Диагноз: Синдром обструктивного апноэ сна тяжелой степени.

У ребенка была проведена тонзилэктомия, рекомендовано обеспечить контроль за массой тела. Клинически уже через несколько дней после операции храп значительно уменьшился, остановки дыхания практически исчезли. Пациент с улучшением выписан на амбулаторный этап лечения. Контрольная полисомнография планируется через год после операции.

Заключение

Синдром обструктивного апноэ сна является актуальной проблемой современной медицины из-за высокой распространенности в популяции, увеличения риска сердечно-сосудистых, неврологических и метаболических осложнений при данном заболевании, а также значительного ухудшения качества жизни пациентов. В настоящее время врач, информированный о данной проблеме, располагает возможностью точной диагностики этой потенциально летальной патологии. Вовремя назначенное лечение позволяет в подавляющем большинстве случаев предотвратить нежелательные последствия и значительно улучшить качество жизни пациента.

Список литературы

1. Kajaste, S; Brander, PE; Telakivi, T;Partinen, M; Mustajoki ,P. A cognitive-behavioral weight reduction program in the treatment of obstructive sleep apnea syndrome with or without initial nasal CPAP: a randomized study. Sleep Med, 2004, 5(2) - pp.125-131.

2. Tanigawa, T; Tachibana, N; Yamagishi, K; Muraki, I; Umesawa,M; Shimamoto, T; Iso, H . Usual Alcohol Consumption and Arterial Oxygen Desaturation During Sleep. JAMA ,2004, 292(8) - pp.923-925.

3. Вейн, А.М. и др . Синдром апноэ во сне и другие расстройства дыхания, связанные со сном: клиника, диагностика, лечение. б.м. : Эйдос Медиа, 2002.

4. Morganthaler, TI and al., et. Complex sleep apnea syndrome. SLEEP,2006, 29(9)-pp.1203-1209.

5. Schutte-Rodin, S; Broch, L; Buysse, D; Dorsey, C; Sateia, M . Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med,2008, 4(5)-pp.487-504.

6. Dunder, Y; et al. . Newer hypnotic drugs for the short-term management of insomnia: a systematic review and economic evaluation. Health Technol. Assess, 2004, 8(24)-p.140.

7. Buscemi, N; et al. Manifestations and Management of Chronic Insomnia in Adults. Evidence Report/Technology Assessment. . Agency for Healthcare Research and Quality, 2005 , 125-pp.1-11.

8. Quera-Salva, MA; McCann, C; Boudet, J; et al . Effects of zolpidem on sleep architecture, night time ventilation, daytime vigilance and performance in heavy snorers. Br J Clin Pharmacol, 1994, 37- pp. 539-543.

9. Cirignotta, F; Mondini, S; Zucconi, M; Gerardi, R; Farolfi, A; Lugaresi, E.. Zolpidem-polysomnographic study of the effect of a new hypnotic drug in sleep apnea syndrome. Pharmacol Biochem Behav, 1988, 29(4)-pp. 807-809.

10. Lim, J; Lasserson, TJ; Fleetham, J; Wright, JJ. Oral appliances for obstructive sleep apnoea (Review) The Cochrane Collaboration. s.l. : Published by JohnWiley & Sons, Ltd., 2009.

11. Ferguson, KA; Cartwright, R; Rogers, R; Schmidt-Nowara, W. Oral Appliances for Snoring and Obstructive Sleep Apnea: A Review. SLEEP,2006, 29 –pp.244-262

12. Ерошина, В.А.; Гасилин, В.С.; Бузунов, Р.В.; Калинкин, А.Л. . Оценка эффективности применения внутриротового аппликатора УПЛХ-01 при храпе и синдроме обструктивного апноэ сна // Клиническая медицина.- 2001.- № 4.- С. 44-47.

13. Gul, A. The prevalence of allergic rhinitis in patients with simple snoring and obstructive sleep apnea syndrome. Kulak Burun Bogaz Ihtis Derg, 2011, 21(2)-pp.70-5.

14. Kiely, JL; Nolan, P; McNicholas, WT. Intranasal corticosteroid therapy for obstructive sleep apnea in patients with co-existing rhinitis . Thorax , 2004, 59(1)-pp.50-55.

15. Mintz, M; Garcia, J; Diener, P; Liao, Y; Duclay, L; Georges, G . Triamcinolone acetonide aqueous nasal spray improves nocturnal rhinitis-related quality of life in patients treated in a primary care setting: the Quality of Sleep in Allergic Rhinitis study. Annals of Allergy, Asthma Immunology: Oficial Publication of the American College of Allergy, Asthma, Immunology, 2004, 92(2)-pp.255-261.

16. Hultcrantz, E; Harder, L; Harder, H; Zetterlun,L; Roberg, K. To treat snoring with nasal steroids - effects on more than one level. Acta Otolaryngol, 2010,130(1)-pp.124-31.

17. Janson, C; Gislason, T; Bengtsson, H; et al. Long-term Follow-up of Patients With Obstructive Sleep Apnea Treated With Uvulopalatopharyngoplasty. Arch Otolaryngol Head Neck Surg, 1997, 123(3)- pp. 257-262.

18. Maw, J; Marsan, J. Uvulopalatopharyngoplasty versus laser-assisted uvulopalatopharyngoplasty in the treatment of snoring. Otolaryngol, 1997, 26(4)- pp. 232-235.

19. Brooks, D. R., L. Horner ; Kimoff,L. ; Kozar, L. F; Render-Teixeira,C. L. ; Phillipson, E. A. Effect of obstructive sleep apnea versus sleep fragmentation on responses to airway occlusion. Am J Respir Crit Care Med, 1997, 155-pp. 1609-1617.

20. Aurora, RN; Casey, KR; Kristo, D. Practice Parameters for the Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults. Sleep, 2010, 33 (10) - pp.1408-1413.

21. SuIlivan, C E; Issa, FG; Berthon-Jones, M; Eves, L. Reversal of obstructive steep apnoea by continuous positive airways pressure applied through the nares. Lancet, 1981, 1- pp. 862-865.

22. Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of obstructive sleep apnea in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI) : s.n., 2008.

23. National Institute for Health and Clinical Excellence (NICE). Continuous positive airway pressure for the treatment of obstructive sleep apnoea/ hypopnoea syndrome. London (UK): National Institute for Health and Clinical Excellence (NICE) : s.n., 2008, Mar. 25 (Technology appraisal guidance; no. 139).

24. Kushida, CA; Littner, MR; Hirshkowitz, M; Morgenthaler, TI; Alessi, CA; Bailey, D; Boehlecke, B; Brown, TM; Coleman, J Jr; Friedman, L; Kapen, S; Kapur, VK; Kramer, M; Lee-Chiong, T; Owens, J; Pancer, JP; Swick, TJ; Wise, MS. American Academy of Sleep Medicine. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-relatedbreathing disorders. Sleep, 2006, 1-29(3), pp. 375-380.

25. Loube, DI; Gay, PC; Strohl, KP; et al.. Indications for positive airway pressure treatment of adult obstructive sleep apnea patients: a consensus statement. Chest, 1999 , 115- pp. 863-866.

26. American Academy of Pediatrics Policy Statement Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome . 2002, 109 (4) -pp. 704-712.

27. Darrow, DH; Siemens, C. Indications for tonsillectomy and adenoidectomy. Laryngoscope, 2002, 112(8 Pt 2 Suppl 100) -pp.6-10. .

28. Garetz, S. Behavior, cognition and quality of life after adenotonsillectomy for pediatric sleep disordered breathing. Otolaryngology-HNSurgery . 2008, 138 -pp.19-26 .

29. Cincinnati Children’s Hospital Medical Center. Best evidence statement (BESt). Long-term outcomes in obstructive sleep apnea. Cincinnati (OH) : s.n., 2009-10 p.

30. Bousquet, J; Khaltaev, N; Cruz, AA; Denburg, J; Fokkens, WJ; Togias, A; et al . Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2) LEN and AllerGen). Allergy, 2008, 63 (86)-pp.8-160.

31. Fokkens, W; Lund, V; Mullol, J . European Position Paper on Rhinosinusitis and Nasal Polyps Group. EP3OS 2007: European position paper on rhinosinusitis and nasal polyps. A summary for otorhinolaryngologists. . Rhinology, 2007 , 45(2)-pp.97-101.

32. Alexopoulos EI; Kaditis, AG; Kalampouka, E; et al. Nasal corticosteroids for children with snoring. Pediatr Pulmonol , 2004; 38-pp.161–166.

33. Kheirandish-Gozal, L; Gozal, D. Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics , 2008; 122-pp.149–155.

34. Berlucchi, M; Salsi, D; Valetti, L; Parrinello, G; Nicolai, P. The role of mometasone furoate aqueous nasal spray in the treatment of adenoidal hypertrophy in the pediatric age group: preliminary results of a prospective, randomized study. Pediatrics, 2007; 119-pp.1392–1397.

35. Minshall, E; Ghaffar, O; Cameron, L; O’Brein, F; Quinn, H; Rowe-Jones, J. Assessment by nasal biopsy of long-term use of mometasone furoate aqueous nasal spray (Nasonex) in the treatment of perennial rhinitis. Otolaryngol Head Neck Surg, 1998, 118 - pp.648–654.

36. Schenkel, EJ; Skoner, DP; Bronsky, EA; et al. Absence of growth retardation in children with perennial allergic rhinitis after one year of treatment with mometasone furoate aqueous nasal spray. Pediatrics, 2000, 105(2) –e22 [Article online]. URL: www.pediatrics.org/cgi/content/full/105/2/e22.

37. Boner, AL. Effects of intranasal corticosteroids on the hypothalamic-pituitary-adrenal axis in children. J Allergy Clin Immunol, 2001, 108(suppl)- pp.S32–S39.

38. Szefler, SJ. Pharmacokinetics of intranasal corticosteroids. J Allergy Clin Immunol, 2001, 108(suppl) -pp.S26–S31.