V Manual IAPO ingles FIM.indd

as a disease characterized by airway obstruction, with alteration of the alveolar ventilation and sleep fragmentation. This syndrome has nocturnal symptoms such as: snoring, neck hyperextension, restless sleep, apneas or pauses in the breathing pattern, apnea-related thoracic respiratory movements, sweating, frequent awakenings, secondary enuresis. Typical daytime manifestations such as: irritability/hyperactivity, somnolence/ tiredness, poor school performance, morning headaches, morning halitosis, poor appetite. This symptomatology generates alterations in the maxillofacial growth such as: adenoid facies, midface hypoplasia, palatine and dental occlusal alteration, retrognathia, pectus excavatum and nutritional alterations. This syndrome affects from 1 to 3 % of children, with a prevalence peak in children between 2 and 8 years of age 1. It is important to point out that there are marked differences in the presentation of this disease between children and adults. Mouth breathing, snoring, episodes of obstructive apnea, special thoracic movement, fragmented and restless sleep, sweating and often also enuresis are characteristic nocturnal signs of this syndrome. Characteristic daytime manifestations are permanent mouth breathing, nasal voice, appetite and eating disorders, an altered behavior with hypersomnia or aggressiveness, and attention defi cit with poor school performance. There are predisposing factors and conditions such as Craniofacial Malformation Syndrome, Neuromuscular Diseases and other Central Nervous System Diseases. Environmental and irritating factors, such as smoke in the case of the passive smoker child, allergens and gastroesophageal reflux constitute other predisposing factors. However, the predisposing conditions that should be here emphasized are the genetic factors. Obstructive Sleep Apnea Syndrome can be considered a familial disease, i. e. a disease presented by two or more members of a family group. Thus defi ned, OSAS is a familial disease in 65% of the cases. Obesity, the craniofacial morphology and ventilatory control of breathing 2 are directly related to it. In 25% of obesity cases, a predisposing factor in this disease, there is a direct infl uence of heredity in the variability of obesity subtypes. Moreover, genetic factors take part in 70% of the different obesity variants 3. The obesity predisposition to Obstructive Sleep Apnea Syndrome has two Morphogenetic Factors: Obesity and Ventilatory Control in Obstructive Sleep Apnea Syndrome (OSAS)