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持續的上氣道陽壓術을 施行하여 治療效課를 본 注意力缺乏·過剩運動障碍를 同伴한 小兒期閉鎖性睡眠無呼吸症 1例
A Case of Childhood Obstructive Sleep Apnea Syndrome with Co-morbid Attention Deficit Hyperactivity Disorder Treated with Continuous Positive Airway Pressure Treatment

수면정신생리 1996년 3권 1호 p.85 ~ p.95

손창호(Sohn Chang-Ho) - 서울대학교병원 신경정신과
신민섭(Shin Min-Sup) - 서울대학교병원 신경정신과
홍강의(Hong Kang-E) - 서울대학교병원 신경정신과
정도언(Jeong Do-Un) - 서울대학교병원 신경정신과

Abstract

외국의 유병율 조사결과로 미루어 보아 국내에도 상당수의 소아 폐쇄성 수면무호흡증 환자가 있을 것으로 판단된다. 본 증례에서 제시된 바와 같이 소아기 수면무호흡증은 성장과 발달 전반에 영향을 미치며 심혈관계장애, 인지기능장애, 주의력 집중장애. 과잉운동, 대인관계장애와 같은 문제를 유발시킬 가능성이 크다. 따라서 소아의 수면 무호흡증에서 그 자체의 치료뿐 아니라 성장 및 발달과 연관된 합병증 발병의 예방 측면에서도 조기 진단과 조기치료가 필수적임을 강조하고자 한다. 또한 소아 폐쇄성 수면무호흡증에서도 성인과 같이 지속적 양 압술이 효과적이고 안전하며 순응도 높게 사용될 수 있음을 본 증례에서 확인한 점도 향후 소아 무호흡증 치료에 유익한 지침이 될 수 있을 것으로 판단된다.

Obstructive sleep apnea syndrome(OSAS) in childhood is unique and different n-om that in adulthood in several aspects, including pathophysiology, clinical features, diagnostic criteria, complications, management, and prognosis. Characteristic features of childhood OSAS in comparison with the adult form are the variety of severe complications such as developmental delay, more prominent behavioral and cognitive impairments, vivid cardiovascular symptoms, and increased death risk, warranting a special attention to the possible diagnosis of OSAS in children who snore. However, the childhood OSAS is often neglected and unrecognized. We, therefore, report a case of very severe OSAS in a 5-year-old boy who was sucessfully treated with continuous positive airway pressure(CPAP) treatment. Interestingly, the patient was comor-bid with the attention deficit hyperactivity disorder. Prior to the initial visit to us, adenotonsillectomy had been done at the age of 4 with no significant improvement of apneic symptoms and heavy snoring. On the initial diagnostic procedures, marked degree of snoring was audible even in the daytime wake state and the patient was observed to be very hyperactive. Increased pulmonary vascularity with borderline cardiomegaly was noted on chest X-ray. The baseline polysomnography revealed that the patient was very sleep-apneic and snored very heavily, with the respiratory disturbance index(RDI) of 46.9 per hour of sleep, the mean SaO2 of 78.8%, and the lowest SaO2 of 40.0%(the lowest detectable oxygen level by the applied oxymeter). The second night polysomnography was done for CPAP titration and the optimal pressure turned out to be . The applied CPAP treatment was well tolerated by the patient and was found to be very effective in alleviating heavy snoring and severe repetitive sleep apneas. After 18 months of the CPAP treatment, the patient was followed up with nocturnal polysomnography(baseline and CPAP nights) and clinical examination. Sleep apneas were still present without CPAP on the baseline night. However, the severity of OSAS was significantly decreased(RDI of 15.7, mean SaO2 of 96.2%, and the lowest SaO2 of 83.0%), compared to the initial polysomnographic findings before initiation of long-term CPAP treatment. Wechsler intelligence tests done before and after the CPAP treatment were compared with each other and surprising improvement of intelligence(total 9 points, performance 16 points) was noted. Clinically he was found to be markedly improved in his attention deficit hyperactive behavior after CPAP treatment, but with minimal change of TOVA(test of variables of attention) scores except conversion of reaction time score into normal range. On the chest X-ray taken after 18 months of CPAP application, the initial cardiopulmonary abnormalities were not found at all. We found that the CPAP treatment in a young child is very effective, safe, and well-tolerated and also improves the co-morbid attention deficit hyperactive symptoms. Overall, the growth and development of the child has been facilitated with the long-term use of CPAP. Cardiovascular complications induced by OSAS have been also normalized with CPAP treatment. We suggest that early diagnosis and active treatment intervention of OSAS in children are crucial in preventing and ameliorating possible serious complications caused by repetitive sleep apneas and consequent hypoxic damage during sleep.

키워드

소아기 폐쇄성 수면무호흡증, 주의력 결핍, 과잉운동장애, 지속적 상기도 양압, 수면 다원검사, 지능, 성장 및 발달,

Childhood obstructive sleep apnea syndrome, Attention deficit hyperactivity disorder, Continuous positive airway pressure treatment, Polysomnography, Intelligence, Growth and development

KMID : 0389519960030010085

원문 및 링크아웃 정보

등재저널 정보

주제코드

주제명(Target field)

연구대상(Population)

연구참여(Sample size)

대상성별(Gender)

질병특성(Condition Category)

연구환경(Setting)

연구설계(Study Design)

연구기간(Period)

중재방법(Intervention Type)

중재명칭(Intervention Name)

키워드(Keyword)

유효성결과(Recomendation)

The applied CPAP treatment was found to be very effective in alleviating heavy snoring and severe repetitive sleep apneas. ; Cardiovascular complications induced by OSAS have been also normalized with CPAP treatment.

연구비지원(Fund Source)

근거수준평가(Evidence Hierarchy)

출판년도(Year)

참여저자수(Authors)

대표저자

DOI

KCD코드

ICD 03

건강보험코드