A А АВАн. АP АP АPАP (upper airway resistance syndrome АV UARS), ) АPapple- АPfi appleаpfi (obstructive hypoventilation) fiаp, appleаp, АPАP АP-

Transcription

1 A А АВАн БG АPappleАP appleаp apple АP appleаp А. АPАP,. apple Бg АPАP АВ А, АPappleАPfi бxfi А А, АP Damianidou L, Eboriadou M. Obstructive sleep apnea syndrome in children. 2 nd Department of Pediatrics, Aristotle University of Thessaloniki, General University Hospital AHEPA, Thessaloniki, Greece. Paediatr N Gr 2008, 20: БG АPappleАP appleаp apple АP appleаp АPapple АP fi- АP АPАP АДАPappleАP apple АPАPАPА АPАPappleАе. fi АPfi АPАPАP apple appleappleаp А АPАPapple, АP АP АP АPАP АP АPappleАP- fi appleаpfi. fi АP АPАP А fiаp АPapple А fiаp fi appleаp - АP АP apple АP АP АP appleаp- АP fi, appleаp АP АP АPapplefi АP-. KАPА АPАP appleаpаp appleаp АP АP АP appleаp АPАP- АP appleаp. M АP fi АPapple appleаpаpаp apple. БGАP АPАP А fiаp АP А А - fi АPapple appleapple АPapplefi АPАPАPfi, АPАPАPА АPapple, apple АP АP. АP АPappleАP АP АPapple АP appleapple, АP apple АP АP- apple fi. Abstract. Obstructive sleep apnea syndrome in children is part of a spectrum of diseases entitled АДsleep disordered breathingае. This term also refers to primary snoring, upper airway resistance syndrome and obstructive hypoventilation. Only the last decades the high prevalence of this disease has been realized in childhood. Since that time, there has been a great interest in pathogenesis of obstructive sleep apnea syndrome, which is different from that found in adults. The most common cause of obstructive sleep apnea in children remains adenotonsillar hypertrophy and the diagnostic test of choice is overnight polysomnography. Consequences that seem to be associated with the syndrome include cardiopulmonary disease, neurocognitive abnormalities, behavioral problems and metabolic disorders. The best treatment is early diagnosis. А -: appleаp, АPappleАP appleаp, АPАPАPА apple, appleаp, А АPfi. Key words: apnea, children, obstructive apnea, sleep disorders, snoring. АP Ан АPappleАP apple АPАPАPА АPАPapple АP- АP apple АP appleаp АPapple АP fiаp, appleаp, АPАP АP-, АPАPАP: АP) appleappleаp - А АPАPapple (primary snoring), ) АP- АP АP АPАP (upper airway resistance syndrome АV UARS), ) АPapple- АPfi appleаpfi (obstructive hypoventilation) АP ) АPappleАP appleаp apple (Obstructive sleep apnea АV OSA). АP АP- АP АPapple appleаp-

2 224 АPАP BАнIАн А А А Ан, 20, 3 БDБiБbБmБb БnБb Б]Б\БlБnБbБnБ\ БnБb Б\БkБpБlБ\БiБb БnБjБo Б\БhБnБ`БlБjБo Б\Б`БlБ\Б^БsБ^Бj БTБ`Б^БqБ_Бb Б\БhБ\БkБhБj БdБ\БnБ\БlБ\Бq БkБhБjБo БkБdБcБ\Бh UARS БWБkБjБ\Б`БlБdБmБg БeБ\Бd Б_БdБ\БnБ\БlБ\Бq БmБnБbБh Б\БhБnБ\БfБfБ\Б^ Б\Б`БlБsБh БWБkБjБnБlБjБkБdБaБjБoБmБ` БkБfБlБ`Бd Б\БkБjБpБlБiБ`Бd БnБjБo Б\Б`БlБ\Б^БsБ^Бj (БkБhБjБdБ\). 1. А АP АPapplefi АP АPАP АPapplefi- АP АP АPАP АP appleаp. UARS: - АP АP АPАP. А АP (. 1) 1, АP fi АPАP, АP АPfi А appleа АPapple- apple, fi apple А АP АPА fi 2,3. БG АPappleАP appleаp apple (А А ) appleаpаp АP appleаp fi 1976 АPapplefi Guilleminult АP 4 АP АP А fiаp АPfi- АP (1982) АP АP appleаp АP АP АP АP- АP АP appleаp 5. А applefi fi АP АP appleаpаp А А appleаp АP АP АP- АP, АP АPapple fi АP - А fi, fi АP fiаp АP - fiаp appleаp АP. Ан appleаp А АPАPapple (appleappleаp А АP- fi): А АPАPБ АP АPapplefi appleаpаp А АPАPapple А АP (АPfi А apple appleаpаp АPapplefi АP АPАPapplefi АP АP АPАPapple apple), А fi АPАPАPА АP- А apple, fi АPfi АP fi АPАP. АPappleАP- АP АP АP АP АPАP АP АPАP - А АP appleаp АP А АPfiАP АPapple - АPАP6-8. appleа apple А Б appleapple АPappleАP appleаp apple, А fi АPfi АP А АPfiАP appleаp АP АP АP- АPАP (upper airway resistance syndrome - UARS): А АPАPБ АP АPapplefi appleаpаp А АPАPapple АP АPapplefiАP АP АP- АP, apple А АP- АP (бx) АPapple АPfiА АP АPАPapple appleappleаp. АPapple АP АP АPapplefi applefiаp appleаp АP appleаpаp, АP АPАPАPА АPА - apple, appleаp АP Б АP (apple.а. appleаp АP АP АP, apple- fiаp,.аp) 13,14. А appleаpfi appleаpfi (obstructive hypoventilation): А АPАPБ АP АPapplefi appleаpаpаp - АPapplefiАP АP АPАP АP - АP apple АPappleАP АP АPАP, appleаp АPАPapple appleappleаp, appleаp АP appleаpappleаp. БGАP appleаp АP А АP АP fi appleapple apple АP А А 15,16 А appleаp applefiappleаp: Б АP 50% - АPАP АPapplefi АP fiаp АP А 2 АPАPapple, АPАP- apple appleapple А Б АP АP - АP АPapplefi appleаpаp / АP АPapple АPappleАP appleаp apple- А А (Obstructive sleep apnea syndrome АV OSAS): А АPАPБ АP АPapplefi apple АPapplefiАP АP АPАP АPapple АPАP АPapplefi - АP fiаp АP А 2 АPАPapple. Ан АPАPapple appleapple А Б АP АP АP АP АP. АPapple АPАP appleаp appleаpfi АP apple- АPАP, appleб АP АP АPА apple. 20,21 АP applefiаp appleаp, АP -, appleаpаpаp fi А АPappleАP appleаp, fi appleаpаpаpаp applefiаp АPapplefi- АP АP АPАP (appleappleаp). бxаp АPfi fi АP А appleаp А АP appleаp fi АPappleАP appleаp АV applefiappleаp apple. 16,22 АВ appleаp (Central apnea): А АPАPБ АP АPapplefi АPapple АPАP АPapplefi АP fiаp АP А 2 АPАPapple, fi АPАP АPАPapple АP АPfi- А АP appleа АPАP АPАPapple appleapple- АP. 16,23 appleаp (Mixed apnea): appleаp АP А АP appleаp АPappleАP А АP. appleаpаp АPАP АPappleАP АPapple 21,23

3 АPАP BАнIАн А А А Ан, 20, appleаp А АPАPapple АPБ АP 17-27% appleаp-. А applefi АP А АPБ АP (АP АP- 4 /АP) 3,2-11%, А fi А А appleб АP 0.7-3% 1, БG А А АPБ АP fi, АPapplefi - А АP. БkАPАP АP - АP А fi АP appleаp appleа АP (2-5 А ), apple fi АPapple АP АPАP АP АP АP apple АP А АPАP. АPАP АP АP АP АP АP, АP, apple fi apple. apple appleаp- АP fi АP АP АP appleаp А -А. 28 АPАP appleаpаp fi АP appleаp АP АP АPapplefi АP АP - АP АP АP АPfi apple apple АP А apple АP АP appleаpаp, АP appleаp А АPАP АPapplefi А fiаp АP А А. Ан fi АP АP : 1) АP apple АPАP АP apple АP apple АP appleаp fi АP АPАPapple- АP fi appleapplefi А fiаp, 2) appleapple - АPБ АP apple apple А А АP appleаp, apple.а. fi АP apple АPappleАP apple, 3) АP appleаp А fi АPapple АP - АP apple, apple fi АPАPАPА АPА apple АPappleАP fi - А apple АP АP - АP, apple.а. appleаp, 4) АP appleаp АPБ apple, АPapplefiАP АP АPАP, apple А - Б АP appleаpappleаp / АP appleаpаp, 5) АP apple- fiаp applefiаp АPappleАP appleаp АP appleаp- АPБ АP REM apple. apple А appleаp АP appleаp- АP fi, apple АPapple applefi appleаp АP - Starling Ан АP АPАP- fi АP АP АPАP appleа, apple appleаp- Б АPfi fi Б АP apple -, fiapple АPАPapple, АPapple, АP. А apple apple АPapple АP АPАPapple, АP- apple АPapplefi 20 А АPfi А АPfi. 29,30 Ан fi А АP- АP, apple АP АP АPА АPfi fi, Б АP АPapplefi: 1) АPАP АP: (V), АPfi (IX), appleаpfi (X) АP apple (XII), 2) АPАPapple АP (apple, АP, appleаp, appleа ), 3) - А appleа АP apple- АP apple, АP АPАP ph АP apple АPАP (P a CO 2 ), 4) apple А appleа АP АP- АP, АP АPАP apple fi (P a O 2 ) АP ph, 5) А АP appleа apple АP АPАPfi АP apple АВАP apple, АP apple, apple АPАP- appleаp АPapplefi appleаp АPАP, apple АP АP applefi, АP. АP А А АPfiАP АP apple АP - А АP АP АP. АВАP appleа appleаp А fi АP АP АPА fi - А АP АP, АPfiАP АPАP АP- АP АPapplefi АPapple apple appleаp- АP АP appleаp АP - АP. 36 АP applefi appleаp, АPappleАP appleаp АP, fiаp - apple appleаpаp АPappleАP АP АPapple АP apple АPАP- appleаp appleа АP, АP АP apple АP apple АP apple. АВАP АP apple o А fi АP Б АP АPapplefi АPАP- apple АP АP АP АP Ан fi fi АPАP АP apple АP Rapid Eye Movement (REM) АV apple АP АP АPfiАP АP, - fi apple АPАP АP АP- АP apple apple АP АP apple АP АPАPapple АPАPАPА REM. 28 applefi АPapple Starling (. 2), apple А АP, АP АP apple: АPАP - АPАP, АP apple АP- АP АPapplefi apple (АP АP АPАP) АP- АP АPАP ( fiаp) АP АP АP АPapplefi apple АP АP АPАP (АPА АP), apple appleаp- АPАP. apple appleаp АP- fi А АP appleapple, Б АP apple -

4 226 АPАP BАнIАн А А А Ан, 20, 3 БDБhБnБmБnБ\БmБb Б\БhБnБ`БlБjБo БnБgБgБ\БnБj БSБ`БmБb БkБjБo БkБ`БlБdБ]БfБfБ`Бd БnБjБh Б\Б`БlБ\Б^БsБ^ (Pcrit) БDБhБnБmБnБ\БmБb БeБ\БnБnБ`БlБjБo БnБgБgБ\БnБj БSБ`БmБb Б\БhБnБ`БlБjБo БnБgБgБ\БnБj БSБ`БmБb БeБ\БnБnБ`БlБjБo БnБgБgБ\БnБj AБhБnБ`БlБj БnБgБgБ\ (БlБdБhБdБe БeБjБdБfБnБbБnБ\) БXБ\БlБoБ^Б^БdБe БnБgБgБ\ БMБ\БnБnБ`БlБj БnБgБgБ\ (БnБlБ\БqБ`Б\). 2. БG Starling. Ан АPАPfi АPappleБ АP АP АP АP apple apple АP appleapple (АP) АP 2 АP АP, АP АP apple (fi АP АPА АPfi АP). Ан АPАPfi appleapple fiаp apple apple apple АPАPfi (Pcrit) АP АP АPapplefi apple fi АPАP. БUБnБhБsБmБb Б\БhБnБ`БlБsБh Б\Б`БlБ\Б^БsБ^Бh * БWБDБD * БMБlБ\БhБdБjБkБlБjБmБsБkБdБe Б\БhБsБgБ\БfБ` * БSБ\БqБoБmБ\БlБeБ\ БdБ\БnБ\БlБ\Бq БhБ`БoБlБjБgБoБeБj БnБhБjБo БmБnБjБh Б\БhБnБ`БlБj Б\Б`БlБ\Б^БsБ^ * БDБhБ\БkБhБ`БoБmБnБdБe БmБb * БDБpБoБkБhБmБ`Бd * БDБhБnБ\БhБ\БeБfБ\БmБnБdБe Б\БhБnБ`БlБjБo БUБDБDБW Б\Б`БlБ\Б^БsБ^Бj БfБfБjБd БkБ\БlБ^БjБhБnБ` * БFБ`БhБ`БnБdБeБj * БfБfБjБd;;;. 3. БG А А АP appleаp АP АPappleАP АP АP АPАP, АPАPАPА fi- АP АPАP, appleаpаpfi АP appleаpfi А АP apple АP АP А АP. А А : АPappleАP appleаp apple, А А : appleаp АPАP АP АP АP. (Pcrit). А Б АP apple apple apple АP А АP АP appleаp - АP fi АPapplefi АP 38. А applefi appleаp- АPapple АP АP АPapple appleаp А АP АP АPappleАP appleаp appleаp- fi fiаp АP АP fi АP АPАP fiаp. 39 А АP АPapplefiАP АPАP АP А А АP АP- АPfiАP apple appleapple АPapplefi АPfi - АPАP АP АPАPАPА. 39 ( 3, 4 40 ) А АP appleаp apple АP АP- АP АPАP АP appleаp АP- apple А А АPАP appleаpаp 1. А Б АP АPАP fi appleаp АP АP- АP АPАP (А А ) АPapple apple А АPАP АPАPАPА АP appleаp АP 2 6 А fi. АPАP apple apple АPАPАPА АP АP АPappleАPАP appleаpаp, АP АP АPfi АP АP appleаp АPapplefi fi А А, АP: АP) fiаp АP appleаp А А А АPАPapple appleаpаp apple, ) fiаp АP appleаp А А А А А, ) АP appleаp apple АPАP АPАP-АP - АP appleаpаp АPapplefiАP АPАP- Б АP ) appleаp А А appleаpб appleаpаp АPapplefiАP АP - АP АP fi АP fi. 34,41,42 O appleаp АPapple - АPАP АPАP apple

5 АPАP BАнIАн А А А Ан, 20, БlБlБ`Бh Б\БiБbБmБb БbБfБdБeБ\ БeБgБrБb БeБ`БpБ\Бf - БfБ\БdБgБj БTБdБhБdБe Б\БkБpБlБ\БiБb БDБoБiБbБgБhБj БgБ^Б`БcБj Б\БgБoБ^Б_Б\БfБh БgБdБeБlБjБ^БhБ\БcБ\, Б\БoБiБbБgБhБb БkБ`БlБgБ`БnБlБj БfБ\БdБgБj БDБiБbБmБb Б\БhБnБmБnБ\БmБb БDБD БDБiБbБmБb БdБeБ\БhБnБbБnБ\ БmБgБkБnБoБiБb БOБ`БsБmБb БnБb Б_БdБ\БgБnБlБjБo БnБjБo БpБlБoБ^Б^Б\ БDБkБjБpБlБ\БeБnБdБe БkБhБjБdБ\ БOБ`БdБsБgБhБb Б\БhБ\БkБhБ`БoБmБnБdБe БmБb Б_БdБ\БnБ\БlБ\Бq Б\БhБnБ\БhБ\БeБfБ\БmБnБdБeБh Б\БhБnБ`БlБjБo Б\Б`БlБ\Б^БsБ^Бj БgБ`БdБsБgБhБb Б\БhБnБfБbБrБb БnБsБh БgБ`БnБ\Б]БjБfБh БnБb БkБ`БmБb X БDБpБkБhБdБmБb R AA БOБ`БnБ\-Б\БkБhБjБe БoБkБ`БlБ\Б`БlБdБmБg БSБfБ^БdБ\ БcБmБb FRC AБhБ\БkБjБnБ`БfБ`БmБgБ\БnБdБe Б`БhБ`БlБ^БjБkБjБbБmБb Б_БdБ\БmБnБjБfБdБeБh БgБoБh БDБD БOБ`БsБmБb Б\БhБ\БkБhБ`БoБmБnБdБe БmБb Pa,O 2 / Pa,CO 2 БSБ\БqБoБmБ\БlБeБ\ БXБlБgБ\БeБ\ БkБhБj. 4. А АP АPapplefi appleаpаp fi АPappleАP appleаp apple. AA: АP АPАPfi, RAA: АPАP АP АPАP, FRC: appleapplefi А fiаp, АPАн 2 : apple АPАP fi, PCO 2 : apple АPАP АPАP, : А АPfi АPapple. АPАP 1. А АP appleаp apple appleаp АP- apple fi АPappleАP appleаp apple АP appleаp. fiаp applefi АP fiаp /АPАP А АP АPАP appleа АP/ АP АP fi appleappleаp, АP, АPАP АP & АнАP appleаp АP АP АP АPАP АPАP АV АВfi АP АV Бg АPАP appleаp АP АP АV appleа АP АV АP АВАPappleapple АPАP АPАP/appleАPАP appleappleаpаp appleapple (АP 21, Crouzon, Apert,..) appleappleаpаp (Pierre-Robin, Treacher Collins, Cornelia de Lange) АВАPappleapplefi АPАP АPАP А А appleаpаp АPАPАPА АPapple fi (Hunter, Huler,..) АPapple fi АP appleаp - АPАPАPА (. 2). А fiаp АP fiаp АPАPАP appleа АP, - АPАP 2. А appleаp apple appleаp АPapple fi АPappleАP appleаp apple АP appleаp АP appleаp АP АP REM- apple АPАPАPА А АV бx appleаp (АP 21) АV БGАPАPfi АВ (АPАP apple, АP apple) АV АP АP А : * АP Chiari (II Бk) * АP АP * БGАPАP (АPАP, fi, ) АPАP АV АВАPАPАP: Б АPБ apple, АPАPБ, АP АV А АP АV АP АP АV АP АPfi АV АPАP АV А АP АV АPА АPАP АV fiаp АВ: АВfi fi АP

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10 232 АPАP BАнIАн А А А Ан, 20, 3 appleаpаp БG АP АP АP АP АPapple- АP apple АPАPАPА АPАPapple АP appleаp- apple fiаp. apple А АP А Б fi АP applefi АPapple appleapple АPapplefi АPАPАPfi АP, АPАPАPА apple АP АP АPАPАPА АPfi, АPАP apple АP fi- АP АP fiаp. АP АPfi - apple А АP appleаp, appleа АPfi АPАPappleАP АPАP А appleаp- АP fi. А fi apple АP apple АP fi - fi АPfi АP appleapple АP АP АP apple- АP appleаpаp А АPАPapple АP appleаp, АP А appleаp appleаpаp АPapplefi -. apple АP appleаpаp А АPАP- apple АP appleаp АP appleapple АP АP АP АP - АP appleаp apple АPapplefi fi, АP apple- АP АPappleАP fi АPappleapple appleapple АP applefiаp Б. БgАPАP 1. Nieminen P. Snoring and obstructive sleep apnea in young children: a 6-month follow-up study. Arch Otolaryngol Head Neck Surg. 2000, 126: Messner AH, Pelayo R. Pediatric sleep-related breathing disorders. Am J Otolaryngol 2000, 21: Carroll JL. Sleep-related upper airway obstruction in children and adolescences. Child Adolesc Phychiatr Clinic N Am 1996, 5: Guilleminault C, Eldridge FL, Simmons FB, Dement WC. Sleep apnea in eight children. Pediatrics 1976, 58: Guilleminault C, Winkle R, Korobkin R, Simmons FB. Children and nocturnal snoring: evaluation of the effects of sleep-related respiratory load and daytime functioning. Eur J Pediatr 1982, 139: Sterni LM. Evaluation of snoring or suspected obstructive sleep apnea-hypopnea in children. Up to date Patient Information (2007) Anstead M. Pediatric sleep disorders: new developments and evolving understanding. Curr Opin Pulm Med 2000, 6: Guilleminault C, Stools R, Duncan S. Snoring: daytime sleepiness in regular heavy snorers. Chest 1991, 99: Blunden S, Lushington K, Kennedy D, Martin J, Dawson D. Behavior and neurocognitive performance in children aged 5-10 years who snore compared to controls. J Clin Exp Neurophychol 2000, 22: Friedman BC, Hendeles-Amitai A,Kozminsky E, et al. Adenotonsillectomy improves neurocognitive function in children with obstructive sleep apnea syndromes. Sleep 2003, 26: Gozal D. Sleep-disordered breathing and school performance in children. Pediatrics 1998, 102: Weissbluth M, Davis AT, Poncher J, Reiff J. Signs of airway obstruction during sleep and behavioral, developmental and academic problems. J Dev Behav Pediatr 1983, 4: Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P. A cause of excessive daytime sleepiness. The upper airway resistance syndrome. Chest 1993, 104: Guilleminault C, Stoohs R, Clerk A, et al. From obstructive sleep apnea syndrome to upper airway resistance syndrome: consistency of daytime sleepiness. Sleep 1992, 15(suppl 6), Marcus CL, Omlin KJ, Basinki DJ, et al. Normal polysomnographic values for children and adolescents. Am Rev Respir Dis 1992, 146: American Thoracic Society. Medical Section of the American Lung Association. Standards and Indications for Cardiopulmonary Sleep Studies in Children. Am Respir Crit Care Med 1996, 153: Gould GA, Whyte KF,,Rhind GB, Airlie MA, Catterall JR, Shapiro CM, et al. The sleep hypopnea syndrome. Am Rev Respir Dis 1988, 137: Cantineau JP, Escourou P, Startine, Gaultier C, Goldman M. Accuracy of respiratory inductive plethysmography during wakefulness and sleep in patients with obstructive sleep apnea. Chest 1992, 102: Moser NJ, Phillips BA, Berry DTR, Harbison L. What is Hypopnea, Anyway? Chest 1994, 105: Montgomery-Downs HE, OАдBrien LM, Gulliver TE, Gozal D. Polysomnographic Characteristics in Normal Preschool and Early School-Aged Children. Pediatrics 2006, 117(3): Uliel S, Tauman R, Greenfeld M, Sivan Y. Normal Polysomnographic Respiratory Values in Children and Adolescents. Chest 2004, 125: Asensi JRV. Sleep Polygraphic Studies in Children: Indications and Techniques. Pediatr Pulmon 2004, Suppl 26: Balbani AP, Weber SA, Montovani JC. Update in Obstructive sleep apnea syndrome in Children. Revista Brasileira de Otorrinolarongologia 2005, 71(1): Teculescu DB, Caillier I, Perrin P, Rebstock E, Rauch A. Snoring in French preschool children. Pediatr Pulmonol 1992, 13: Owen GO, Canter RJ, Robinson A. Snoring, apnoea and ENT symptoms in the paediatric community. Clin Otolaryngol 1996, 21: Lu LR, Peat JK, Sullivan CE. Snoring in preschool children: prevalence and association with nocturnal cough and asthma. Chest. 2003, 124: Kaditis A, Finder J, Alexopoulos E, Starantzis K, Tanou K, Gampeta S, et al. Sleep-disordered Breathing in Greek Children. Pediatr Pulmonol 2004, 37:

11 АPАP BАнIАн А А А Ан, 20, Rosen CL, Kass LJ, Haddad GG. Obstructive Sleep Apnea and Hypoventilation In: Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics, 17th ed. Philadelphia: WB Saunders Co, 2004: Series F. Upper airway muscles awake and asleep. Sleep Med Rev 2002, 6: Schwab RJ, Kuna ST, Remmers JE. Anatomy and physiology of upper airway obstruction. In: Kryger MH, Roth T, Dement WC. The principles and practice of sleep medicine. 4th ed. Pennsylvania Elsevier Saunders, 2005 [chapter 82]. 31. Nolte J. The human brain: an introduction to its functional anatomy, 5th ed St Louis: Mosby, Malhotra A, Pillar G, Fogel RB, Edwards JK, Ayas N, et al. Pharyngeal pressure and flow effects on genioglossus activation in normal subjects. Am J Respir Crit Care Med 2002, 165(1): Malhotra A, Fogel RB, Edwards JK, Shea SA, White DP. Local mechanisms drive genioglossus activation in obstructive sleep apnea. Am J Respir Crit Care Med 2000, 161: Marcus CL. Pathophysiology of childhood obstructive sleep apnea: current concepts. Respir Physiol 2000, 119: Marcus CL, Katz ES, Lutz J, Black CA, Galster P, Carson KA. Upper Airway Dynamic Responses in Children with the Obstructive Sleep Apnea Syndrome. Pediatr Res 2005, 57: Conduit R, Sasse A, Hodgson W, Trinder J, Veasey S, Tucker A. A neurotoxical approach to the treatment of obstructive sleep apnoea. Sleep Medicine Reviews 2007, 11: Marcus CL, Lutz J, Hamer A, Smith PL, Schwartz A. Developmental changes in response to subatmospheric pressure loading of the upper airway. J Appl Physiol 1999, 87: Isono S, Shimada A, Utsugi M, Konno A, Nishino T. Comparison of static mechanical properties of the passive pharynx between normal children and children with sleepdisordered breathing. Am J Respir Crit Care Med 1998: 157, Murphy TD. Obstructive Sleep Apnea Syndrome. e- medicine (2007) Deegan PC, MCNicholas WT. Pathophysiology of obstructive sleep apnea. ERJ, 1995: Suen JS, Arnold JE, Brooks LJ. Adenotonsillectomy for treatment of obstructive sleep apnea in children. Arch Otoryngol Head Neck Surg 1995, 121: Tasker C, Crosby JH, Stradling JR. Evidence for persistence of upper airway narrowing during sleep, 12 years after adenotonsillectomy. Arch Dis Child 2002, 86: Jennum P, Sjol A. Epidemiology of snoring and obstructive sleep apnoea in a Danish population, age 30АV60. J Sleep Res , 4: 240АV Redline S, Tishler P.V, Tosteson T.D, Williamson J, Kump K, Browner I. et al. The familial aggregation of obstructive sleep apnea. Am J Respir Crit Care Med 1995, 151: (3 Pt 1): 682АV Kalra M, Lemasters G, Bernstein D, Wilson K, Levin L. and Cohen A, et al. Atopy as a risk factor for habitual snoring at age 1 year. Chest 2006, 129(4): 942АV Schwab R.J, Pasirstein M, Kaplan L, Pierson R, Mackley A, Hachadoorian R et al. Family aggregation of upper airway soft tissue structures in normal subjects and patients with sleep apnea. Am J Respir Crit Care Med 2006, 173(4): 453АV Guilleminault C, Partinen M, Hollman K, Powell N, Stoohs R. Familial aggregates in obstructive sleep apnea syndrome. Chest 1995, 107(6): 1545АV Mathur R and Douglas N.J. Family studies in patients with the sleep apneaаvhypopnea syndrome. Ann Intern Med 1995, 122(3): 174АV Maninder K, Ranajit C. Genetic susceptibility to obstructive sleep apnea in the obese child. Sleep Medicine 2007, 8(2): Corbo GM, Fuciarelli F, Foresi A, De Benedetto F. Snoring in children: association with respiratory symptoms and passive smoking. Br Med J 1989, 299: Ng DK, Lam YY, Kwok KL, Chow PY. Obstructive sleep apnea syndrome and obesity in children. Hond Kong Med J 2004, 10: Chng SY, Goh DYT, Wang XS, Tan TN, Ong NBH. Snoring and Atopic Disease: A Strong Association. Ped Pulmon 2004, 38: Li AM, Chan DFY, Fok TF. Childhood obstructive sleep apnea: an update. Hong Kong Med J 2004, 10(6): Ng DK, Chow PY, Chan CH, Kwok KL, Cheung JM, Kong FY. An update on childhood snoring. Acta Pediatrica 2006, 95(9): Goodwin JL, Babar SI, Kaemingk KL, et al. Symptoms related to sleep-disordered breathing in white and Hispanic children: the Tucson ChildrenАдs Assessment of Sleep Apnea Study. Chest. 2003, 124: Contencin P, Guilleminault C, Manach Y. Long-term follow-up and mechanisms of obstructive sleep apnea (OSA) and related syndromes through infancy and childhood. Int J Pediatr Otorhinolaryngol. 2003, 67(suppl 1): S119-S Goldstein NA, Pugazhendhi V, Rao SM, et al. Clinical assessment of pediatric obstructive sleep apnea. Pediatrics. 2004, 114: Parker JD, Brooks D, Kozar LF, Render-Teixeira CL, Horner RL, Bradley TD. Acute and Chronic Effects of Airway Obstruction on Canine Left Ventricular Performance. Am J Respir Crit Care Med 1999, 160: Dursunoglu N, Dursunoglu D, Kihc M. Impact of Obstructive Sleep Apnea on Right Ventricular Global Function: Sleep Apnea and Myocardial Performance Index. Respir 2005, 72(3): Amin RS, Kimball TR, Bean JA, Jeffries JL, Willging JP, Cotton RT. Left Ventricular Hypertrophy and Abnormal

12 234 АPАP BАнIАн А А А Ан, 20, 3 Ventricular Geometry in Children and Adolescences with Obstructive Sleep Apnea. Am J Respir Crit Care Med 2002, 165: Blunden S, Lushinghton K, Kennedy D, Martin J, Dawson D. Behavior and neurocognitive performance in children aged 5-10 years who snore compared to controls. J Clin Exp Neurophychol 2000, 22: Bass JL, Corwin M, Cozal D, et al. The effect of Chronic and Intermittent Hypoxia on Cognition in Childhood: A review of the evidence. Pediatrics 2004, 114: Nieminen P, Lopponen T, Tolonen U, Lanning P, Knip M, Lopponen H. Growth and biochemical markers of growth in children with snoring and obstructive sleep apnea. Pediatrics 2002, 109: e De la Eva RC, Baur LA, Donaghue KC, Waters KA. Metabolic correlates with obstructive sleep apnea in obese subjects. J Pediatr 2002, 140: Moustaki M, Gialouros P, Karpathios T. Polygraphic sleep studies in children. Paediatriki 2001, 64: Gozal D, Kheirandish L. Disorders of Breathing during sleep. In: Chernick V, Boat T, Wilmott RW, Bush A, (eds). KendigАдs Disorders of the Respiratory Tract in Children, 7th ed. Philadelphia, WB Saunders, 2006: Lamm C, Mandeli J, Kattan M. Evaluation of home audiotapes as an abbreviated test for obstructive sleep apnea syndrome (OSAS) in children. Pediatr Pulmonol 1999, 27: Cohen LM, Koltai PJ, Scott JR. Lateral cervical radiograpgs and adenoid size: do they correlate? Ear Nose Throat J 1992, 71: 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: Brouillette RT, Manouklan JJ, Ducharme FM, Oudjihane K, Earle LG, Ladan S. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr 2001, 138: Goldbart AD, Goldman JL, Veling MC, Gozal D. Leukotriene Modifier Therapy for Mild Sleep-disordered Breathing in Children. Am J Respir Crit Care Med 2005, 172: Hoeve HL, Joosten KF, Van den Berg S. Management of obstructive sleep apnea syndrome in children with craniofacial malformation. Int J Pediatr Otorhinolar 1999, 499(Supp 1): S Guilleminault C, Li KK, Quo S, Inouye R. A prospective study of surgical outcomes of children with sleep-disordered breathing. Sleep. 2004, 27: Waters KA, Everett FM, Bruderer JW, Sullivan CE. Obstructive sleep apnea: the use of nasal CPAP in 80 children. Am J Respir Crit Care Med. 1995, 152: Uong C, Epperson M, Sharon A. Bathon, RN, Jeffe DB. Adherence to Nasal Positive Airway Pressure Therapy Among School-aged Children and Adolescents With Obstructive Sleep Apnea Syndrome. Pediatrics 2007, 120(5): e American Academy of Pediatric. Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome. Pediatrics 2002, 109: Chan J, Edman JC, Koltai PJ. Obstructive sleep apnea in Children. Am Fam Physic 2004, 69(5). А АPАP: M. apple. АВАP , АP БG/Fax: eboriad@med.auth.gr Coresponding author: M. Eboriadou St. Kiriakidi , Thessaloniki Greece