliana G, Spinuzza P, La Mantia G, Maniscalco L, Pizzo G, et al. Paediatric sleep questionnaire for obstructive sleep apnoea syndrome screening: is sleep quality worthy of note? Appl Sci. 2021;11(4):1440.
30 Borgström A, Nerfeldt P, Friberg D. Questionnaire OSA-18 has poor validity compared to polysomnography in pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol. 2013;77(11):1864-8.
Submetido em:
26/05/2023
Aceito em:
05/09/2023
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email