Abstract Ref Number = APCP1208
CASE REPORT OBSTRUCTIVE SLEEP APNEU SYNDROME
ARYA PUTRA SYUHADA,NIA KANIASARI DEFININGSIH
HERMINA GRAND WISATA HOSPITAL GENERAL HOSPITAL OF KARAWANG
Background : Pediatric obstructive sleep apnea syndrome (OSAS) has become widely recognized only in the last few decades as a likely cause of significant morbidity among children. The incidence of OSAS is estimated to be 1-4% of the general population. Sixty percent OSAS patients are overweight (weight over 20 percent above ideal). Neck size, distal pharyngeal area and body mass index are associated with frequency of apnea. The number of obesity in Indonesian children increased multiply. Based on Riskerdas 2013, the condition of children in Indonesia as many as 8 out of 100 Indonesian children are obese. the highest prevalence of obesity in children aged 5-12 years is DKI Jakarta
Case Presentation Summary : A 4 years-old boy admitted to emergency room due to worsening snoring 2 days before. He developed breathing difficulties accompanied by chronic cough and cold since a month ago. His vital sign are: BP: 120/70 mmHg, P: 140 bpm, RR: 36 bpm, T: 36.8?C. His height is 137 cm and his weight is: 60 kg. His laboratories are: leucositosis (21.050), and he has a normal result of blood gas analyze. Thoraks photo : Cardiomegaly and Bronchopneumina duplex. SPN photo: Sinusitis maxilaris bilateral, Rhinitis and Hypertrophy adenoid. His primary diagnosis is Bronchopneumonia, and Secondary diagnosis are: Obesity, Obstructive Sleep Apneu Syndrome, Cardiomegaly. He was intubated and respiration depend on ventilator. He was consulted to a pediatrician cardiologist and the result is normal intracardiac based on echo examination.After 6 days later, he extubated and using cpap home. He was also consulted to medical rehabilitation physician and otorhinolaryngology. And 7 days later, he can go home and consulted to a pediatrician who concern about child nutrition
Learning Points/Discussion : OSAS consists of decreased airflow due to repetitive complete or partial obstruction of the upper airway associated with progressive respiratory effort to overcome the obstruction. OSAS is defined by the American Thoracic Society (ATS) as “a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns.” Obstructive hypoventilation during sleep is included in the above definition of OSAS by the ATS, as it is in the definition given by the International Classification of Sleep Disorders. Several risk factors have been identified in the development of OSAS but undoubtedly, the strongest risk factor is obesity reflected by several markers including BMI, neck circumference, and waist-to-hip ratio. Snoring is frequently associated with OSAS, and patients who initially have only primary snoring may be at risk for the future development of OSAS with age or weight gain. The criteria for paediatric OSAS are reported to apply to patients younger than 18 years; however, polysomnography (PSG) is scored following the AASM Manual, which states that adult diagnostic criteria may be used for patients aged 13–18 years. Obstructive apneas and hypopneas recorded on PSG are most frequently summarized by the AHI, which represents the average number of such events per hour of sleep. Diagnostic criteria for OSAS among adults are typically the product of expert consensus and often include an AHI of 5 or greater on nocturnal PSG and evidence of disturbed or unrefreshing sleep, daytime sleepiness, or other daytime symptoms. AHI cut points of 5, 15, and 30 events/hour have been suggested to indicate mild, moderate, and severe levels of OSAS. Recent recommendations suggest inclusion of respiratory event–related arousals, in addition to apneas and hypopneas, in a respiratory disturbance index (RDI). The rationale for specific AHI diagnostic criteria in children, in comparison to adults, suffers from less available data and perhaps more heterogeneity across studies. Part of the problem is that few studies have been performed to link specified levels of pediatric OSAS with adverse outcomes. At present, an AHI or RDI of 1 to 5 events per hour is most often used in research to identify children with OSAS. There are 3 therapy for OSAS: surgery, lifestyle changes and artificial tool. Continous positive airway pressure (CPAP) is a gold standart therapy for OSASS. Therapy with CPAP will be increase quality of life and decreased blood pressure. This therapy considered effective for OSAS, so it is a first-line therapy and first choice. The sign of successful OSAS therapy are patients can sleep better, feel more refreshed on waking hours and decreased of blood pressure and eliminate symptoms of OSAS.
Keywords: OSAS Obesity CPAP AHI