Linguagem em crianças com apneia obstrutiva do sono
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Data
2019-03-15
Autores
Corrêa, Camila de Castro
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Universidade Estadual Paulista (Unesp)
Resumo
INTRODUÇÃO A Apneia Obstrutiva do Sono (AOS) na população pediátrica pode gerar consequências devido à hipoxemia intermitente, hipercapnia transitória e despertares frequentes. Como exemplo estão as repercussões cardiovasculares, alteração no crescimento pôndero-estatural, redução da atenção, da capacidade da memória, impacto na aprendizagem e na qualidade de vida. Ainda a literatura é escassa no que se refere à investigação da linguagem oral nas crianças com AOS. OBJETIVO Analisar as habilidades de linguagem oral receptiva e expressiva em crianças com Apneia Obstrutiva do Sono (AOS). MÉTODOS A presente tese foi desenvolvida em três fases, sendo cada uma composta por métodos específicos, contidos nos artigos apresentados no decorrer deste documento. 1ª fase – Investigação da literatura: correspondeu ao levantamento da literatura para se investigar os estudos já realizados sobre a linguagem oral em crianças com AOS, analisando esta possível relação, os protocolos de linguagem oral utilizados e os protocolos de qualidade de vida mais aplicados para a população brasileira. 2ª fase – Investigação Clínica: foi referente à avaliação clínica de 52 crianças com e sem queixas respiratórias, de 4 a 11 anos, aplicando protocolos para a investigação da: orelha média, linguagem oral expressiva (fonologia, sintaxe, semântica expressiva e pragmática) e receptiva (compreensão de instruções e semântica receptiva) e aspectos da motricidade orofacial. 3ª fase – Análise pelo Sleep Clinical Record: análise da amostra pelo protocolo Sleep Clinical Record. RESULTADOS 1ª fase – Investigação da literatura: Na literatura, foi possível averiguar poucos estudos investigando a linguagem oral em crianças com AOS, indicando possíveis alterações em alguns níveis de linguagem. Os estudos demonstraram investigações pontuais, sem considerar todos os níveis da linguagem oral, por meio de diferentes protocolos, dificultando comparações. Os protocolos mais usados no Brasil para investigar a qualidade de vida, foram o questionário OSA18 e o OSD-6. 2ª fase – Investigação Clínica: Em relação à avaliação de orelha média prévia à cirurgia de adenotonsilectomia, foi observada elevada ocorrência de alterações na timpanometria. Quanto aos hábitos orais deletérios foi verificada maior ocorrência e persistência do histórico de uso de chupeta e mamadeira no grupo com AOS, além da correlação do uso e da persistência do hábito de mamadeira com a gravidade da AOS. Avaliando-se a função respiratória, observou-se que o grupo AOS apresentou a permeabilidade nasal diminuída em relação às crianças sem AOS. A avaliação de linguagem expressou pior desempenho para o Grupo AOS 8 no que se refere à fonologia, sintaxe, semântica expressiva e receptiva, com significância para o nível fonológico. Ainda vale ressaltar que houve alta ocorrência de alteração de linguagem em pelo menos um nível comunicativo considerando os dois grupos estudados. 3ª fase – Análise pelo Sleep Clinical Record: Na extensão da tese, em parceria com a Sapienza Università di Roma, foi verificado que as crianças brasileiras com AOS apresentam escore SCR maior quando comparadas com crianças italianas. Além disso, quando se considerou a avaliação miofuncional orofacial em adição ao SCR, aumentou a sensibilidade e especificidade deste protocolo para se identificar crianças com risco para AOS. CONCLUSÃO Neste estudo pioneiro, verificou-se a possibilidade de alteração da linguagem oral em crianças com AOS, além de apontar grande defasagem no desempenho da linguagem nas crianças em geral. O presente estudo possibilitou integrar não apenas a atuação conjunta de diferentes profissões, mas também investigou a comunicação da criança com AOS de uma forma ampla, considerando os níveis da linguagem, bem como as condições auditivas e das musculaturas e funções orofaciais.
INTRODUCTION Obstructive Sleep Apnea (OSA) in the pediatric population could cause consequences due to intermittent hypoxemia, transient hypercapnia, and frequent arousals. As an example are the cardiovascular repercussions, alteration in growth, reduced attention, memory capacity, impact on learning and quality of life. The literature is scarce regarding the investigation of oral language in children with OSA. AIM To analyze receptive and expressive oral language in children with Obstructive Sleep Apnea (OSA). METHODS The present thesis was developed in three stages, each being composed of specific methods, contained in articles presented throughout this document. 1 st stage - Literature Investigation: The review of the literature investigated publications of studies related to oral language disorders in children with OSA, focusing on the possible relationship of OSA and language disorders, on which oral language protocols were used and on which were the most frequently applied protocols of quality of life in the Brazilian population. 2 nd stage - Clinical Investigation: 52 children, both genders, with and without respiratory complaints, aged from 4 to 11 years, were submitted to the clinical evaluation applying protocols for the investigation of: hearing, expressive oral language (phonology, syntax, expressive semantics and pragmatic) and receptive language (instruction comprehension and receptive semantics) and aspects of orofacial myology. 3 rd phase - Analysis by the Sleep Clinical Record: The study sample of 52 children were submitted to a screening for OSA by the Sleep Clinical Record protocol. RESULTS 1 st stage - Literature Investigation: The review of the literature found only few studies which investigated oral language in children, indicating possible disorders in some language levels. The studies mostly performed timely investigations, not considering all levels of oral language, applying different protocols, what made a comparison difficult. The most used protocols in Brazil to investigate quality of life were the OSA-18 and OSD-6 questionnaires. 2 nd stage - Clinical Investigation: The evaluation of the middle ear showed a high frequency of tympanometric alterations. Regarding deleterious oral habits, there was a greater occurrence and persistence of the history of pacifier and bottle use in the OSA group, the use and persistence of the bottle use showed a positive correlation to the OSA severity When evaluation of the respiratory functions, the OSA group presented decreased nasal permeability in relation to the children without OSA. The language evaluation expressed a worse performance for the OSA Group regarding phonology, syntax, expressive and receptive semantics, being significant for the phonological level. It is worth mentioning that there was a 10 high occurrence of language alteration in at least one communicative level ofboth groups 3 rd phase - Analysis by the Sleep Clinical Record: In partnership with Sapienza Università di Roma, the sleep clinical record questionnaire was applied to the OSA children and it was verified that the Brazilian OSA children presented a higher SCR score when compared to Italian children. In addition, the orofacial myofunctional evaluation associated tothe SCR increased the sensitivity and specificity of this protocol to identify children at risk for OSA. CONCLUSION In this pioneer study, the possibility of oral language alteration in children with OSA was verified, besides pointing out a large gap in language performance in children in general. The present study allowed to integrate not only the joint performance of different professions, but also investigated the communication of the child with OSA in a broad way, considering the different language levels as well as the auditory and orofacial muscles and functions.
INTRODUCTION Obstructive Sleep Apnea (OSA) in the pediatric population could cause consequences due to intermittent hypoxemia, transient hypercapnia, and frequent arousals. As an example are the cardiovascular repercussions, alteration in growth, reduced attention, memory capacity, impact on learning and quality of life. The literature is scarce regarding the investigation of oral language in children with OSA. AIM To analyze receptive and expressive oral language in children with Obstructive Sleep Apnea (OSA). METHODS The present thesis was developed in three stages, each being composed of specific methods, contained in articles presented throughout this document. 1 st stage - Literature Investigation: The review of the literature investigated publications of studies related to oral language disorders in children with OSA, focusing on the possible relationship of OSA and language disorders, on which oral language protocols were used and on which were the most frequently applied protocols of quality of life in the Brazilian population. 2 nd stage - Clinical Investigation: 52 children, both genders, with and without respiratory complaints, aged from 4 to 11 years, were submitted to the clinical evaluation applying protocols for the investigation of: hearing, expressive oral language (phonology, syntax, expressive semantics and pragmatic) and receptive language (instruction comprehension and receptive semantics) and aspects of orofacial myology. 3 rd phase - Analysis by the Sleep Clinical Record: The study sample of 52 children were submitted to a screening for OSA by the Sleep Clinical Record protocol. RESULTS 1 st stage - Literature Investigation: The review of the literature found only few studies which investigated oral language in children, indicating possible disorders in some language levels. The studies mostly performed timely investigations, not considering all levels of oral language, applying different protocols, what made a comparison difficult. The most used protocols in Brazil to investigate quality of life were the OSA-18 and OSD-6 questionnaires. 2 nd stage - Clinical Investigation: The evaluation of the middle ear showed a high frequency of tympanometric alterations. Regarding deleterious oral habits, there was a greater occurrence and persistence of the history of pacifier and bottle use in the OSA group, the use and persistence of the bottle use showed a positive correlation to the OSA severity When evaluation of the respiratory functions, the OSA group presented decreased nasal permeability in relation to the children without OSA. The language evaluation expressed a worse performance for the OSA Group regarding phonology, syntax, expressive and receptive semantics, being significant for the phonological level. It is worth mentioning that there was a 10 high occurrence of language alteration in at least one communicative level ofboth groups 3 rd phase - Analysis by the Sleep Clinical Record: In partnership with Sapienza Università di Roma, the sleep clinical record questionnaire was applied to the OSA children and it was verified that the Brazilian OSA children presented a higher SCR score when compared to Italian children. In addition, the orofacial myofunctional evaluation associated tothe SCR increased the sensitivity and specificity of this protocol to identify children at risk for OSA. CONCLUSION In this pioneer study, the possibility of oral language alteration in children with OSA was verified, besides pointing out a large gap in language performance in children in general. The present study allowed to integrate not only the joint performance of different professions, but also investigated the communication of the child with OSA in a broad way, considering the different language levels as well as the auditory and orofacial muscles and functions.
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Palavras-chave
Síndromes da Apneia do Sono, Sono, Fonoaudiologia, Linguagem, Criança, Sleep Apnea Syndromes, Sleep, Speech, Language and Hearing Sciences, Language, Child