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Síndrome de apneia obstrutiva do sono e síndrome metabólica em idade pediátrica : entidades relacionadas?
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A Síndrome de Apneia Obstrutiva do Sono (SAOS) é uma perturbação da respiração durante o sono, caraterizada por eventos obstrutivos da via aérea que alteram as normais trocas gasosas e determinam despertares frequentes. É uma patologia frequente nas crianças, também associada a morbilidade cardiovascular, metabólica e neuro-cognitiva.
A Síndrome Metabólica (SMet) é uma entidade clínica constituída pela coocorrência de obesidade central, resistência insulínica, hipertensão arterial e dislipidémia, associando-se a um aumento da morbilidade cardiovascular. Na idade pediátrica, a sua prevalência tem vindo a aumentar expressivamente em consequência do aumento da obesidade.
Existe evidência crescente que a SAOS está implicada no desenvolvimento de insulinorresistência, dislipidémia, obesidade e hipertensão arterial, particularmente em adolescentes e crianças obesas; em crianças pré-púberes, é a obesidade quem parece ser determinante na eclosão da SMet. No fundo, a SAOS parece, de forma independente ou sinérgica, contribuir para o aumento da morbilidade cardiovascular e metabólica em crianças, principalmente na presença de obesidade ou de maior severidade da patologia.
Crê-se que os mecanismos fisiopatológicos envolvidos na associação SAOS – SMet sejam a hipoxemia intermitente, hiperatividade simpática, stress oxidativo e um estado inflamatório sustentado.
Na ausência de conhecimento de mecanismos fisiopatológicos específicos e de uma relação causal SAOS – SMet bem estabelecida, são necessários mais estudos populacionais, de grandes dimensões.
Obstructive Sleep Apnea Syndrome (OSAS) is a disorder of breathing during sleep, characterized by upper-airway obstructive events that disrupt normal ventilation during sleep and determine frequent awakenings. It is a common disorder in the pediatric age and is associated with cardiovascular, metabolic and neuro-cognitive morbidity. Metabolic Syndrome (MetS) is a clinical entity in which central obesity, insulin resistance, hypertension and dyslipidemia co-occur, and is associated with increased cardiovascular morbidity. Its prevalence has been increasing in the pediatric age as a result of an obesity increase. There is increasing evidence that OSAS is implicated in the development of insulin resistance, dyslipidemia, obesity and hypertension, particularly in adolescents and obese children; in prepubertal children it is obesity who seems to be decisive in the outbreak of MetS. Basically, OSA seems to, independently or synergistically, contribute to increased cardiovascular and metabolic morbidity in children, especially in the presence of obesity or increased severity of the disease. It is believed that the pathophysiological mechanisms involved in the association OSAS – MetS are intermittent hypoxemia, sympathetic hyperactivity, oxidative stress and a sustained inflammatory state. In the absence of knowledge of specific pathophysiological mechanisms and a wellestablished causal relationship between OSAS – MetS, there is a need for more population-based studies, with larger samples.
Obstructive Sleep Apnea Syndrome (OSAS) is a disorder of breathing during sleep, characterized by upper-airway obstructive events that disrupt normal ventilation during sleep and determine frequent awakenings. It is a common disorder in the pediatric age and is associated with cardiovascular, metabolic and neuro-cognitive morbidity. Metabolic Syndrome (MetS) is a clinical entity in which central obesity, insulin resistance, hypertension and dyslipidemia co-occur, and is associated with increased cardiovascular morbidity. Its prevalence has been increasing in the pediatric age as a result of an obesity increase. There is increasing evidence that OSAS is implicated in the development of insulin resistance, dyslipidemia, obesity and hypertension, particularly in adolescents and obese children; in prepubertal children it is obesity who seems to be decisive in the outbreak of MetS. Basically, OSA seems to, independently or synergistically, contribute to increased cardiovascular and metabolic morbidity in children, especially in the presence of obesity or increased severity of the disease. It is believed that the pathophysiological mechanisms involved in the association OSAS – MetS are intermittent hypoxemia, sympathetic hyperactivity, oxidative stress and a sustained inflammatory state. In the absence of knowledge of specific pathophysiological mechanisms and a wellestablished causal relationship between OSAS – MetS, there is a need for more population-based studies, with larger samples.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Síndrome de apneia obstrutiva do sono Síndrome metabólica Resistência à insulina Obesidade Crianças Mecanismos fisiopatológicos