Correlations between polysomnographic and lateral airway radiograph measurements in paediatric obstructive sleep apnoea (original) (raw)
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Use of tonsil size in the evaluation of obstructive sleep apnoea
Archives of Disease in Childhood, 2002
Aims: (1) To determine the extent to which tonsil size contributes to the severity of obstructive sleep apnoea (OSA) in children; and (2) to assess the use of tonsillar-pharyngeal (TP) ratio in differentiating patients with different severity of OSA. Methods: Lateral neck radiograph was performed on 35 children referred consecutively to a university paediatric chest clinic for suspected OSA secondary to tonsillar hypertrophy. The tonsil size was determined by measuring the TP ratio on the radiographs. The severity of OSA was assessed by overnight polysomnography. Results: A total of 24 boys and 11 girls (median age 6.2 years) were studied. All presented with symptoms of OSA, and tonsillar hypertrophy was detected on clinical examination. The median apnoea-hypopnoea index (AHI) was 16.93 (interquartile range: 8.41 to 28.29). The median TP ratio was 0.76 (interquartile range: 0.65 to 0.80). AHI was positively correlated with the TP ratio. The clinical tonsil size did not correlate with the AHI or the TP ratio. Using a TP ratio of 0.479, the sensitivity and specificity in predicting cases with moderate/severe OSA (AHI >10) were 95.8% and 81.8% respectively, while the positive and negative predictive values were 92.0% and 90.0% respectively. Conclusions: Results show that in a population of children with OSA, tonsillar hypertrophy as assessed by lateral neck radiograph correlates positively with the severity of obstructive sleep apnoea. The TP ratio has high sensitivity and specificity in predicting those with moderate/severe disease and this feature may be used as a clinical screening method in prioritising patients with OSA for further assessment.
Clinical Assessment of Pediatric Obstructive Sleep Apnea
PEDIATRICS, 2004
Objective. To determine whether children with a clinical assessment suggestive of obstructive sleep apnea (OSA) but with negative polysomnography (PSG) have improvement in their clinical assessment score after tonsillectomy and adenoidectomy (T&A) as compared with similar children who do not undergo surgery.
Dentomaxillofacial Radiology, 2012
In general, no consensus has been reached regarding the diagnostic criteria for obstructive sleep apnoea syndrome (OSAS) in children and the criteria for selecting treatment are inconsistent. Therefore, the craniofacial and pharyngeal airway morphology of OSAS in children who had undergone drug therapy (non-op group) and OSAS in children who had undergone both drug therapy and surgical therapy (adenotonsillectomy) (op group) were compared. The purpose of this study was to examine the effectiveness of craniofacial morphology and pharyngeal airway morphology analysis in the treatment of children with OSAS. Methods: The craniofacial and pharyngeal airway morphology of the control group, the non-op group and the op group were compared to examine the differences of each group. The comparison used Mann-Whitney's U test. Results: A comparison between the non-op and the op groups showed significant differences in the facial axis, mandibular plane angle, ramus plane to the SN (porion and orbit) point, point Pog (pogonion) to the McNamara line, anteroposterior dysplasia indicator (APDI), D-AD1 [the distance between the posterior nasal spine (PNS) point and the nearest adenoid tissue, measured along the PNS-Ba (basion) point plane], D-AD2 (the distance between the PNS point and the nearest adenoid tissue, measured along a line from the PNS point perpendicular to the S (sella turcica)-Ba point plane), upper pharynx and soft palatal length. The op group showed significantly lower values of APDI than the non-op group, indicating that the op group showed a significant occlusion of class II, and that the mandibular bone was positioned posteriorly relative to the maxillary bone. Conclusions: The op group showed a significant posterior position and backward rotation of the mandibular bone, stenosis of the nasopharyngeal airway and an elongated soft palate compared with the non-op group, and it was speculated that there was a high probability of the necessity of surgical therapy (adenotonsillectomy) when a morphological factor played a major role as a cause of obstructive sleep apnoea. We recommend craniofacial morphology analysis and pharyngeal airway morphology analysis in the diagnosis and treatment planning of OSAS children.
Objectives: Obstructive sleep apnea (OSA) is the result of pharyngeal obstruction that occurs predominantly during REM in children. Pathophysiologic mechanisms responsible for upper airway obstruction, however, are poorly understood. Thus, we sought to characterize upper airway obstruction in apneic compared to snoring children during sleep. We hypothesized that apneic compared to snoring children would exhibit an increased prevalence and severity of upper airway obstruction, that would be greater in REM compared to non-REM, and would improve following adenotonsillectomy. Study Design: Apneic children were assessed with routine polysomnography before and after adenotonsillectomy, and compared to snoring children matched for gender, age, and BMI z-score. In addition to traditional scoring metrics, the following were used to characterize upper airway obstruction: maximal inspiratory airflow (%VImax) and percent of time with inspiratory flow-limited breathing (%IFL). Results: OSA compared to snoring children had similar degrees of upper airway obstruction in non-REM; however, during REM, children with sleep apnea exhibited a higher %IFL (982% vs.738%, P<0.01) and lower %VImax (566 vs.9310%, P<0.01). In children with OSA, CO2 levels were elevated during both wake and sleep. Following adenotonsillectomy, upper airway obstruction improved during REM manifest by decreased %IFL (982 to 639%, P¼0.04), increased %VImax (566 to 955%, P¼0.01) and decreased CO2 levels. Conclusions: Differences in the prevalence and severity upper airway obstruction suggest impaired compensatory responses during REM in children with OSA, which improved following adenotonsillectomy
Pediatric sleep apnea-a simplified approach
Indian Journal of Sleep Medicine, 2015
Pediatric sleep-disordered breathing in children is a spectrum of primary snoring, upper airway resistance syndrome, obstructive hypoventilation, and obstructive sleep apnea syndrome (OSAS). The prevalence of pediatric OSAS is 1%-3%. Pediatric OSAS is most commonly caused by adenoid and tonsillar hypertrophy, which is correctable by surgery. The gold standard test for diagnosis is polysomnography (PSG). OSA in children is a distinct disorder form that occurs in adults with respect to clinical manifestations, PSG diagnostic criteria, and treatment approaches. In addition, PSG has its own challenges in children. Hence, simplification of approach by appropriate use of alternative diagnostic tests including oximetry scoring systems, questionnaires, and home respiratory polygraphy is highlighted. This will ensure early diagnosis, referral for corrective surgical management versus medical therapy on basis of severity, and performance of PSG in only selective cases.
Analysis of possible risk factors for the severity of paediatric obstructive sleep apnoea syndrome
European Archives of Oto-Rhino-Laryngology
Purpose This study aimed to determine the effect of body mass index (BMI) percentile, asthma, sex, and age on the paediatric obstructive sleep apnoea (OSA) severity. Furthermore, to determine the possible predictive role of the BMI percentile and age in severe OSA. Methods This retrospective study included 921 children aged 2–18 years diagnosed with OSA by polysomnography. Analysis of Covariance (ANCOVA), Spearman’s correlation, Receiver Operating Characteristics (ROC) analyses were performed and area under the curve (AUC) was determined. Results We observed a significant association between a higher BMI percentile and the severity of OSA (p < 0.001, ρ = 0.15). The correlation also was significant under (p = 0.007, ρ = 0.11) and over 7 (p = 0.0002, ρ = 0.23) years of age. There was no association between the severity of OSA and the presence of asthma (p = 0.9) or sex (p = 0.891), respectively. Age was significantly related to OSA severity (p = 0.01, ρ = 0.08). Although both the B...
Respiratory polygraphy for follow-up of obstructive sleep apnea in children
Sleep Medicine, 2012
Objectives: (1) To evaluate the effectiveness of adenotonsillectomy for the treatment of Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) in children. (2) To evaluate the usefulness of respiratory polygraphy (RP) for controlling post-adenotonsillectomy effects. Methods: The children studied were referred to the Burgos Sleep Unit (SU) with clinical suspicion of OSAHS before undergoing adenotonsillectomy. For all patients, a clinical history was taken and a general physical examination, as well as a specific ear, nose, and throat examination was done. RP before adenotonsillectomy, and seven months afterwards, was also done. OSAHS was diagnosed if the Apnea Hypopnea Index (AHI) was P4.6. Results: Of the 100 children studied, 68 were male and 32 female, with an age of 4.17 ± 2.05 years. Using RP, 86 of them were diagnosed with OSAHS before undergoing adenotonsillectomy. There was a significant improvement in all clinical and polygraphic variables after adenotonsillectomy. The pre and post surgery AHI index was 11.9 ± 11.0 and 2.6 ± 1.5, respectively, with a significant mean difference (9.4 ± 10.9, p < 0.01). The residual OSAHS was 11.6% (CI 95%: 4.3-19%). Conclusions: Respiratory polygraphy is a useful tool for monitoring the effectiveness of surgical treatment and the detection of residual OSAHS in children with adenotonsillar hypertrophy.
Obstructive Sleep Apnea in Children
CHEST Journal, 2009
Background: The obesity epidemic has prompted remarkable changes in the proportion of obese children who are referred for habitual snoring. However, the contribution of obesity to adenotonsillar hypertrophy remains undefined. Methods: In our study, 206 nonobese habitually snoring children with polysomnographically diagnosed obstructive sleep apnea (OSA) were matched for age, gender, ethnicity, and obstructive apnea-hypopnea index (OAHI) to 206 obese children. Size estimates of tonsils and adenoids, and Mallampati class scores were obtained, and allowed for the assessment of potential relationships between anatomic factors and obesity in pediatric OSA. Results: The mean OAHI for the two groups was approximately 10.0 episodes/h total sleep time. There was a modest association between adenotonsillar size and OAHI in nonobese children (r ؍ 0.22; p < 0.001) but not in obese children. The mean (؎ SEM) adenotonsillar size was larger in nonobese children (3.85 ؎ 0.16 vs 3.01 ؎ 0.14, respectively; p < 0.0001), and conversely Mallampati class scores were significantly higher in obese children (p < 0.0001). Conclusion: The magnitude of adenotonsillar hypertrophy required for any given magnitude of OAHI is more likely to be smaller in obese children compared to nonobese children. Increased Mallampati scores in obese children suggest that soft-tissue changes and potentially fat deposition in the upper airway may play a significant role in the global differences in tonsillar and adenoidal size among obese and nonobese children with OSA.
Update in Obstructive Sleep Apnea Syndrome in Children
Brazilian Journal of Otorhinolaryngology, 2005
The prevalence of OSAS in children is 0.7-3%, with peak incidence in pre-schoolers. It is characterised by partial or complete upper airway obstruction during sleep, causing intermittent hypoxia. Both anatomical (severe nasal obstruction, craniofacial anomalies, hypertrophy of the pharyngeal lymphoid tissue, laryngeal anomalies, etc.) and functional factors (neuromuscular diseases) predispose to OSAS during childhood. The main cause of OSAS in children in adenotonsillar hypertrophy. The most common clinical manifestations of OSAS are: nocturnal snoring, respiratory pauses, restless sleep and mouth breathing. Nocturnal pulse oximetry, nocturnal noise audio/videotape recording and nap polysomnography are useful tools for screening suspected cases of OSAS in children, and the gold-standard for diagnosis is overnight polysomnography in the sleep laboratory. On the contrary of SAOS adults, children usually present: less arousals associated to apnea events, more numerous apneas/hypopneas during REM sleep, and more significant oxihemoglobin dessaturation even in short apneas. The treatment of OSAS may be surgical (adenotonsillectomy, craniofacial abnormalities correction, tracheostomy) or clinical (sleep hygiene, continuous positive airway pressure-CPAP).