Diagnosis Of Obstructive Sleep Apnea In Children Research Articles

The future of paediatric obstructive sleep apnoea assessment: Integrating artificial intelligence, biomarkers, and more.

Assessing obstructive sleep apnoea (OSA) in children involves various methodologies, including sleep studies, nocturnal oximetry, and clinical evaluations. Previous literature has extensively discussed these traditional methods. Despite this, there is no consensus on the optimal screening method for childhood OSA, further complicated by the complexity and limited availability of diagnostic polysomnography (PSG). Recent advancements, such as the integration of artificial intelligence, biomarkers, 3D facial photography, and wearable technology, offer promising alternatives for early detection and more accurate diagnosis of OSA in children. This article provides a comprehensive review of these innovative techniques, highlighting their potential to enhance diagnostic accuracy and overcome the limitations of current methods. With an emphasis on cutting-edge technologies and emerging biomarkers, we discuss the future directions for paediatric OSA assessments and their potential to revolutionise clinical practice.

Diagnostic value of upper airway morphological data based on CT volume scanning combined with clinical indexes in children with obstructive sleep apnea syndrome.

Early diagnosis is important for treatment and prognosis of obstructive sleep apnea (OSA)in children. Polysomnography (PSG) is the gold standard for the diagnosis of OSA. However, due to various reasons, such as inconvenient implementation, less equipped in primary medical institutions, etc., it is less used in children, especially in young children. This study aims to establish a new diagnostic method with imaging data of upper airway and clinical signs and symptoms. In this retrospective study, clinical and imaging data were collected from children ≤10 years old who underwent nasopharynx CT scan(low-dose protocol)from February 2019 to June 2020,including 25 children with OSA and 105 non-OSA. The information of the upper airway (A-line; N-line; nasal gap; upper airway volume; upper and lower diameter, left and right diameter and cross-sectional area of the narrowest part of the upper airway) were measured in transaxial, coronal, and sagittal images. The diagnosis of OSA and adenoid size were given according to the guidelines and consensus of imaging experts. The information of clinical signs, symptoms, and others were obtained from medical records. According to the weight of each index on OSA, the indexes with statistical significance were screened out, then were scored and summed up. ROC analysis was performed with the sum as the test variable and OSA as the status variable to evaluate the diagnostic efficacy on OSA. The AUC of the summed scores (ANMAH score) of upper airway morphology and clinical index for the diagnosis of OSA was 0.984 (95% CI 0.964-1.000). When sum = 7 was used as the threshold (participants with sum>7 were considered to have OSA), the Youden's index reached its maximum at which point the sensitivity was 88.0%, the specificity was 98.1%, and the accuracy was 96.2%. The morphological data of the upper airway based on CT volume scan images combined with clinical indices have high diagnostic value for OSA in children; CT volume scanning plays a great guiding role in the selection of treatment scheme of OSA. It is a convenient, accurate and informative diagnostic method with a great help to improving prognosis. - Early diagnosis of OSA in children is very important for the treatment.- However, the traditional diagnostic gold-standard PSG is difficult to implement.- This study aims to explore convenient and reliable diagnostic methods for children.- A new diagnostic model was established combining CT with signs and symptoms.- The diagnostic method in this study is highly effective, informative, and convenient.

Telehealth sleep labs: bringing pediatric polysomnography home.

Telehealth sleep labs: bringing pediatric polysomnography home.

Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020).

Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020).

American Academy of Sleep Medicine Position Paper for the Use of a Home Sleep Apnea Test for the Diagnosis of OSA in Children.

The purpose of this position paper is to establish the American Academy of Sleep Medicine's (AASM) position on the use of a home sleep apnea test (HSAT) for the diagnosis of obstructive sleep apnea (OSA) in children (birth to 18 years of age). The AASM commissioned a task force of 8 experts in sleep medicine to review the available literature on the use of an HSAT to diagnose OSA in children. The task force developed the position statement based on a thorough review of these studies and their clinical expertise. The AASM Board of Directors approved the final position statement. Use of a home sleep apnea test is not recommended for the diagnosis of obstructive sleep apnea in children. The ultimate judgment regarding propriety of any specific care must be made by the clinician, in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources.

Sleep-disordered breathing in children with Down syndrome: Usefulness of home polysomnography

ObjectiveTo investigate the technical feasibility of unattended home polysomnography (HPSG) in children with Down syndrome. MethodsData from children with Down syndrome under 10 years of age referred to a diagnostic sleep study was analyzed. A full sleep-lab based polysomnography (PSG) or a HPSG with a portable device was performed. Uninterpretable HPSGs were defined as: recordings with (i) loss of ≥2 of the following channels: nasal flow, or thoracoabdominal sensors, or (ii) HPSG with less than 4h of artifact-free recording time or (iii) less than 4h SpO2 (peripheral capillary oxygen saturation) signal. ResultsA total of 44 children (68% males) were included in the study, with a mean age of 3.6 (0.1–10) years. PSG was performed in 8 cases and HPSG in 36 cases. Six HPSG recordings were classified as uninterpretable and had to be repeated. Age, gender and BMI were no significant predictors of uninterpretability of the HPSG. Obstructive sleep apnea (OSA) was present in 61% (n=27) of all subjects, and classified as mild, moderate, and severe in 43% (n=19), 11% (n=5), and 7% (n=3) of cases, respectively. Interpretable and technically acceptable HPSGs were obtained in 30 subjects (83%). Age, gender and BMI were no significant predictors for interpretability of the HPSG. DiscussionThis study demonstrates that a portable polysomnographic home device may be helpful for diagnosing OSA in children with Down syndrome. Considering the potential consequences of untreated OSA, this screening test may be helpful for early diagnosis of OSA in children with Down syndrome.

Characteristics and surgical and clinical outcomes of severely obese children with obstructive sleep apnea.

To describe characteristics and surgical and clinical outcomes of obese children with obstructive sleep apnea (OSA). At our institution from 2000 to 2010, 143 obese children with an overnight polysomnography (OPSG) diagnosis of OSA, excluding children with comorbidities, were identified. Relationships between demographics, clinical findings, and the severity of OSA were assessed. Presurgery and postsurgery OPSG indices were compared. We defined cure as an apneahypopnea index (AHI) < 1.5/h on the postsurgery OPSG, and we compared the cure rates of different surgeries. A total of 143 children, median age 12.4 y (interquartile range [IQR] 9.6-14.9) and BMI z-scores 2.8 (IQR 2.6-2.9), were included. Seventy-eight (55%) (Median age 12 y [IQR 9-15]) underwent surgery: 1 had tonsillectomy; 1 tonsillectomy + uvulopharyngopalatoplasty (UPPP); 23 adenotonsillectomy (AT); 27 AT + UPPP; 11 adenoidectomy + UPPP; 8 UPPP; and 7 AT + turbinate trim ± tongue base suspension. Overall, surgery cured 19 children (26%), but AHI improved in the majority of children (p = 0.001). Similarly, the arousal index, PETCO2, and SpO2 nadir improved significantly (p < 0.002, p = 0.019, p < 0.001, respectively). AHI improved significantly in children with mild-to-moderate OSA in comparison to severe OSA (p < 0.001). Children with enlarged tonsils and no history of prior surgery benefitted more often from surgery (p < 0.004 and p = 0.002, respectively). AT was the only surgery reducing the AHI significantly (p = 0.008). Children did not lose weight despite intervention. Adherence with PAP was poor. Surgery improved OPSG indices in the majority of obese children with OSA.

Clinical Efficacy of Symptomatic Manifestations in Prediction of Pediatric Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) in children can also lead to several co-morbidities such as attention deficit, dentofacial abnormality, poor school performance, growth retardation, heart problem, hypertension, or enuresis.1,2 It was also reported that the children with OSA had high prevalence of neurobehavioral deficiency and it was significantly improved after adenotonsillectomy.3 Therefore, its early diagnosis and treatment has drawn attention from sleep physicians and parents. Hypertrophy of the tonsils and adenoids are the most common cause of OSA in children.4 The severity of OSA can be diagnosed by full night polysomnography and American Academy of Pediatrics recommends nocturnal polysomnography as a gold standard test for diagnosis of OSA in children before adenotonsillectomy.5 However, most of the patients undergo adenotonsillectomy without sleep study results when they are diagnosed as having hypertrophic tonsils or adenoids because surgeons contemplate that the night time symptoms will be much improved after adenotonsillectomy in general. However, it is still difficult to predict the severity of OSA and explain it to parents simply on the basis of adenotonsillar hypertrophy. The main manifestations of OSA in children are snoring, pause of breathing, apnea, and mouth breathing. The present study is aimed to identify whether a minimal combination of questionnaires will be useful in prediction of OSA in children. Received: December 1, 2014 Revised: December 10, 2014 Accepted: December 15, 2014

The multiple challenges of obstructive sleep apnea in children: diagnosis

To review some of the inherent problems in defining the diagnosis of pediatric obstructive sleep apnea (OSA) and propose a novel approach to clinical evaluation and referral of habitually snoring children. OSA has emerged in the last 30 years as a highly prevalent condition in children. However, the diagnostic uncertainties associated with the clinical presentation and physical examination, and changes in the clinical phenotype over time dictated by the escalation of obesity in children, along with the objective difficulties in accessing appropriately equipped sleep laboratories, have led to substantial underrecognition and to implementation of empirically driven treatment interventions for which scientific validity and efficacy remain undefined. Current tools for the diagnosis of OSA in children are labor-intensive, and onerous, and remain unvalidated. Novel diagnostic approaches linking objective physiological, biological, or both, measures to defined outcomes of pediatric OSA need to be developed and validated to enable wider and earlier recognition of this condition.