Obstructive Sleep Apnea in Children with Cerebral Palsy

Tomoko Shintani; Kohji Asakura; Kan Ishi; Mizuki Yoshida; Akikatsu Kataura; Hideki Ogasawara

doi:10.3950/jibiinkoka.101.266

脳性麻痺小児における閉塞性睡眠時無呼吸

新谷朋子, 朝倉光司, 石井歓, 吉田瑞生, 形浦昭克, 小笠原英樹

著者情報

キーワード: 睡眠時無呼吸, 小児脳性麻痺, アデノイド・扁桃摘出術, 口蓋垂軟口蓋咽頭形成術

ジャーナルフリー

1998 年 101 巻 3 号 p. 266-271

DOI https://doi.org/10.3950/jibiinkoka.101.266

詳細

発行日: 1998/03/20 受付日: - J-STAGE公開日: 2008/03/19 受理日: - 早期公開日: - 改訂日: -
訂正情報
訂正日: 2008/03/19 訂正理由: - 訂正箇所: PDFファイル訂正内容: -

訂正日: 2008/03/19 訂正理由: - 訂正箇所: 論文タイトル訂正内容: Right : Obstructive Sleep Apnea in Children with Cerebral Palsy

訂正日: 2008/03/19 訂正理由: - 訂正箇所: 論文抄録訂正内容: Right : To determine the etiology of obstructive sleep apnea (OSA) in children with cerebral palsy (CP), a survey using questionnaire was conducted on parents of 233 CP children (1 5 years old. mean age : 2.7) and on those of 343 control children during a routine medical check up at the age of three. The prevalence of habitual snoring and nasal obstruction was 63 and 20% in CP children, which were significantly higher than in control children. Sleep apnea episodes and stridor were noted in 19.7 and 15.1% of CP children. A screening sleep study was performed using Apnomonitor II and a pulseoximeter(Pulsox 5) in 48 CP children whose questionnaires revealed habitual snoring and sleep apnea, and it was found that 27 and 58% of the children had on apnea hypopnea index (AHI) of greater than 5 and a low level of SaO, (LSaO) of less than 85% respectively. When another 10 CP children visited our hospital for treatment of severe OSA, precise evaluations including pharyngeal pressure and fiberscopic examination during sleep as well as a sleep study using an inductive prezysmograph (Respigraph) were performed. Adenoid and/or tonsillar hypertrophy were noted in only 4 children, and the main cause of sleep apnea in the other 6 children was pharyngeal collapse at the lingual base. Their OSA was successfully treated by adenotonsillectomy in 2 children, adenotomy in 2 children, UPPP and lingualplasty in I child, tracheostomy in 2 children, and nasal CPAP in I child. Before treatment of OSA in CP children, precise evaluation is recommended in order to perform appropriate treatment.

訂正日: 2008/03/19 訂正理由: - 訂正箇所: 著者情報訂正内容: Right : Tomoko Shintani¹⁾, Kohji Asakura¹⁾, Kan Ishi¹⁾, Mizuki Yoshida¹⁾, Akikatsu Kataura¹⁾, Hideki Ogasawara²⁾

訂正日: 2008/03/19 訂正理由: - 訂正箇所: 所属機関情報訂正内容: Right :
1) Department of Otolaryngology, Sapporo Medical University, School of Medicine

訂正日: 2008/03/19 訂正理由: - 訂正箇所: キーワード情報訂正内容: 訂正前 : 睡眠時無呼吸小児脳性麻痺アデノイド扁桃摘出術口蓋垂軟口蓋咽頭形成術nasal continuous positive airway pressure
訂正後 : 睡眠時無呼吸小児脳性麻痺アデノイド・扁桃摘出術口蓋垂軟口蓋咽頭形成術

訂正日: 2008/03/19 訂正理由: - 訂正箇所: PDFファイル訂正内容: -

抄録

脳性麻痺の小児(CP児)における夜間の呼吸障害の程度と病態について考察する目的で,アンケート調査および睡眠時無呼吸を有するCP児の臨床的検討を行った.CP児233名を対象に夜間の呼吸状態についてアンケートを行った結果,いびきは147名(63%),鼻閉は46名(19.7%)と健常児に比べ有意に多く見られた.また,喘嗚は37名(15.9%),無呼吸は46名(19.7%)に認められた.アンケートの中で無呼吸を訴えたCP児48名を対験に閉塞性睡眠時無呼吸(OSA)のスクリーニング検査を行つ.27%の例でapnea-hypopnea index(AHI)5の病的無呼吸を認め,57.5%例で最低酸素飽和度85％以下の低酸素状態を認めた.蜜た.重度の無呼吸があり精査•治療を行ったCP児10名では頸定してない症例が多く,アデノイド,扁桃肥大例は4名と比較的少なく,舌根レベルでの狭窄が多かつた.無呼吸に対する手術内容は,アデノイド•扁挑摘出術2名,アデノイド切除術2名,口蓋垂軟口蓋嘱頭形成術(UPPP)と舌根切除術1名,気管切開術2名で,いずれも術後経過良好であつた.保存的治療3例の内訳は,抗痙攣荊を変更して改善した1例,側臥位睡眠で改善した1例およびnasal continuous positlve alrway pressu (nasa1 CPAI)にて改善した1例であつた.このようにCP児の無呼吸は多種の要因がからみ治療が困難なことが多いが,閉塞部位の確定を行った後に手術を含めた適切な治療を行う必要があると考えられた.

責任著者(Corresponding author)

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