OSA-18 Scores Research Articles

The Impact of Adenotonsillectomy on the Quality of Life of Children with Obstructive Sleep Apnea.

Introduction In children, obstructive sleep apnea (OSA) is a sleep-related breathing disorder that is caused by adenotonsillar hypertrophy and is characterized by upper airway obstruction disturbing sleep. Objective We conducted this study to evaluate health-related quality of life (QoL) in children with OSA before and after adenotonsillectomy. Methods A descriptive, observational study was conducted among 43 children in the 4-to-12 years old age group who had symptoms of OSA due to adenotonsillar hypertrophy and who underwent adenotonsillectomy at a tertiary care center during the period from February 2020 to February 2021. The QoL was assessed using the OSA-18 questionnaire preoperatively and at 2 and 6 months postoperatively. Results Among the study population, males (72)%) were more affected with OSA, with a male-to-female ratio of 2.6:1. Based on the OSA-18 questionnaire assessment, the most severe and frequently observed symptoms were in the domains of sleep disturbance and physical symptoms, in which the mean score was 77 preoperatively. After adenotonsillectomy, the mean OSA-18 score decreased to 28.605 and 22.465 at 2 and 6 months, respectively. At 2 months postsurgery, more significant improvement was noticed in sleep disturbances, physical symptoms, and parent's concern while at 6 months postsurgery, all domains showed equal improvement. Therefore, following adenotonsillectomy, the QoL improved significantly. Conclusion Obstructive sleep apnea can adversely affect sleep quality as well as neurocognitive and cardiovascular functions. Adenotonsillectomy resulted in significant improvement in the QoL.

Drug-Induced Sleep Endoscopy Predicts Subjective Outcomes of Adenotonsillectomy.

Persistent obstructive sleep apnea (OSA) after adenotonsillectomy (AT) has been reported in 20%-30% of children. The aim of this study was to determine the predictive value of drug-induced sleep endoscopy (DISE) at the time of AT on subjective AT outcomes. This was a prospective cohort study of children aged 2-18 years being treated with AT for sleep disordered breathing (SDB) with one or more risk factors for AT failure: age >7 years, obesity, severe baseline OSA, Black race. All underwent DISE at the time of AT. Potential predictors of subjective AT outcome included age, sex, obesity, and DISE patterns. Multivariable linear regression was used to model predictors of post-AT Pediatric Sleep Questionnaire (PSQ) and OSA-18 outcomes. Pre- and post-AT PSQ/OSA-18 responses were available from 194 children. Mean age was 9.3 ± 3.5 years, with 59% obese, 50% female, and 67% White. After AT, mean PSQ score decreased from 0.60 ± 0.19 to 0.28 ± 0.22, p < 0.001 and mean OSA-18 score decreased from 66 ± 21 to 37 ± 18, p < 0.001. The most frequent sites of obstruction were the tonsils (92%), nasal airway (77%), adenoids (64%), and velopharynx (65%). Multivariable regression modeling demonstrated worse outcomes with obesity, male gender, and multilevel obstruction that included the nasal airway and tongue base in addition to adenotonsillar obstruction. Persistent OSA and symptom burden after AT was common in this population. Obesity, male gender, and multilevel obstruction during DISE were all associated with worse subjective outcomes. 3 Laryngoscope, 2024.

Adenotonsillectomy Versus Watchful Waiting for Children with Obstructive Sleep Apnea Syndrome: A Systematic Review with Meta-Analysis

The treatment of children with Obstructive Sleep Apnea Syndrome (OSAS) remains a point of debate among otorhinolaryngologists worldwide. This study aims to comparatively assess the clinical outcomes of adenotonsillectomy (ATE) and watchful waiting in children with OSAS. We searched the databases of PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL), until the 1st of October 2023. Comparative trials assessing the efficacy of adenotonsillectomy and watchful waiting in children with OSAS were considered. The primary outcome measure was the apnea-hypopnea index (AHI), and secondary outcomes included quality of life as measured by OSA-18 score, and mean SpO2 levels. A subgroup analysis evaluating the changes in AHI depending on the severity of the initial disease was also executed. We conducted a random-effects pairwise meta-analysis of change scores to include randomized and non-randomized controlled trials. The quality assessment was carried out by using the Cochrane risk of bias tool for randomized and the ROBINS-I tool for non-randomized trials, respectively. Two randomized and five non-randomized trials were included. There was a statistically significant difference regarding AHI in favor of the ATE group compared to the watchful waiting group (Standardized mean difference [SMD] was − 0.60, 95%CI −0.79 to −0.41, p < 0.001). Likewise, a statistically significant decrease in change scores for OSA-18 between ATE and watchful waiting was noted (SMD was − 0.79, 95%CI −0.97 to −0.61, p < 0.001). On the other hand, there was no significant difference when ATE and watchful waiting groups were compared for SpO2 levels between each other (SMD was 0.52, 95%CI −1.53 to 2.56, p < 0.62). In the subgroup analysis assessing mild OSAS, there was a significant difference in favor of ATE compared to watchful waiting (SMD was −0.91, 95%CI −1.35 to −0.47, p < 0.0001). For mild to moderate OSAS, similar results were noted favoring ATE as well (SMD was − 0.53, 95%CI −0.87 to −0.19, p < 0.003). This study provides evidence of moderate strength supporting the superiority of ATE over the watchful waiting approach in terms of AHI and OSA-18. This also appears to be the case for AHI in children with mild and mild to moderate OSAS.

Comparison of Epworth Sleepiness Scale and OSA-18 Scores With Polysomnography in Children.

Our goal is to determine if there is a correlation between Modified Epworth Sleepiness Scale (M-ESS) scores, obstructive sleep apnea (OSA)-18 scores, and polysomnography (PSG) outcomes in children. Retrospective chart review. Pediatric otolaryngology clinic. Charts of consecutive children presenting from July 2021 to July 2023 were reviewed. Demographics, body mass index (BMI), BMI Z score, M-ESS score, OSA-18 score, PSG results, and sleep apnea severity were included. One-way analysis of variance and Pearson/Spearman correlation coefficients were calculated. Three hundred sixty-seven children were included, 162 (44.1%) girls and 205 (55.9%) boys. Mean patient age was 7.8 (95% confidence interval [CI]: 7.3-8.3) years. M-ESS score was 6.3 (n = 348, 95% CI: 5.8-6.8), mean OSA-18 score was 56.2 (n = 129, 95% CI: 53.0-59.4). Mean apnea-hypopnea index (AHI) was 10.1 (95% CI: 8.7-11.4) events/h, obstructive AHI 9.3 (95% CI: 8.0-12.7) events/h, respiratory distress index 14.6 (95% CI: 8.4-20.8) events/h, and oxygen saturation nadir 89.8% (95% CI: 89.1-90.4). Sixty-two children (17.2%) had mild, 192 (53.5%) moderate, and 105 (29.2%) severe sleep apnea. M-ESS score correlated weakly to AHI (r = .19, P = <.001), and OSA-18 score to oxygen saturation nadir (r = -.16, P = .002). After logistic regression adjusted for age and BMI, neither clinical scores were independently associated with AHI. M-ESS and OSA-18 scores have a weak correlation with OSA severity in children. More reliable, age-appropriate screening tools are needed in pediatric sleep apnea.

Association of allergic rhinitis with persistent obstructive sleep apnea: A secondary analysis of the childhood adenotonsillectomy trial

Study objectivesAllergic rhinitis (AR) is frequently reported in children suffering from obstructive sleep apnea (OSA). This study aimed to assess whether children with AR are more likely to experience persistent OSA after AT. MethodsThis study is a secondary analysis of a multi-center randomized clinical trial, the Childhood Adenotonsillectomy Trial. Children were categorized into the AR group or Non-AR group according to AR response. A subgroup analysis was conducted using a logistic regression model. ResultsA total of 372 children (177 boys [47.6%]; median [IQR] age, 6.0 [5.0–8.0] years) were analyzed. Approximately 25% (93/372) of children presented with AR. Baseline data indicated higher PSQ scores and OSA-18 scores in the AR group. Children with AR demonstrated lower OSA resolution rates after AT (aOR, 0.43; 95% CI, 0.19 to 0.96). However, there was no significant difference in OSA resolution between the AR and Non-AR groups who underwent watchful waiting (aOR, 0.98; 95% CI, 0.50 to 1.93). Also, the AR group was more likely to maintain a PSQ score greater than 0.33 after AT (OR, 2.16; 95% CI, 1.01 to 4.61). There was no significant association between AR and higher follow-up OSA-18 scores after AT and watchful waiting. ConclusionsIn this secondary analysis, children with AR were more likely to experience persistent OSA, highlighting the importance of effective AR management even post-adenotonsillectomy. A purposefully designed, prospective randomized trial is needed to verify the association between AR and persistent OSA. Trial registrationClinicalTrials.gov Identifier: NCT00560859.

(332) Predictors of being at High Risk for Obstructive Sleep Apnea in Men Presenting for Low Testosterone Evaluation

Abstract Introduction Obstructive sleep apnea (OSA) is a common condition and is more common in men with obesity and low testosterone (T). In men with OSA, T therapy is associated with the development of polycythemia (POLY). It has been shown that men with OSA have a higher risk of POLY with T therapy. Objective We aimed to identify the predictors of being at high risk for OSA in men presenting for low T assessment. Methods The study population included men undergoing low T assessment who completed the OSA risk assessment questionnaire, the STOP-BANG (SB). SB contains 8 questions: STOP (Snoring, Tiredness, Observed apnea during sleeping and high blood Pressure); BANG (BMI ≥ 35, Age ≥ 50, Neck circumference ≥ 17 inches, Gender). Each question is scored as yes (1) or no (0) and is scored 0-8. Using this score, patients are categorized as low risk of OSA (score 0-2), intermediate risk (score 3-4), or high risk (score ≥ 5 or ≥ 3 plus a BMI ≥ 35 or a neck circumference ≥ 17 inches). We also measured total T and free T levels, hematocrit (HCT), and recorded BMI and demographics. Multivariable analysis (MVA) was performed to define predictors of having a high risk of OSA. Parameters in the model included: age, comorbidities (hypertension, diabetes, dyslipidemia, coronary arterial disease), total T, HCT, and BMI. Receiver operating characteristic (ROC) analysis was performed to identify a BMI cut-off point associated with high risk OSA. Results 321 men were analyzed. Median age was 64 (56, 69) years. Median SB score was 4 (3, 5), 55% were high risk, 25% moderate risk, and 19% low risk. 46% had 2 ≥ comorbidities. 57% had T levels ≤300 ng/dL. Median total and free T were 281 (222, 373) and 7.5 (5.4, 10) ng/dL and median LH was 3.7 (2.2, 6.7). Median HCT was 44% (41, 46). 33% had HCT ≥ 45%, and 4% had HCT &amp;gt; 50%. Median BMI was 29 (26, 33) kg/m2 and 42% had obesity (BMI ≥ 30 kg/m2). On MVA, BMI and ≥2 comorbidities predicted high risk for OSA. ROC analysis showed cut-off point BMI ≥ 27 kg/m2 is associated with high risk for OSA by SB (sensitivity=0.8; specificity=0.6; AUC=0.77; p&amp;lt;0.001). For men with BMI ≥27 kg/m2, the rate of high risk OSA was 71%, versus 29% rate of high risk in men with BMI &amp;lt;27 kg/m2. Conclusions BMI ≥ 27 kg/m2 or higher and the presence of 2 or more comorbidities are the main predictors of high risk OSA. Disclosure No.

Lung Structure and Risk of Sleep Apnea in SPIROMICS.

The SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) is a prospective cohort study that enrolled 2981 participants with the goal of identifying new chronic obstructive pulmonary disease (COPD) subgroups and intermediate markers of disease progression. Individuals with COPD and obstructive sleep apnea (OSA) experience impaired quality of life and more frequent exacerbations. COPD severity also associates with computed tomography scan-based emphysema and alterations in airway dimensions. The objective was to determine whether the combination of lung function and structure influences the risk of OSA among current and former smokers. Using 2 OSA risk scores, the Berlin Sleep Questionnaire (BSQ), and the DOISNORE50 (Diseases, Observed apnea, Insomnia, Snoring, Neck circumference > 18 inches, Obesity with body mass index [BMI] > 32, R = are you male, Excessive daytime sleepiness, 50 = age ≥ 50) (DIS), 1767 current and former smokers were evaluated for an association of lung structure and function with OSA risk. The study cohort's mean age was 63 years, BMI was 28 kg/m2, and forced expiratory volume in 1 second (FEV1) was 74.8% predicted. The majority were male (55%), White (77%), former smokers (59%), and had COPD (63%). A high-risk OSA score was reported in 36% and 61% using DIS and BSQ respectively. There was a 9% increased odds of a high-risk DIS score (odds ratio [OR]=1.09, 95% confidence interval [CI]:1.03-1.14) and nominally increased odds of a high-risk BSQ score for every 10% decrease in FEV1 %predicted (OR=1.04, 95%CI: 0.998-1.09). Lung function-OSA risk associations persisted after additionally adjusting for lung structure measurements (%emphysema, %air trapping, parametric response mapping for functional small airways disease, , mean segmental wall area, tracheal %wall area, dysanapsis) for DIS (OR=1.12, 95%CI:1.03-1.22) and BSQ (OR=1.09, 95%CI:1.01-1.18). Lower lung function independently associates with having high risk for OSA in current and former smokers. Lung structural elements, especially dysanapsis, functional small airways disease, and tracheal %wall area strengthened the effects on OSA risk.

326 Pre-morbid sleep disturbance and its association with stroke severity: results from the international INTERSTROKE study

Abstract Background We have previously shown that disturbances in sleep to be associated with acute stroke, but their association with stroke severity is less certain. In the INTERSTROKE study, we evaluated the association of pre-morbid sleep disturbance with stroke severity and functional outcome in acute stroke patients. Methods INTERSTROKE was an international case–control study of first acute stroke. This analysis comprised cases who completed a standardised questionnaire concerning nine symptoms of sleep disturbance (sleep onset latency, duration and quality, nocturnal awakening, napping, snoring, snorting and breathing cessation) in the prior month (n = 2,361). Two indices were derived representing sleep disturbance (range 0–9) and Obstructive Sleep Apnoea (OSA; range 0–3) symptoms. The modified-Rankin score (m-RS) was used to measure stroke severity at initial assessment and functional outcome at 1-month follow-up. Severe stroke was defined as an m-RS of &amp;gt;3, and functional deterioration was defined as an increase in m-RS at 1-month. Logistic regression was used to estimate the magnitude of association between symptoms and stroke severity. Results The mean age of participants was 62.9 years, with 42% female, 80% diagnosed with ischaemic stroke and 17% reporting &amp;gt;5 sleep symptoms. On multivariable analysis, there was a graded association between increasing number of sleep disturbance symptoms and initially severe stroke (2–3: Odds Ratio [OR]:1.44; 95% CI [Confidence Interval]:1.07–1.94, 4–5: OR:1.66; CI:1.23–2.25, &amp;gt;5: OR:2.58; CI:1.83–3.66). Having &amp;gt;5 sleep disturbance symptoms was associated with a significant increased odds of functional deterioration at 1-month (OR:1.54; CI:1.01–2.34). A higher OSA score (2–3 vs 0–1) was also associated with a significant increased odds of initially severe stroke (OR:1.48; CI:1.20–1.83) but not functional deterioration at 1-month (OR:1.19; CI:0.93–1.52). Conclusion Symptoms of sleep disturbance were common and associated with an increased odds of severe stroke and functional deterioration at 1-month. Interventions to modify sleep disturbance may help prevent disabling stroke/improve functional outcome after stroke, and should be the subject of future research.

Adenotonsillectomy in Children with Obstructive Sleep Apnea Syndrome: Clinical and Functional Outcomes.

Adenotonsillectomy (AT) is the first-line treatment for pediatric obstructive sleep apnea syndrome (OSAS). Relatively few studies have evaluated the clinical and functional outcomes of AT in children with OSAS, but these studies show that surgery improves behavior and quality of life (QOL). However, residual OSAS after AT is reported in severe cases. This study aimed to retrospectively evaluate the clinical and functional outcomes of AT in a cohort of children with OSAS. We consecutively enrolled children with OSAS who underwent AT and were admitted to our clinic from 1 July 2020 to 31 December 2022. For each participant, medical history and physical examinations were performed. Before and after surgery, all patients underwent a standard polygraphic evaluation, and caregivers completed the OSA-18 questionnaire. A total of 65 children with OSAS, aged 2-9 years, were included. After AT, 64 (98.4%) children showed a reduction in AHI, with median (IQR) values decreasing from 13.4/h (8.3-18.5/h) to 2.4/h (1.8-3.1/h) (p-value < 0.0001). Conversely, median (IQR) SpO2 nadir increased after surgery from 89% (84-92%) to 94% (93-95%) (p-value < 0.0001). Moreover, 27 children (18%) showed residual OSAS. The OSA-18 score decreased after AT from median (IQR) values of 84 (76-91) to values of 33 (26-44) (p-value < 0.0001). A positive significant correlation was found between OSA-18 post-operative scores and AHI post-operative scores (rho 0.31; p-value = 0.01). Our findings indicate that, in children with OSAS, AT is associated with significant improvements in behavior, QOL, and polygraphic parameters. However, long-term post-surgical follow-up to monitor for residual OSAS is highly recommended, especially in more severe cases.

How Pediatric Sleep Disordered Breathing Impacts Parental Fatigue.

Previous research has indicated that sleep disordered breathing (SDB) can lead to a decreased quality of life in children and their families as compared to children who do not have SDB. The purpose of this study was to examine fatigue levels in parents who had young children who were impacted by sleep symptoms as determined by the OSA-18 scale. Survey. Three pediatric otolaryngology clinics associated with a tertiary care children's hospital in Buffalo, NY. Fatigue levels for parents of children with OSA-18 ≥ 60 were assessed using the Fatigue Severity Scale and the Chalder Fatigue Scale. Consecutive parents with at least one child between the ages of 1 and 10 were recruited. Parents scored their youngest child on the OSA-18 scale. Of the 261 respondents included, 37 parents had a child with an OSA-18 score ≥60. The majority, 211 (82.1%), of participants reported 2 caregivers in the household while 30 (11.7%) had 1 caregiver in the household. Parents of children with OSA-18 ≥60 had a significantly higher mean fatigue score, 16.5 ± 5.8, compared to their counterparts, 11.9 ± 5.2, on the Chalder Fatigue Scale (P < .001). Similar results were reported for the total score on the Fatigue Severity Scale, 34.7 ± 10.8 compared to 28.9 ± 12.0 (P = .004). Parents of children with OSA-18 score ≥60 are significantly more fatigued than parents of children with lower scores. Recognition of this is important for the health care community as it impacts not just the child with OSA but also their family.

Habitual Snoring in Pediatric Thalassemia Disease; Prevalence, Quality of Life and Risk Factors

Objective: To compare the prevalence of HS and quality of life in non-transfusion dependent thalassemia (NTDT) and Transfusion dependent thalassemia (TDT) patients and to identify risk factors associated with HS in pediatric thalassemia. Materials and Methods: We conducted a cross-sectional study of pediatric thalassemic patients aged from 6 months - 18 years between January 2020 and October 2020, at Thammasat University Hospital, Thailand. Results: There were 141 thalassemia patients (35 TDT and 106 NTDT), aged 7 months-18 years, 73 (51.8%) were male. Sixty-eight patients (48.2%) reported snoring; 28 patients (19.9%) had HS; the remaining 40 patients (28.4%) had simple snoring. The prevalence of HS was not significantly different between TDT and NTDT group (6 (17.1%) VS 22 (20.8%); P= 0.527). Quality of life assessed by OSA-18 score was not significant difference between TDT and NTDT groups (51.3 ± 18.8 VS 45.7 ± 11.4; P=0.141). The associating risk factors for the development of HS after multivariate logistic analysis were nasal congestion, and male gender, with an adjusted OR of 5.3 and 3.0, respectively. Conclusion: Prevalence of HS was increased in children with thalassemia. Factors such as nasal congestion and male gender were strongly associated with HS in this population. The quality of life assessment using the OSA-18 questionnaire indicated that thalassemia children generally exhibited a good quality of life. Additionally, our study observed relatively low serum ferritin levels in comparison to previous studies. The standard care provided for TDT patients, includes regular blood transfusion and effective iron chelation, may contribute to slowing down the degree of nasopharyngeal narrowing in thalassemia patients.

Efficacy of Montelukast combined with Sublingual Immunotherapy in the treatment of children with Obstructive Sleep Apnea Hypopnea Syndrome Complicated with allergic rhinitis.

To observe the efficacy of Montelukast combined with sublingual immunotherapy (SLIT) in the treatment of children with obstructive sleep apnea hypopnea syndrome (OSAHS) complicated with allergic rhinitis (AR). This is a prospective study. A total of 102 children with OSAHS complicated with allergic rhinitis admitted to Hunan Children's Hospital from April 2020 to April 2021 were selected and randomly divided into two groups: sublingual group and two-drug combination group. Children in the sublingual group were treated with standardized dust mite drops Nos. 1-4 for SLIT, while those in the two-drug combination group were treated with Montelukast on top of the sublingual group. Statistical analysis and comparison were made between the two groups of children in terms of Sleep apnea hypopnea index (AHI), Hypoxic saturation (Lsao2), interleukin-4, Il-4), interleukin-17 (IL-17), OSA-18 Snoring Symptom Scale for Children (OSA-18), allergic rhinitis symptom scale (TNSS), efficacy, occurrence of adverse reactions, etc. After treatment, the AHI index of the two-drug combination group was significantly decreased, and the Lsao2 index was significantly increased compared with the sublingual group (P<0.05). Compared with the sublingual group, the levels of IL-4 and IL-17 in the two-drug combination group were significantly decreased (P<0.05), the OSA-18 score and TNSS score were significantly lower (P<0.05). Moreover, compared with the sublingual group, the efficacy of the two-drug combination group was significantly increased (P<0.05), the incidence of adverse reactions was significantly lower (P<0.05). Montelukast combined with sublingual immunotherapy offers many advantages, such as effectively controlling nasal allergy symptoms in children with OSAHS complicated with allergic rhinitis and improving OSAHS symptoms.

Obstructive sleep apnea in type 2 diabetes mellitus patients

Abstract Objective The study aims to identify the prevalence and risk factors for OSA in a group of Egyptian patients with type 2 diabetes. Methods 125 type 2 diabetes mellitus patients visited Mansoura University Hospital (Diabetes Mellitus Outpatient Clinic (OPC) at Specialized Medical Hospital and the Sleep Disordered Breathing Unit of the Chest Department), all of them exposed to history taking, the patients underwent anthropometric measurements (weight, height, body mass index, neck circumference), a test of their tonsillar size, Malampati score, Friedman OSA score, Epworth sleepiness scale (ESS), Berlin questionnaire, STOP BANG questionnaire, full-night polysomnography, fasting, and postprandial blood sugar. Results The study included 125 T2DM Egyptian patients with a mean age of 54.63 ± 9.47 years. Males accounted for 35.2 percent of patients, while females accounted for 64.8%. According to the study of co-morbidity, hypertension constituted 77 (61.1%), ischemic heart disease 28 (22.4%), other cardiac diseases 11 (8.8%), bronchial asthma 6 (4.8%), liver diseases 6 (4.8%), hypothyroidism 3 (2.4%), and renal diseases 3 (2.4%). A total of seven patients (5.6%) had no OSA symptoms, 87 had borderline symptoms, and 31 had positive symptoms. There were 51 (40.8%) normal patients, 12 (9.6%) borderline patients, and 62 (49.6%) sleepy patients on the Epworth scale. According to the Stop-Bang questionnaire, 121 (96.8%) patients answered positively. It was determined that 122 patients (97.6%) were at high risk based on the Berlin questionnaire. There were 17 patients (13.6%) with OSA on polysomnography, of which six were moderate (35.3%) and 11 were severe (64.7%). Among moderate and severe OSA patients, glycosylated hemoglobin levels differed significantly. Multivariate logistic regression analysis for independent predictors of OSA, chronic renal disease patients is the most common associated risk factor (OR = 14.3, CI = 1.2–67) then hypertension (OR = 5.6,CI=1.2–25.5) and heart failure (OR = 4.4). Conclusions OSA affects 13.6% patients with type 2 diabetes patients who are hypertensive are at higher risk of OSA, chronic renal failure is considered another risk factor Furthers studies are needed on a big scale of Egyptian diabetic patients to detect the prevalence of OSA

Novel Classification System of Adenoids Based on Appearance and Its Relationship with Drug Therapy

Introduction: Adenoidectomy is a common procedure in children who have adenoid hypertrophy (AH), but anesthesia risks should be considered. We proposed a novel classification system for adenoids based on their appearance. Additionally, we explored whether the novel classification of adenoids correlates with the response to therapy and thus might be helpful for further treatment recommendations. Methods: We used fiberoptic nasal endoscopy to determine the degree and appearance of AH. Obstructive Sleep Apnea Questionnaire (OSA-18) was used to assess the quality of life of children with AH. The adenoids were divided into three types: edematous type, common type, and fibrous type. In adenoid tissues, the eosinophils were counted. Immunohistochemistry and Western blot were done to determine the expression of CysLTR1, CysLTR2, CGR-α, and CGR-β in different types of adenoids. Results: 70.67% (106/150) of AH patients presented with allergic rhinitis (AR), and of them, 68% (72/106) of adenoids were the edematous type. The expressions of CGR-α, CGR-β, and eosinophil count were higher in the edematous compared with the common and fibrous types. The expression of the leukotriene receptor was similar in all types. Upon montelukast combined with nasal glucocorticoid therapy, improvement of OSA-18 scores and AH grade was significantly compared to montelukast monotherapy for edematous type. There was not any statistically significant difference between the scores upon montelukast combined with nasal glucocorticoid and montelukast monotherapy for common and fibrous type. We observed a positive correlation between eosinophil count in the blood and in the adenoid tissue. Conclusion: AR was the risk factor for the development of edematous AH. All subtypes of AH responded to montelukast, while there was an additional effect of nasal glucocorticoid in the edematous type. A combination therapy of nasal glucocorticoid with leukotriene receptor antagonist can be recommended for AH patients with AR, patients with edematous adenoids, and/or patients with increased eosinophils in blood routine.

Adenotonsillectomy-related changes in systemic inflammation among children with obstructive sleep apnea.

Adenotonsillar hypertrophy is the most common cause of pediatric obstructive sleep apnea (OSA). Although adenotonsillectomy considerably reduces OSA and systemic inflammation, whether and how systemic inflammation influences the effects of adenotonsillectomy on OSA has yet to be determined. This study investigated the associations between changes in anatomical variables, % changes in subjective OSA-18 questionnaire scores, % changes in 11 polysomnographic parameters, and % changes in 27 systemic inflammatory biomarkers in 74 children with OSA. Fifty-six (75.6%) boys and 18 (24.4%) girls with the mean age of 7.4 ± 2.2 years and apnea-hypopnea index (AHI) of 14.2 ± 15.9 events/h were included in the statistical analysis. The mean period between before and after adenotonsillectomy was 5.6 ± 2.6 months. After adenotonsillectomy, the OSA-18 score, eight of 11 polysomnographic parameters, and 20 of 27 inflammatory biomarkers significantly improved (all p < 0.005). Notably, there were significant associations between change in tonsil size and % change in AHI ( r = 0.23), change in tonsil size and % changes in interleukin-8 (IL-8) ( r = 0.34), change in tonsil size and % change in and IL-10 ( r = -0.36), % change in IL-8 and % change in C-C chemokine ligand 5 (CCL5) ( r = 0.30), and % change in CCL5 and % change in AHI ( r = 0.38) (all p < 0.005). Interestingly, % change in IL-8 and % change in CCL5 serially mediated the relationship between change in tonsil size and % change in AHI (total effect: β = 16.672, standard error = 8.274, p = 0.048). These preliminary findings suggest that systemic inflammation is not only a complication of OSA but also that it mediates the surgical effects, which may open avenues for potential interventions to reduce tonsil size and OSA severity through the regulation of IL-8 and CCL5.

Modified dindo-clavien system for registration of perioperative complications in children undergoing adenotonsillectomy.

Surgical procedures in children are among the most commonly performed procedures in otolaryngology. Perioperative safety and documentation of complications are becoming increasingly important. This study investigates perioperative complications in a clinical cohort of children with adenotonsillar hyperplasia undergoing adenotonsillectomy using the standardized Dindo-Clavien reporting system. Retrospective evaluation of 402 children who underwent adenotonsillectomy between 2009 and 2015. Patient parameters including all perioperative complications were investigated. In the study, 124 complications were found (106 mild, 16 severe). According to the Dindo-Clavien classification, 93 grade I, 15 grade II, 5 grade III, 11 grade IV and 0 grade V complications were documented. Complications were associated with additional diagnoses (p = 0.001), long-term medication intake (p = 0.003), duration of hospitalization (p < 0.001) and duration of surgery (p < 0.001), undergoing tonsillotomy (p = 0.022) or tonsillectomy (p < 0.001), differences in ASA score (p = 0.005) and differences in OSA-18 score (p = 0.011). Severe complications, classified as grade III and IV, were associated with premature birth (p = 0.026), additional diagnoses (p = 0.017), long-term medication intake (p < 0.001) and differences in ASA score (p =< 0.001). The Dindo-Clavien classification is a standardized reporting system which can also be used for surgical procedures in children with adenotonsillar hyperplasia. The system shows associations with clinical parameters and thus can help to identify subgroups at risk of severe complications.

Adenotonsillar Hypertrophy: The Relationship Between Obstruction Type and Attention in Children.

We aimed to investigate the attention function, which is a parameter of cognitive functions, at different obstruction types (adenoid and tonsil hypertrophy, adenoid hypertrophy only, tonsillar hypertrophy only, and normal) of oral cavity and nasopharynx, and the relationship between obstruction level, type, and attention (N = 80). To evaluate attention function, Stroop test has been performed. Eighteen-item Quality of Life (OSA-18) and Brouillette Symptom Score questionnaires have been completed with each child's parents. Significant and positive relation has been found between Brouillette Symptom Score, OSA-18 score, and each 5 sections of Stroop test's points. It has been shown that children with adenotonsillar hypertrophy (ATH) are negatively affected in terms of obstructive symptoms and quality of life. At the situation of obstructive pathology, the Stroop test durations are affected negatively. Results are supporting that quality of life and attention parameter are affected negatively at children with ATH.

Persistent pediatric obstructive sleep apnea treated with skeletally anchored transpalatal distraction

The aim of this study was to evaluate the impact of nasomaxillary expansion using skeletally anchored transpalatal distraction (TPD) in children without transverse maxillary deficiency that were previously treated by rapid palatal expansion (RPE). Twenty-nine consecutive children were treated by TPD. Twenty-five children, aged 10-16 years completed pre- and post-operative clinical evaluations, questionnaires (OSA-18), cone beam computed tomography (CBCT), and polysomnography (PSG). The pre- and post-operative CBCT data were used to reconstruct the 3-dimensional shape of the upper airway. Two measures of airflow function (pressure and velocity) were simulated by using computational fluid dynamics (CFD) at four different airway segments (nasal, nasopharyngeal, oropharyngeal and hypopharyngeal). Twenty-three patients (92%) experienced improvement based on PSG. The apnea hypopnea index (AHI) improved from 6.72±4.34 to 3.59±5.11 (p<0.001) events per hour. Clinical symptoms based on OSA-18 scores were improved in all patients. Twenty-five patients (100%) had successful expansion defined as separation of the midpalatal suture at least 1 mm from anterior nasal spine (ANS) to posterior nasal spine (PNS). The nasal sidewall widening was 2.59±1.54 mm at canine, 2.91±1.23 mm at first molar and 2.30±1.29 mm at PNS. The ratio of dental expansion to nasal expansion was 1.12:1 (2.90 mm:2.59 mm) at canine and 1.37:1 (3.98 mm:2.91 mm) at first molar. The nasal airflow pressure reduced by 76% (-275.73 to -67.28 Pa) and the nasal airflow velocity reduced by over 50% (18.60 to 8.56 m/s). Nasomaxillary expansion by skeletally anchored TPD improves OSA in children without transverse maxillary deficiency that were previously treated by RPE. A nearly parallel anterior-posterior opening of the mid-palatal suture achieves enlargement of the entire nasal passage with improvement of the airflow characteristics in the nasal and pharyngeal airway. The improved airflow characteristic is significantly correlated with the improved polysomnographic findings, thus demonstrating that nasomaxillary expansion in previously expanded patients is a viable treatment option.

The effects of rapid maxillary expansion on persistent pediatric snoring post-tonsillectomy.

To investigate the short-term effects of rapid maxillary expansion (RME) on the quality of life of children who had persistent snoring post-adenotonsillectomy (AT). The study included childrenwith maxillary constriction aged 5 to 12years, two or more years after AT whose parents/guardians reported that they still snored ≥ 5 nights per week. We enrolled children with sleep-disordered breathing, including children with primary snoring and children with obstructive sleep apnea(OSA). All patients underwent laryngeal nasofibroscopy and complete polysomnography. Quality of Life (QOL) Questionnaire (OSA-18), the Pediatric Sleep Questionnaire (PSQ), Conners Abbreviated Scale (CAS), and the Epworth Sleepiness Scale (ESS) were administered before and after RME. Of 24 children enrolled, 13 had primary snoring and 11 had OSA.Overall OSA-18 scores were reduced in both groups (intragroup difference, p < 0.001). The PSQ total score, CAS, and ESS were significantly reduced in both groups (p < 0.001) In the evaluation of snoring, there was a reduction due to the treatment effect in both groups (p < 0.001). Daytime sleepinessand attention deficit hyperactivity disorders were also positively affected in both groups. Our study demonstrated the potential benefit of RME in treating children with persistent snoring and transverse maxillary deficiency (TMD). RME can improve snoring and the QOL of children with refractory SDB after AT. ClinicalTrials.gov Identifier: RBR-463byn.

The Association of Tonsil Hypertrophy with Pediatric Dentofacial Development: Evidence from a Cross-Sectional Study of Young Children in Shanghai, China.

PurposeThe prevalence of dentofacial deformity was reportedly higher than decades ago, to which upper airway (UA) obstruction-induced sleep-disordered breathing (SDB) might contribute a lot. Tonsil hypertrophy appears relatively common in the population of young children. Given that the association between tonsil hypertrophy and pediatric dentofacial deformity remained controversial, this cross-sectional research was designed to explore the internal relationship of those among young children in Shanghai, China.Patients and MethodsA stratified cluster sampling procedure was adopted, and a representative sample of 715 young children (8–10 years old) was recruited. The OSA-18 quality-of-life questionnaires (OSA-18) were finished by their guardians, and well-trained orthodontists performed the oral examinations. After collecting the valuable information, the descriptions and analyses were run by statistical software (SPSS, version 26.0).Results715 participants (334 boys and 381 girls) were involved in the analyses. As calculated, the current prevalence of malocclusion identified by Angle’s classification was 45.6% in this sample. No evident relation between OSA-18 scores and dentofacial abnormalities (P > 0.05) was found. With the enlargement of tonsil size, the proportion of children with triangular dental arch form (P < 0.05) and high vault palate (P < 0.001) was increasingly higher. More children with protruding profiles and fewer upright profiles were observed as the tonsil size increased, although it did not show a statistical difference (P = 0.103).ConclusionDental and craniofacial growth deficiency has become more prevalent among children, demanding more concerns from health authorities. Tonsil hypertrophy plays an essential role in the direction of dentofacial development. More efforts from local health authorities should be made to enhance public propaganda and education on the prevention and interruption of tonsil hypertrophy and related dentofacial abnormalities.