{"id":1253,"date":"2025-06-25T11:57:18","date_gmt":"2025-06-25T09:57:18","guid":{"rendered":"https:\/\/recette.sfmds-sommeil.org\/?p=1253"},"modified":"2025-06-25T15:36:18","modified_gmt":"2025-06-25T13:36:18","slug":"le-syndrome-dapnees-obstructives-du-sommeil-saos-de-ladolescent-attitude-therapeutique","status":"publish","type":"post","link":"https:\/\/sfmds-sommeil.org\/?p=1253","title":{"rendered":"Michel-Christian Ouayoun – Le syndrome d\u2019apn\u00e9es obstructives du sommeil (SAOS) de l\u2019adolescent : attitude th\u00e9rapeutique"},"content":{"rendered":"\t\t
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Revue de la litt\u00e9rature\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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par Michel-Christian Ouayoun<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Revue d\u2019Orthop\u00e9die Dento-Faciale 2017;51:1-9<\/strong> https:\/\/odf.edpsciences.org\/articles\/odf\/abs\/2017\/04\/contents\/contents.html<\/a><\/span><\/p>

Le syndrome d\u2019apn\u00e9es obstructives du sommeil (SAOS) de l\u2019adolescent : attitude th\u00e9rapeutique<\/strong><\/p>

A. Amaddeo1,2,3, L Griffon1, B. Thierry4, V. Couloigner4, A. Joly5, E. Galliani5, E. Arnaud6, S. Khirani1,7, B. Fauroux1,2,3<\/p>

1 Unit\u00e9 de ventilation noninvasive et du sommeil de l\u2019enfant, H\u00f4pital universitaire Necker-Enfants Malades, Assistance Publique \u2013 H\u00f4pitaux de Paris<\/p>

2 Universit\u00e9 Paris Descartes<\/p>

3 INSERM U955, Equipe 13, Cr\u00e9teil<\/p>

4 Service de chirurgie ORL p\u00e9diatrique, H\u00f4pital universitaire Necker-Enfants Malades, Assistance Publique \u2013 H\u00f4pitaux de Paris<\/p>

5 Service de chirurgie plastique et maxillofaciale p\u00e9diatrique, H\u00f4pital universitaire Necker-Enfants Malades, Assistance Publique \u2013 H\u00f4pitaux de Paris<\/p>

6 Service de neurochirurgie p\u00e9diatrique, H\u00f4pital universitaire Necker-Enfants Malades, Assistance Publique \u2013 H\u00f4pitaux de Paris<\/p>

7 ASV Sant\u00e9, Gennevilliers<\/p>

Cet article \u00e9crit par une \u00e9quipe exp\u00e9riment\u00e9e propose une strat\u00e9gie th\u00e9rapeutique de qualit\u00e9 pour le SAOS de l\u2019adolescent. Cette p\u00e9riode de la vie cruciale et vuln\u00e9rable pr\u00e9sente des caract\u00e9ristiques sp\u00e9cifiques et n\u00e9cessite une attitude th\u00e9rapeutique adapt\u00e9e aux comportements des jeunes, \u00e0 leur transformation physique et psychique et leur scolarit\u00e9.<\/p>

Les auteurs rappellent l\u2019importance du surpoids ou de l\u2019ob\u00e9sit\u00e9 dans la constitution du SAOS de l\u2019adolescent. Si les \u00e9tudes sur le b\u00e9n\u00e9fice de la perte de poids sur le SAOS de l\u2019adolescent sont peu nombreuses, le contr\u00f4le du poids doit \u00eatre une priorit\u00e9 chez tout adolescent, quelle que soit la prise en charge ult\u00e9rieure. La chirurgie bariatrique peut \u00e9galement \u00eatre propos\u00e9e m\u00eame \u00e0 cet \u00e2ge.<\/p>

La chirurgie ORL repose comme chez l\u2019enfant sur l\u2019ad\u00e9no-amygdalectomie (AA). Elle reste le traitement de r\u00e9f\u00e9rence en cas d\u2019hypertrophie ad\u00e9no\u00efdienne et amygdalienne chez l\u2019adolescent ob\u00e8se ou non, surtout si le SAOS est s\u00e9v\u00e8re. Les auteurs en profitent pour rappeler les diff\u00e9rentes techniques d\u2019amygdalectomie palatine (totale ou partielle), et que le risque accru de complications contre-indique la chirurgie ambulatoire chez l\u2019adolescent ob\u00e8se. L\u2019AA est souvent associ\u00e9e \u00e0 une prise de poids post-op\u00e9ratoire. Encore une fois, les auteurs soulignent l\u2019importance de la prise en charge hygi\u00e9no-di\u00e9t\u00e9tiques per- et post-op\u00e9ratoires. La turbinoplastie inf\u00e9rieure et l\u2019amygdalectomie linguale sont rarement indiqu\u00e9es chez l\u2019adolescent.<\/p>

Le traitement m\u00e9dical anti-inflammatoire, la prise en charge par l\u2019orthop\u00e9die dento-faciale, la ventilation non invasive (VNI) ou par pression positive continue (PPC) et les autres traitements chirurgicaux tels que la distraction mandibulaire ou maxillaire, la chirurgie orthognathique ou l\u2019avancement frontofaciale sont regroup\u00e9s sous la banni\u00e8re des autres traitements.<\/p>

Le traitement anti-inflammatoire \u00e0 vis\u00e9e ORL repose sur les cortico\u00efdes locaux et\/ou le Mont\u00e9lukast peut \u00eatre utilis\u00e9 dans le SAOS l\u00e9ger \u00e0 mod\u00e9r\u00e9.<\/p>

L\u2019orthop\u00e9die dento-faciale repose sur la disjonction maxillaire rapide et la propulsion mandibulaire. Les auteurs rapportent que la disjonction maxillaire rapide a montr\u00e9 son efficacit\u00e9 sur l\u2019index d\u2019apn\u00e9es-hypopn\u00e9es avec persistance d\u2019un b\u00e9n\u00e9fice jusqu\u2019\u00e0 l\u2019\u00e2ge adulte. Les auteurs \u00e9galement rapprochent de ses traitements la r\u00e9\u00e9ducation myofonctionnelle de la langue.<\/p>

La VNI ou la PPC s\u2019adresse pour les auteurs prioritairement aux adolescents ayant un SAOS associ\u00e9 \u00e0 des malformations des voies a\u00e9riennes sup\u00e9rieures comme les craniofaciost\u00e9noses, des syndromes de Pierre Robin, de Treacher Collins etc. ou des ob\u00e9sit\u00e9s syndromiques comme le syndrome de Prader Willi. Cette ventilation pour l\u2019adolescent n\u00e9cessite la prise en charge par un centre multidisciplinaire p\u00e9diatrique sp\u00e9cialis\u00e9, un r\u00e9glage de la pression en laboratoire de sommeil et un prestataire \u00e0 domicile form\u00e9 \u00e0 la p\u00e9diatrie. L\u2019adh\u00e9sion au traitement par l\u2019adolescent est \u00e0 ce prix.<\/p>

En conclusion, un suivi \u00e0 long terme avec des explorations du sommeil s\u2019impose pour v\u00e9rifier la correction du SAOS et \u00e9viter toutes cons\u00e9quences d\u00e9l\u00e9t\u00e8res d\u2019un SAOS persistant \u00e0 l\u2019\u00e2ge adulte.<\/p>

Bibliographie <\/strong>:<\/p>

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    Revue de la litt\u00e9rature par Michel-Christian Ouayoun Revue d\u2019Orthop\u00e9die Dento-Faciale 2017;51:1-9 https:\/\/odf.edpsciences.org\/articles\/odf\/abs\/2017\/04\/contents\/contents.html Le syndrome d\u2019apn\u00e9es obstructives du sommeil (SAOS) de l\u2019adolescent : attitude th\u00e9rapeutique A. Amaddeo1,2,3, L Griffon1, B. Thierry4, […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16],"tags":[],"class_list":["post-1253","post","type-post","status-publish","format-standard","hentry","category-revue-litteraire"],"yoast_head":"\nMichel-Christian Ouayoun - Le syndrome d\u2019apn\u00e9es obstructives du sommeil (SAOS) de l\u2019adolescent : attitude th\u00e9rapeutique - SFMDS Soci\u00e9t\u00e9 Fran\u00e7aise de M\u00e9decine du Sommeil<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/sfmds-sommeil.org\/?p=1253\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Michel-Christian Ouayoun - Le syndrome d\u2019apn\u00e9es obstructives du sommeil (SAOS) de l\u2019adolescent : attitude th\u00e9rapeutique - SFMDS Soci\u00e9t\u00e9 Fran\u00e7aise de M\u00e9decine du Sommeil\" \/>\n<meta property=\"og:description\" content=\"Revue de la litt\u00e9rature par Michel-Christian Ouayoun Revue d\u2019Orthop\u00e9die Dento-Faciale 2017;51:1-9 https:\/\/odf.edpsciences.org\/articles\/odf\/abs\/2017\/04\/contents\/contents.html Le syndrome d\u2019apn\u00e9es obstructives du sommeil (SAOS) de l\u2019adolescent : attitude th\u00e9rapeutique A. 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