SÃndrome de apnea del sueño central en una lactante sin antecedente de prematuridad: ¿cuál es el manejo?
Central sleep apnea syndrome in not premature infant. How should it be treated?
1Servicio de PediatrÃa. Hospital Universitario Fundación Jiménez DÃaz. Madrid. 2Servicio de PediatrÃa. Hospital General de Villalba. Madrid. 3Servicio de NeumologÃa. Hospital Universitario Fundación Jiménez DÃaz. Madrid. 4Unidad Multidisciplinar del Sueño. Hospital Universitario Fundación Jiménez DÃaz. Madrid
Abstract
Clinical case: A one-month-old infant presented to our department with sleep apnea since birth and no other significant past history. Physical examination was normal. A polysomnography was carried out, confirming the diagnosis of severe central SAS. Predisposing pathologies were ruled out following an ultrasound scan of the brain, an echocardiogram, blood testing, and metabolic studies. Treatment with caffeine was initiated, well-tolerated by the patient, causing the symptoms to disappear. A second polysomnography evidenced improvement. Subsequently, caffeine dose levels were reduced until complete discontinuation. A third sleep study was performed, with no evidence of SAS. The patient has been asymptomatic since then.
Discussion and conclusions: Central SAS must be considered as a possibility in children, especially among newborns and infants younger than 3 months of age. Prognosis is usually favorable, as it tends to resolve spontaneously, except when associated with severe pathology. Diagnosis is reached using a polysomnogram, and most patients require no treatment unless they have a severe form of SAS or clinical repercussions. It may be treated with caffeine, acetazolamide or oxygen, with noninvasive ventilation reserved for refractory cases.
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