Pediatric sleep apnea-a simplified approach (original) (raw)
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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.
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).
Trends in Diagnosing Obstructive Sleep Apnea in Pediatrics
Children, 2022
Obstructive sleep apnea in children has been linked with behavioral and neurocognitive problems, impaired growth, cardiovascular morbidity, and metabolic consequences. Diagnosing children at a young age can potentially prevent significant morbidity associated with OSA. Despite the importance of taking a comprehensive sleep history and performing thorough physical examination to screen for signs and symptoms of OSA, these findings alone are inadequate for definitively diagnosing OSA. In-laboratory polysomnography (PSG) remains the gold standard of diagnosing pediatric OSA. However, there are limitations related to the attended in-lab polysomnography, such as limited access to a sleep center, the specialized training involved in studying children, the laborious nature of the test and social/economic barriers, which can delay diagnosis and treatment. There has been increasing research about utilizing alternative methods of diagnosis of OSA in children including home sleep testing, espe...
Obstructive sleep apnea syndrome is one of the most common types of sleep-disordered breathing in children and is characterized by partial or complete obstruction of the upper airways during sleep with repeated episodes of airflow cessation, reduction in blood oxygen saturation and sleep disruption to restore patency of the upper airways. Because polysomnography, the gold-standard test for the diagnosis of obstructive sleep apnea, is a costly procedure with technical difficulties, home respiratory polygraphy is used as an alternative diagnostic method. This review seeks to summarize the utility of home respiratory polygraphy in detecting obstructive sleep apnea syndrome and to show if it can be used as a substitute for polysomnography in children.
Diagnostic issues in pediatric obstructive sleep apnea
Proceedings of the American Thoracic Society, 2008
Obstructive sleep apnea syndrome (OSAS) in children includes a spectrum of respiratory disorders with significant morbidities. Diagnosis of OSAS is based on clinical suspicion, history, and physical findings, and confirmation is made by polysomnography. There has been significant progress in recent years in technologies available for diagnosis of OSAS since the consensus statement of the American Thoracic Society in 1996. The current review describes methodologies that are available today for assessment and diagnosis of OSAS in children and summarizes the most recent recommendations of the American Academy of Sleep Medicine Task Force regarding scoring sleep-related respiratory events in children.
Journal of Paediatrics and Child Health, 2013
Obstructive Sleep Apnoea (OSA) affects around 4% of children and adenotonsillar hypertrophy is the most common treatable cause. Lateral airway radiography (LAR) is a non-invasive screening tool to assess adenoidal hypertrophy in children. To date, any assessments of predictive values of lateral airway radiographs for OSA severity tested only one method of evaluating the LAR in each study. We evaluated the interrater reliability of four LAR assessment methods against polysomnographicallydetermined criteria for OSA. Lateral airway radiography and polysomnogram (PSG) were performed on 72 consecutive children with varying severities of OSA. Five assessors with varying experience and blinded to the PSG results independently analysed the LAR. The assessment methods were as described by , Johannesson , Fujioka (1979) and Cohen and Konak (1984). Inter-observer variability was tested using ICC. Pearson's Correlation test was undertaken for correlations between these assessments and measures of OSA severity. Inter-rater correlations were moderate to high for all four LAR assessment methods ranging from values 0.51 to 0.96 with various degrees of agreement between individual assessor and the "gold standard" on different measures ranging from 0.05 to 0.91. The best correlations between LAR and PSG (Obstructive Apnoea Hypopnea Index (OAHI) and minimum oxygen saturation) were seen using the anterior airway measurement with r values of -0.25 and 0.25 respectively (p< 0.05) for all. We conclude that OSA severity correlates best with assessment of anterior airway size . These results support the use of assessing adenoid size on LAR to predict OSA severity in snoring children.
Sleep, 2014
Australia, polysomnography (PSG) is the accepted gold standard, as recommended by the American Academy of Pediatrics. 1-3 In Europe, the vast majority of laboratories perform respiratory polygraphy (RP). 4-6 A substantial number of physicians believe that RP is sufficient to diagnose OSA, and the Royal College of Paediatrics and Child Health Working party on Sleep Physiology and Respiratory Control Disorders in Childhood has recommended that RP provides a satisfactory approach to diagnose OSA in uncomplicated children over the age of 2 years. 7 However, if the 2 types of diagnostic studies, i.e., RP and PSG, yield different results, then centers
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.