Efeito da expansão rápida da maxila na qualidade de vida de crianças com distúrbios respiratórios do sono
Data
2021-10-18
Autores
Bariani, Rita Catia Brás 
Orientadores
Fujita, Reginaldo Raimundo
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Faltam estudos para avaliar alternativas de tratamento em crianças com distúrbios respiratórios do sono (DRS) refratário à adenotonsilectomia. A expansão rápida da maxila (ERM) pode representar uma opção de tratamento para crianças com DRS e anomalias craniofaciais ou para as quais a adenotonsilectomia ou outras modalidades de tratamento falharam ou quando a cirurgia é contra-indicada. Objetivo: Avaliar a eficácia em curto prazo da expansão rápida da maxila na qualidade de vida em crianças com distúrbios respiratórios do sono após adenotonsilectomia tardia 2 anos ou mais, usando o questionário OSA-18. Método: Estudo de ensaio clínico prospectivo, utilizando a terapia com expansão rápida da maxila. Os critérios de inclusão dos participantes foram: crianças de 5 a 12 anos, que fizeram adenotonsilectomia, mas cujos pais/responsáveis relataram que ainda roncam ≥4 noites por semana, têm atresia maxilar e índice de apneia-hipopneia obstrutivo (IAHO) > 1. Participaram deste estudo 24 crianças com distúrbios respiratórios do sono, incluindo 13 pacientes com ronco primário e 11 pacientes com apneia obstrutiva do sono (AOS) antes e após seis meses da ERM. Os pacientes foram submetidos a nasofaringoscopia e polissonografia completa, questionário de qualidade de vida (OSA-18), questionário de sono pediátrico (PSQ), Escala Abreviada de Conners, Escala de Sonolência de Epworth (ESS), avaliação tomográfica e testes neurocognitivos. Resultados: Os escores totais do domínio OSA-18 reduziram significativamente em ambos os grupos (diferença intragrupo, p < 0,001). Na avaliação do ronco, houve redução devido ao efeito do tratamento em ambos os grupos, mas mais significativa no grupo AOS. A sonolência diurna, o déficit de atenção e os transtornos de hiperatividade foram reduzidos em ambos os grupos. Conclusão: A ERM pode ser um tratamento alternativo que melhora o ronco, a sonolência e a qualidade de vida em crianças com distúrbios respiratórios do sono após adenotonsilectomia. Sugere-se uma abordagem multidisciplinar para o tratamento dos distúrbios respiratórios do sono. Registro Brasileiro de Ensaios Clínicos (ReBEC): número RBR-463byn.
Studies to evaluate treatment alternatives in children with refractory sleep-disordered breathing (SDB) to adenotonsillectomy are scarce. Rapid maxillary expansion (RME) may represent a treatment option for children with SDB and craniofacial anomalies or for whom adenotonsillectomy or other treatment modalities have failed or when surgery is contraindicated. Objective: To evaluate the short-term influence of rapid maxillary expansion on the quality of life in children with persistent snoring after late adenotonsillectomy 2 years or more. Method: Prospective clinical trial study using rapid maxillary expansion therapy. Participant inclusion criteria were children aged 5 to 12 years who had adenotonsillectomy but whose parents/guardians reported that they still snore ≥ 4 nights per week, have maxillary atresia and Obstructive Apnea-Hypopnea Index (OAHI) > 1. 24 children with sleep-disordered breathing, including 13 patients with primary snoring only and 11 patients with snoring and obstructive sleep apnea (OSA) before and after 6 months of RME participated in this study. All patients underwent nasopharyngoscopy and complete polysomnography, and the Quality of Life Questionnaire (OSA-18), Pediatric Sleep Questionnaire (PSQ), Conners abbreviated scale, Epworth Sleepiness Scale (ESS) were applied, tomographic analysis and neurocognitive tests. Results: OSA-18 domain total scores significantly reduced in both groups (intragroup difference, p < 0.001). In the evaluation of snoring, there was a reduction due to the treatment effect in both groups but more significant in the OSA group. Daytime sleepiness, attention deficit, and hyperactivity disorders were reduced in both groups. Conclusion: Our study demonstrates the potential benefit of evaluating and treating children with residual snoring. RME may be an alternative treatment that improves children’s snoring, sleepiness, and quality of life with refractory SDB after adenotonsillectomy, suggesting a multidisciplinary approach for treating sleep disorders in children. Brazilian Registry of Clinical Trials (ReBEC): number RBR-463byn.
Studies to evaluate treatment alternatives in children with refractory sleep-disordered breathing (SDB) to adenotonsillectomy are scarce. Rapid maxillary expansion (RME) may represent a treatment option for children with SDB and craniofacial anomalies or for whom adenotonsillectomy or other treatment modalities have failed or when surgery is contraindicated. Objective: To evaluate the short-term influence of rapid maxillary expansion on the quality of life in children with persistent snoring after late adenotonsillectomy 2 years or more. Method: Prospective clinical trial study using rapid maxillary expansion therapy. Participant inclusion criteria were children aged 5 to 12 years who had adenotonsillectomy but whose parents/guardians reported that they still snore ≥ 4 nights per week, have maxillary atresia and Obstructive Apnea-Hypopnea Index (OAHI) > 1. 24 children with sleep-disordered breathing, including 13 patients with primary snoring only and 11 patients with snoring and obstructive sleep apnea (OSA) before and after 6 months of RME participated in this study. All patients underwent nasopharyngoscopy and complete polysomnography, and the Quality of Life Questionnaire (OSA-18), Pediatric Sleep Questionnaire (PSQ), Conners abbreviated scale, Epworth Sleepiness Scale (ESS) were applied, tomographic analysis and neurocognitive tests. Results: OSA-18 domain total scores significantly reduced in both groups (intragroup difference, p < 0.001). In the evaluation of snoring, there was a reduction due to the treatment effect in both groups but more significant in the OSA group. Daytime sleepiness, attention deficit, and hyperactivity disorders were reduced in both groups. Conclusion: Our study demonstrates the potential benefit of evaluating and treating children with residual snoring. RME may be an alternative treatment that improves children’s snoring, sleepiness, and quality of life with refractory SDB after adenotonsillectomy, suggesting a multidisciplinary approach for treating sleep disorders in children. Brazilian Registry of Clinical Trials (ReBEC): number RBR-463byn.
Descrição
Citação
BARIANI, Rita Catia Brás. Efeito da expansão rápida da maxila na qualidade de vida de crianças com distúrbios respiratórios do sono. 2021. 134 f. Dissertação (Mestrado em Otorrinolaringologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2021.