我曾经写博文建议“睡眠时常打呼噜的成人和儿童接受睡眠呼吸监测，以明确其是否患睡眠呼吸暂停综合征，及是否需要接受进一步的治疗等？”日前，美国儿科医生协会发布了新一代防治指南正式明确地要求“广大儿科医师在接诊儿童患者时，宜主动询问他或她在睡眠时是否打呼噜？如是，则应建议他或她接受睡眠呼吸监测，以明确其是否患有睡眠呼吸暂停综合征？”

为何专业人士如此强调给睡眠过程中打呼噜者进行睡眠监测？其原因是“睡眠过程中频繁打呼噜者常伴有睡眠过程中的呼吸暂停，即睡眠呼吸暂停综合征。”睡眠呼吸暂停综合征的患者，因为在睡眠过程中常反复出现呼吸暂停，故可影响大脑和心脏等重要器官的供血供氧，进而影响睡眠质量、生长发育与智力，甚至可诱发猝死。因此，排查睡眠呼吸暂停综合征具有非常重要的临床意义。

请各位家长留意您的孩子，特别是超重或肥胖的孩子在睡眠过程中是否呼噜声不断而需要看医生啊！

Snoring Kids Should Be Screened for Sleep Apnea: Experts

New guidelines issued by American Academy of Pediatrics also urge weight loss for obese snorers

TUESDAY, Aug. 28 (HealthDay News) -- Kids who snore should be evaluated for sleep apnea. That's the main recommendation that comes from a set of updated guidelines released by the American Academy of Pediatrics.

"The evidence is much stronger today," said Dr. Carole Marcus, a professor of pediatrics at the Children's Hospital of Philadelphia. "Pediatricians should routinely ask parents about snoring, but if they don't, parents should bring it up," she said. "Snoring in kids can be a sign of a serious medical illness."

Marcus was referring to sleep apnea, which is marked by pauses in breathing that occur throughout the night and disrupt sleep. When left untreated, sleep apnea in children can result in behavioral and learning difficulties and may also affect growth. These consequences are largely related to lack of quality sleep.

Researchers led by Marcus reviewed studies on diagnosis and management of sleep apnea in kids published between 1999 and 2011, most of them appearing after the last set of guidelines were released in 2002. The new guidelines are published in the September issue of Pediatrics.

If a child snores, pediatricians need to follow-up with a thorough history and exam, she noted. "If this all points to sleep apnea, then get a sleep study," Marcus said. The gold standard for diagnosing sleep apnea is a formal sleep study, but this is not always possible for young children because it involves sleeping in a laboratory environment away from home. Other options may include a home sleep study where children are hooked up to a monitor in the comfort of their regular bedroom, or asking parents to videotape the child during what they believe may be an apnea episode.

Many children with sleep apnea have enlarged tonsils and adenoids. In these kids, removing tonsils and adenoids may cure the sleep apnea. Other treatments include positive airway pressure (PAP) machines to help keep the airways open during sleep. Some medications may also help treat sleep apnea.

Dr. Michael Rothschild, the director of pediatric otolaryngology at Mount Sinai Medical Center in New York City, agreed that kids who snore should be screened for sleep apnea. "If the child snores, but has small tonsils and I get a good history from parents, and they show no signs of struggling when I watch a video of them at night, I feel comfortable that this is just uncomplicated snoring," he said. "Not every kid who snores needs surgery."

And surgery alone doesn't cure every kid with sleep apnea, Rothschild added. Obesity is on the rise among kids, and is linked to sleep apnea. "There are obese kids with small tonsils and thin kids with big tonsils," he said. In obese children, weight loss is also part of the treatment plan as surgery alone may not resolve the sleep apnea entirely.

The guidelines recommend weight loss in obese or overweight children who snore, in addition to other therapy.

SOURCES: Michael Rothschild, M.D., director, pediatric otolaryngology, Mount Sinai Medical Center, New York City; Carole L. Marcus, MBBCh, professor of pediatrics, Children's Hospital of Philadelphia; September 2012, Pediatrics

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