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Abstract(s)
Introdução: As crianças com Distúrbios Respiratórios Obstrutivos do Sono (DROS) podem apresentar sintomas comportamentais similares àqueles da Perturbação de Hiperatividade e Défice de Atenção (PHDA): hiperatividade, impulsividade e falta de atenção. Este quadro clínico pode levar a diagnósticos erróneos de PHDA, com consequente instituição de terapêutica farmacológica a longo prazo. Em idade pediátrica, a hipertrofia adenoamigdalina (HAA) é a principal causa dos DROS; por isso, a adenoamigdalectomia (AVA) pode resolver este quadro clínico.
Objetivo: Esta monografia pretende avaliar o papel da AVA nas perturbações comportamentais dos DROS infantis.
Metodologia: O conjunto de artigos incluídos nesta revisão sistemática foi obtido com recurso à base de dados eletrónicos PubMed. A pesquisa foi restrita à bibliografia publicada nos últimos quatro anos e utilizou as seguintes expressões: (“adenotonsillectomy” [Title/Abstract] OR “sleep-disordered breathing” [Title/Abstract] OR “obstructive sleep apnea” [Title/Abstract]) AND (“behavior” [Title/Abstract] OR “ADHD” [Title/Abstract]).
Resultados: Todos os estudos concluíram que, após a realização da AVA, como modalidade terapêutica para os DROS em crianças com HAA, ocorria melhoria do comportamento, denotada objetivamente por alterações correspondentes nos instrumentos de avaliação comportamental (Nível de Evidência IB). Os benefícios comportamentais da cirurgia verificaram-se precocemente e mantiveram-se por, pelo menos, um ano (Nível de Evidência III). Não se identificou nenhuma característica individual do paciente que influenciasse o efeito da cirurgia no comportamento (Nível de Evidência IB).
Conclusão: A AVA está associada a melhoria das perturbações comportamentais dos DROS da criança (Grau de Recomendação A), pode prevenir sequelas cerebrais irreversíveis e evitar o recurso a terapia médica prolongada.
Introduction: Children with Sleep-disordered breathing (SDB) can display behavioral symptoms similar to those that occur in Attention-Deficit/Hyperactivity Disorder (ADHD): hyperactivity, impulsivity and attention deficit. This clinical presentation can lead to a wrong diagnosis of ADHD and a prescription of long-term drug therapy. In children, adenotonsillar hypertrophy is the major cause of SDB; therefore, adenotonsillectomy can solve this clinical picture. Objective: This monograph aims to investigate the role of adenotonsillectomy in behavioral disturbances of childhood’s SDB. Methods: The set of articles included in this systematic review was obtained through electronic data base PubMed. The research was restricted to literature published in the last four years and used the follow expressions: (“adenotonsillectomy” [Title/Abstract] OR “sleep-disordered breathing” [Title/Abstract] OR “obstructive sleep apnea” [Title/Abstract]) AND (“behavior” [Title/Abstract] OR “ADHD” [Title/Abstract]). Results: All studies concluded that, after adenotonsillectomy, performed as a treatment for SDB in children with adenotonsillar hypertrophy, there was an improvement in behavior, objectively denoted by changes in behavioral assessment tools (Level of Evidence IB). The benefits of surgery occured quickly and remained for, at least, one year (Level of Evidence III). No study identified any individual characteristics of the patient that could influence the effect of the surgery in behavior (Level of Evidence IB). Conclusions: Adenotonsillectomy is associated with improvement in behavioral disturbances of childhood’s SDB (Grade of Recommendation A), can prevent irreversible brain sequelae and avoid long-term drug therapy.
Introduction: Children with Sleep-disordered breathing (SDB) can display behavioral symptoms similar to those that occur in Attention-Deficit/Hyperactivity Disorder (ADHD): hyperactivity, impulsivity and attention deficit. This clinical presentation can lead to a wrong diagnosis of ADHD and a prescription of long-term drug therapy. In children, adenotonsillar hypertrophy is the major cause of SDB; therefore, adenotonsillectomy can solve this clinical picture. Objective: This monograph aims to investigate the role of adenotonsillectomy in behavioral disturbances of childhood’s SDB. Methods: The set of articles included in this systematic review was obtained through electronic data base PubMed. The research was restricted to literature published in the last four years and used the follow expressions: (“adenotonsillectomy” [Title/Abstract] OR “sleep-disordered breathing” [Title/Abstract] OR “obstructive sleep apnea” [Title/Abstract]) AND (“behavior” [Title/Abstract] OR “ADHD” [Title/Abstract]). Results: All studies concluded that, after adenotonsillectomy, performed as a treatment for SDB in children with adenotonsillar hypertrophy, there was an improvement in behavior, objectively denoted by changes in behavioral assessment tools (Level of Evidence IB). The benefits of surgery occured quickly and remained for, at least, one year (Level of Evidence III). No study identified any individual characteristics of the patient that could influence the effect of the surgery in behavior (Level of Evidence IB). Conclusions: Adenotonsillectomy is associated with improvement in behavioral disturbances of childhood’s SDB (Grade of Recommendation A), can prevent irreversible brain sequelae and avoid long-term drug therapy.
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Keywords
Comportamento Criança Distúrbios Respiratórios Obstrutivos do Sono Perturbação de Hiperatividade e Défice de Atenção Síndrome de Apneia Obstrutiva do Sono