Pediatric sleep apnea-need for multidisciplinary approach

Abstract

Sleep disordered breathing (SDB) in children is a frequent disease with a prevalence varying from 1–5%. It is distinct from adults with respect to ideology, gender distribution, clinical manifestation, and treatment. Adenotonsillar enlargement is the most common cause of SDB in children. The diagnosis of SDB requires the use of special sensors such as nasal pressure transducer and esophageal pressure monitoring. The treatment of SDB in children includes amelioration of symptoms, normal cranio-facial growth and prevention of adult SDB. Adenotonsillectomy (AT) is the first line treatment of otherwise healthy children and also the initial treatment for children with multifactorial SDB. The success of AT as defined by reduction of AHI below 1 varies between 30 and 50% in various studies. A number of clinical factors such as nasal allergy, narrow and high hard palate, retro-position of mandible, enlargement of nasal inferior turbinates, high Mallampatti scale score, long face syndrome, age more than 8 years at the time of AT, and pretreatment apnea- hypopnea index (AHI) were associated with poor outcome. An impairment of nasal breathing due to adenotonsillar enlargement results in abnormal development of maxilla-mandibular skeleton resulting in narrowed upper airway. Surgery should be performed in young children as early as possible. Majority of patients have residual disease which requires additional treatment with orthodontic procedures such as rapid maxillary expansion (RME) and nasal CPAP. A multidisciplinary approach to evaluation and management of these children may lead to better treatment outcome.