Upper airways obstruction and cerebrovascular accident in children with sickle cell anemia

The Lancet (Impact Factor: 45.22). 08/1989; 2(8657):283-4. DOI: 10.1016/S0140-6736(89)90477-7
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    • "A subsequent study by the same group showed that the mean overnight oxygen saturation correlated directly with the severity of intracranial vasculopathy, as determined by flow turbulence on MRA (Kirkham et al, 2001b). These findings are supported by previous reports of an association between obstructive sleep apnea and stroke in SCD (Robertson et al, 1988; Davies et al, 1989; Wali et al, 2000). Adenotonsillectomy has also been shown to reduce the risk of stroke in children with documented obstructive sleep apnea (Wali et al, 2000). "
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    ABSTRACT: Sickle cell anaemia (SCA) is the most common cause of childhood stroke, occurring with the highest frequency before the age of 6 years. Despite the relative frequency of stroke in SCA, few predictors of risk exist. Anaemia, leucocytosis, hypertension, silent infarction, and history of acute chest syndrome are well-documented risk factors for ischaemic stroke in SCA. Recent data suggest that other environmental and genetic factors, many unrelated to SCA, influence the development of cerebrovascular disease. Non-invasive assessment of individual stroke risk using transcranial Doppler ultrasonography has provided a means of selecting and prophylactically treating SCA children at highest risk. With the ultimate goal of preventing stroke, the information gained from the studies reviewed here may lead to improved prediction of stroke so that clinical trials to assess risk-based therapy may be carried out on selected children with SCA.
    British Journal of Haematology 04/2005; 128(6):751-66. DOI:10.1111/j.1365-2141.2004.05310.x · 4.71 Impact Factor
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    ABSTRACT: 61 snoring children selected for adenotonsillectomy, mainly for recurrent tonsillitis, were compared with a matched group of 31 healthy children for symptoms of sleep apnoea, extent of sleep hypoxaemia, and amount of sleep disturbance. The studies were repeated six months postoperatively, and after six months in the healthy children. Preoperatively, 61% of the children had degrees of sleep hypoxaemia above normal and 65% had abnormally disturbed sleep. A questionnaire administered to the parents about their children showed abnormal patterns of answers about sleep problems daytime sleepiness, hyperactivity, aggression, learning difficulties, restless sleep, and odd sleeping positions. After adenotonsillectomy, the abnormal hypoxaemia, excessive sleep disturbance, and multiple symptoms almost resolved; a growth spurt also occurred.
    The Lancet 03/1990; 335(8684):249-53. DOI:10.1016/0140-6736(90)90068-G · 45.22 Impact Factor
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    ABSTRACT: Sickle cell disease (SCD) and thalassaemia major are the most important syndromes of the haemoglobinopathies. Complications of SCD can be life threatening and include stroke, hyposplenism and vaso-occlusive crises. Treatment of SCD is generally supportive or by transfusion, hydroxyurea or bone marrow transplant (BMT). β Thalassaemia major is treated with transfusion and chelation for the resulting iron overload which is the cause of most morbidity, with BMT the only curative procedure.
    Baillière s Clinical Haematology 05/1991; 4(2):361-89. DOI:10.1054/cupe.2002.0301
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