A patient, named V.S.G, male, 3-years-old, residing in a social assistance institution since 2 years of age, with no previous data. Complaint of high intensity snoring and night agitation since the time of arrival at the institution. An otorhinolaryngological physical examination was performed with findings suggestive of allergic rhinopathy. There were no noticeable alteration on the nasal videoendoscopy. Treatment for allergic rhinitis was instituted, using nasal corticosteroids, oral antihistamines, and oral antileukotriene for three months. The patient followed-up, reporting a significant decrease in snoring and night agitation.
Two years later, as a newly adopted child, his parents with the same prior complaint brought him. The patient was reevaluated and no changes were observed when compared to previous examinations. Similarly, he underwent treatment for allergic rhinitis. After 2 months, there was a significant decrease in snoring and night agitation, however, he persisted with groaning episodes, despite the decrease in frequency when compared to the condition before to treatment. The father performed video and sound monitoring at night with a home camera and sent it to us. When evaluating the video, we observed that the child had several outbreak episodes at night apparently of expiratory groaning and, during these events he had rhythmic movement of the hip several times, before or after the outbreaks of groaning.
A polysomnography exam with extended electroencephalogram assembly and observation of sound and video was requested. The examination was performed, however, did not comply with the explicit requests in the medical order. There was no mention of the groans in the report and a slightly increased apnea/hypopnea index (IAH-1.8) was observed, without significant desaturation.
During the follow-up, we observed that the child did not have complete remission of the groans, but if he had an upper airway infection or allergic rhinitis crisis, the snores and groans increased in frequency and intensity.