Tratamiento quirúrgico en los trastornos respiratorios del sueño en los niños
Surgical treatment of sleep-related breathing disorders in children
Enrique Fernández Julián
Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España
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La amigdaloadenoidectomía (AA) es la técnica quirúrgica más frecuentemente realizada, con una eficacia del 70–80%. Su objetivo es conseguir la normalización del cuadro respiratorio nocturno y de la clínica diurna, así como la reversión, o al menos el freno, de las complicaciones cardiovasculares, alteraciones neurocognitivas, retraso del crecimiento y enuresis, que pueden presentarse en los casos no tratados o tratados tardíamente. Ahora bien, aunque la AA ha mostrado una gran eficacia, no debemos olvidar que conlleva una incidencia de complicaciones en el postoperatorio inmediato mayor que en el caso de los niños intervenidos por otras causas. Por otro lado, un 20–30% de los niños con síndrome de apnea-hipopnea del sueño (SAHS), sometidos a AA presentará un SAHS residual, y hasta un 70% en casos de SAHS severo, anomalías craneofaciales, alteraciones neuromusculares y obesidad mórbida. Por consiguiente, se recomienda un seguimiento, tanto clínico como polisomnográfico, tras la AA, sobre todo en este último grupo de riesgo. Finalmente, aunque menos frecuentemente por su menor incidencia, habrá que tratar otras patologías obstructivas de la VAS, como estenosis o atresia de coanas, laringomalacia, hipoplasia mediofacial o mandibular, etc., y a veces habrá que recurrir a la traqueotomía.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The surgical treatment of sleep-related breathing disorders in children depends on the cause of the upper airway obstruction, which can be located in the nasal fossae, pharynx (the most frequent adenotonsillar hyperplasia), or larynx (laryngomalacia, cysts…), or can be multilevel, as in syndromic diseases. Adenotonsillectomy is the most frequently performed and effective (70–80%) procedure. The aim of this technique is to normalize nocturnal respiratory parameters and daytime symptoms, as well as to revert, or at least to halt, cardiovascular complications, neurocognitive disturbances, growth delay and enuresis, which can develop if treatment is not provided or is delayed. However, despite its effectiveness, adenotonsillectomy more frequently leads to complications in children with sleep apnea-hypopnea syndrome (SAHS) than in those undergoing this procedure for other reasons. Moreover, 20–30% of children with SAHS who undergo adenotonsillectomy will show residual SAHS, and this percentage can increase to 70% in patients with severe SAHS, Down syndrome, craniofacial anomalies, neuromuscular disturbances, and morbid obesity.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Consequently, both clinical and polysomnographic follow-up are recommended after adenotonsillectomy, especially in the latter risk group. Finally, other obstructive disorders of the upper airway must also be treated, although less frequently due to their lower incidence. These disorders include choanal atresia or stenosis, laryngomalacia, and hypoplasia of the midface or mandible. Tracheotomy will sometimes be required.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:61 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sleep apnoea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Primhak" 1 => "C. 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| año/Mes | Html | Total | |
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| 2020 Agosto | 0 | 5 | 5 |
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| 2020 Junio | 0 | 1 | 1 |
| 2020 Mayo | 0 | 3 | 3 |
| 2020 Abril | 1 | 2 | 3 |
| 2020 Marzo | 1 | 2 | 3 |
| 2020 Febrero | 6 | 12 | 18 |
| 2020 Enero | 8 | 14 | 22 |
| 2019 Diciembre | 10 | 18 | 28 |
| 2019 Noviembre | 7 | 5 | 12 |
| 2019 Octubre | 8 | 13 | 21 |
| 2019 Septiembre | 3 | 9 | 12 |
| 2019 Agosto | 3 | 21 | 24 |
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| 2019 Junio | 21 | 28 | 49 |
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| 2019 Febrero | 4 | 5 | 9 |
| 2019 Enero | 3 | 14 | 17 |
| 2018 Diciembre | 4 | 8 | 12 |
| 2018 Noviembre | 7 | 17 | 24 |
| 2018 Octubre | 11 | 11 | 22 |
| 2018 Mayo | 0 | 2 | 2 |
| 2018 Abril | 2 | 11 | 13 |
| 2018 Marzo | 1 | 15 | 16 |
| 2018 Febrero | 2 | 13 | 15 |
| 2018 Enero | 0 | 3 | 3 |
| 2017 Diciembre | 0 | 9 | 9 |
| 2017 Noviembre | 3 | 14 | 17 |
| 2017 Octubre | 3 | 11 | 14 |
| 2017 Septiembre | 5 | 10 | 15 |
| 2017 Agosto | 2 | 13 | 15 |
| 2017 Julio | 1 | 16 | 17 |
| 2017 Junio | 4 | 16 | 20 |
| 2017 Mayo | 4 | 16 | 20 |
| 2017 Abril | 18 | 18 | 36 |
| 2017 Marzo | 40 | 40 | 80 |
| 2017 Febrero | 19 | 24 | 43 |
| 2017 Enero | 17 | 6 | 23 |
| 2016 Diciembre | 29 | 23 | 52 |
| 2016 Noviembre | 36 | 39 | 75 |
| 2016 Octubre | 33 | 24 | 57 |
| 2016 Septiembre | 27 | 21 | 48 |
| 2016 Agosto | 29 | 20 | 49 |
| 2016 Julio | 24 | 1 | 25 |
| 2016 Junio | 25 | 47 | 72 |
| 2016 Mayo | 19 | 29 | 48 |
| 2016 Abril | 19 | 28 | 47 |
| 2016 Marzo | 23 | 29 | 52 |
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| 2016 Enero | 24 | 24 | 48 |
| 2015 Diciembre | 27 | 24 | 51 |
| 2015 Noviembre | 14 | 27 | 41 |
| 2015 Octubre | 24 | 25 | 49 |
| 2015 Septiembre | 23 | 19 | 42 |
| 2015 Agosto | 9 | 10 | 19 |
| 2015 Julio | 6 | 12 | 18 |
| 2015 Junio | 10 | 9 | 19 |
| 2015 Mayo | 6 | 19 | 25 |
| 2015 Abril | 10 | 20 | 30 |
| 2015 Marzo | 20 | 30 | 50 |
| 2015 Febrero | 12 | 11 | 23 |
| 2015 Enero | 13 | 3 | 16 |
| 2014 Diciembre | 12 | 5 | 17 |
| 2014 Noviembre | 8 | 4 | 12 |
| 2014 Octubre | 9 | 3 | 12 |
| 2014 Septiembre | 13 | 7 | 20 |
| 2014 Agosto | 11 | 8 | 19 |
| 2014 Julio | 5 | 5 | 10 |
| 2014 Junio | 10 | 13 | 23 |
| 2014 Mayo | 9 | 3 | 12 |
| 2014 Abril | 8 | 2 | 10 |
| 2014 Marzo | 8 | 4 | 12 |
| 2014 Febrero | 5 | 6 | 11 |
| 2014 Enero | 4 | 3 | 7 |
| 2013 Diciembre | 9 | 3 | 12 |
| 2013 Noviembre | 10 | 13 | 23 |
| 2013 Octubre | 14 | 9 | 23 |
| 2013 Septiembre | 8 | 9 | 17 |
| 2013 Agosto | 7 | 4 | 11 |
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| 2010 Diciembre | 552 | 0 | 552 |
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