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Advisor(s)
Abstract(s)
A apneia obstrutiva do sono é um distúrbio respiratório do sono prevalente na população
pediátrica afetando 1-3% desta. Ocorre quando a respiração é interrompida de forma
total ou parcial de forma intermitente. O gold-standard para o diagnóstico desta
patologia é a Polissonografia, um exame que apesar das suas capacidades a nível
diagnóstico não está livre de diversas limitações.
O objetivo desta revisão de literatura foi analisar e discutir as diversas inconveniências
associadas à Polissonografia e indicações para a sua utilização analisando
concomitantemente algumas alternativas diagnósticas que possam compensar as
desvantagens do gold-standard.
Foi utilizado o motor de busca Pubmed e foi utilizada informação de guidelines de
academias como a AAP, AAO-HNS e American Thoracic Society para além de outros
artigos considerados relevantes para contextualizar. Numa primeira pesquisa foi
imposto o limite temporal até 2000 para avaliar as inconveniências da PSG e numa
segunda pesquisa sobre alternativas de diagnóstico o limite temporal foi de estudos até
2018.
A Polissonografia é um exame pouco prescrito pelos médicos que se deparam com a AOS
pediátrica na sua prática clínica, existindo diversas razões para isso. Embora exista
evidência de que os pais estão dispostos a pagar o valor necessário para a realização da
PSG, esta não deixa de ser um exame dispendioso, para além dos custos na qualidade de
vida e de sono que não só a criança experiencia, mas também os seus pais. Para além de
caro é um método indisponível em cenários socioeconómicos mais desfavoráveis. Mas
talvez a maior critica à PSG é a inconsistência no que toca às suas indicações e
interpretação de seus resultados, com diferentes academias de renome a apresentarem
guidelines que variam nas situações em que promulgam ser necessária a PSG e mesmo
quando realizada, a classificação dos eventos respiratórios e sua significância clínica
ainda é um tema controverso.
Posto isto, foram investigadas alternativas à PSG nos mais variados moldes.
Questionários clínicos como o PSQ e OSA-18 mostraram-se sensíveis e práticos de
utilizar, mas pouco específicos, sendo mais indicados como métodos de rastreio.
Alternativas mais objetivas como Monitores Portáteis e Oximetria noturna apresentaram uma maior precisão diagnóstica apesar de não ser a mais ideal, no entanto colmatam
algumas limitações da PSG por serem mais amigas do usuário.
Em suma, a investigação constante que se desenvolve neste campo da Pediatria e
Otorrinolaringologia caminha para um futuro que compreende a limitada aplicabilidade
da PSG e procura alternativas mais exequíveis, com uma melhor definição e
criteriosidade na indicação deste exame, tornando o papel da Polissonografia num de
confirmação de diagnóstico em situações incertas e, portanto, mais raras em vez de um
exame a aplicar a todas as crianças com suspeita de AOS.
Obstructive sleep apnea is a prevalent sleep-related breathing disorder in the pediatric population, affecting 1-3% of it. It is characterized by intermittent total or partial interruptions in breathing. The gold standard for diagnosing this condition is Polysomnography, a test that, despite its diagnostic capabilities, is not without various limitations. Therefore, the objective of this literature review was to analyze and discuss the various inconveniences associated with PSG and indications for its use, concurrently examining some diagnostic alternatives that may compensate for the drawbacks of the gold standard. The PubMed search engine was utilized, and information from guidelines of academies such as the AAP, AAO-HNS, and American Thoracic Society was used, along with other relevant articles for contextualization. In the initial search, a temporal limit until 2000 was imposed to assess PSG inconveniences, and in a second search regarding diagnostic alternatives, the temporal limit was studies up to 2018. Polysomnography is a test seldom prescribed by physicians encountering pediatric obstructive sleep apnea in their clinical practice, there are several reasons for this. Although there is evidence that parents are willing to pay the necessary amount for PSG, it remains an expensive test, in addition to the costs on quality of life and sleep, experienced not only by the child but also by their parents. Apart from being costly, it is unavailable in socioeconomically disadvantaged scenarios. Perhaps the biggest criticism of PSG is its inconsistency regarding its indications and interpretation of results, with different reputable academies presenting guidelines that vary in situations where PSG is deemed necessary, and even when performed, the classification of respiratory events and their clinical significance remains controversial. Given this, alternatives to PSG were investigated in various forms. Clinical questionnaires such as the PSQ and OSA-18 proved to be sensitive and practical to use but less specific, being more suitable as screening methods. More objective alternatives, such as Portable Monitors and Overnight Oximetry showed greater diagnostic accuracy despite not being the most ideal, however, they address some limitations of PSG by being more user-friendly In summary, ongoing research in the fields of Pediatrics and Otorhinolaryngology is moving towards a future that acknowledges the limited applicability of PSG and seeks more feasible alternatives, with better definition and discretion in the indication of this test, making the role of Polysomnography one of confirming diagnosis in uncertain and thus rarer situations rather than an exam to be prescribed to every child with a suspition of Obstructive Sleep Apnea.
Obstructive sleep apnea is a prevalent sleep-related breathing disorder in the pediatric population, affecting 1-3% of it. It is characterized by intermittent total or partial interruptions in breathing. The gold standard for diagnosing this condition is Polysomnography, a test that, despite its diagnostic capabilities, is not without various limitations. Therefore, the objective of this literature review was to analyze and discuss the various inconveniences associated with PSG and indications for its use, concurrently examining some diagnostic alternatives that may compensate for the drawbacks of the gold standard. The PubMed search engine was utilized, and information from guidelines of academies such as the AAP, AAO-HNS, and American Thoracic Society was used, along with other relevant articles for contextualization. In the initial search, a temporal limit until 2000 was imposed to assess PSG inconveniences, and in a second search regarding diagnostic alternatives, the temporal limit was studies up to 2018. Polysomnography is a test seldom prescribed by physicians encountering pediatric obstructive sleep apnea in their clinical practice, there are several reasons for this. Although there is evidence that parents are willing to pay the necessary amount for PSG, it remains an expensive test, in addition to the costs on quality of life and sleep, experienced not only by the child but also by their parents. Apart from being costly, it is unavailable in socioeconomically disadvantaged scenarios. Perhaps the biggest criticism of PSG is its inconsistency regarding its indications and interpretation of results, with different reputable academies presenting guidelines that vary in situations where PSG is deemed necessary, and even when performed, the classification of respiratory events and their clinical significance remains controversial. Given this, alternatives to PSG were investigated in various forms. Clinical questionnaires such as the PSQ and OSA-18 proved to be sensitive and practical to use but less specific, being more suitable as screening methods. More objective alternatives, such as Portable Monitors and Overnight Oximetry showed greater diagnostic accuracy despite not being the most ideal, however, they address some limitations of PSG by being more user-friendly In summary, ongoing research in the fields of Pediatrics and Otorhinolaryngology is moving towards a future that acknowledges the limited applicability of PSG and seeks more feasible alternatives, with better definition and discretion in the indication of this test, making the role of Polysomnography one of confirming diagnosis in uncertain and thus rarer situations rather than an exam to be prescribed to every child with a suspition of Obstructive Sleep Apnea.
Description
Keywords
Apneia Obstrutiva do Sono Criança Diagnóstico Polissonografia