Disordini comportamentali e indice di stress genitoriale nei bambini affetti da Sindrome dell’apnea ostruttiva nel sonno: confronto pre e post adenotonsillectomia.
Riassunto: Scopo del presente lavoro è valutare la relazione esistente tra le difficoltà respiratorie legate all’OSAS ed i possibili disordini neurocomportamentali correlando questi ultimi al grado di stress genitoriale. Non tutti i pazienti affetti da OSAS presentano questo tipo di problematiche tuttavia i disturbi di comportamento non sembrano essere associati con la severità del SBD; è probabile che una suscettibilità genetica associata a particolari fattori ambientali abbia un ruolo determinante nello sviluppo fenotipico di queste manifestazioni. Sono stati utilizzati due questionari: Conners’ Rating Scale Revised; Parenting Stress Index. Sono stati arruolati nello studio pazienti con OSAS di grado moderato-severo, con Mc Gill score 3 o 4 in cui non fossero presenti criteri di esclusione, la valutazione dei genitori è stata effettuata durante il ricovero e 6 mesi dopo l’intervento di adenotonsillectomia. I risultati ottenuti hanno dimostrato che risolvendo l’OSAS si ottengono miglioramenti nelle competenze e nel comportamento dei pazienti ed inoltre si riducono le difficoltà genitoriali. L’identificazione di tali indicatori può rappresentare un supporto all’indicazione chirurgica anche in casi di DRS non severo.
Keywords: Conner’s rating scale revised (CRS-R); McGill score; excessive daily drowsiness; obstructive sleep apnea syndrome (OSAS); parental stress; parenting stress index.
The primary goal of the present study was to compare breathing difficulties resulting from OSAS to possible cognitive-behavioural problems of the child linked to their parents’ emotional-relational aspects. There is strong evidence that sleep breathing disorders are associated with behavioural alterations, a tendency towards aggressiveness, weak school performance and a clear disorder in continuous and selective attention other than vigilance status. Not all patients suffering from OSA have cognitive and/or behavioural manifestations; furthermore, the degree of dysfunction that the patient may present does not seem to be associated with the seriousness of sleep breathing disorder (SBD). It is therefore likely that genetic susceptibility associated with particular environmental factors has a role in determining phenotypic manifestations which are unique for every single patient. Questionnaires were given to parents, one regarding executive functions and one regarding parental stress: Conners’ Rating Scale Revised; Parenting Stress Index. All parents of children who suffer from moderate to severe OSA, with a McGill score of 3 to 4 and with no exclusion criteria are included in the study; behavioural and parental stress evaluation was made during hospitalisation and at 6 months after adenotonsillectomy. The results show that resolving OSAS led to important improvements in the competence and behavioural attitudes of the patient, as well as in relational and management difficulties by parents. The identification of such indicators could represent a support to surgical programming, even in non-severe SBD. Future research will have the goal of identifying standardised risk indicators that can provide further indications for surgical treatment in children up to 5 years of age.