OSA Children Research Articles

Reported Symptoms of Obstructive Sleep Apnea in a Group of Saudi Children

Objective: To report the most commonly experienced night and daytime behavior and symptoms by a group of Saudi OSA children and compare them with a healthy control. Methods: 27 mothers of OSA children (study group) and 27 mothers of healthy, none OSA children, with comparable age and gender, (control group) answered the study questionnaire, on behalf of their children, about sleep-time and daytime behavior and symptoms. Results: The mean (±SD) yes answers for the night-time questions for the study group was 6.07 (±2.759), and 0.7 (±0.8) for the control. For the daytime, the mean yes answers was 1.6 (±0.9) for the study and 0.19 (±0.3) for the control group. Independent samples t-test showed statistically significant differences between the means P=0.000. A statistically significant difference was found between the two groups in the responses for ten of the evaluated night-time symptoms and only one of the daytime symptoms. Conclusions: 1. OSA children had significantly more night and daytime symptoms than the control. 2. Chronic, heavy snoring, difficult breathing during sleep, mouth breathing (during sleep and daytime), and restless sleep were the most commonly reported symptoms.

Adenotonsillectomy outcomes regarding bone age and osteocalcin in treatment of obstructive sleep apnea syndrome in children.

To investigate the effect of adenotonsillectomy (AT) on bone development, quality of life and polysomnography evaluation in children with obstructive sleep apnea syndrome (OSA). Preoperative and postoperative (6 months) physical examination, PSG, bone age (BA) and osteocalcin (OC) evaluation were performed on the selected OSA children (n=92) and the healthy children (n=87). The OSA children were also scored based on the OSA 18-item questionnaire. A two-year follow-up was conducted to evaluate BA and OC changes. After AT, 81 (88.04%) OSA children recovered completely, eight (8.70%) achieved remarkable improvements, and three (3.26%) achieved moderate improvements. In the OSA children, postoperative OSA 18-item score and the scores of the five domains were significantly higher than preoperative ones. Compared with the preoperative, body mass index (BMI), weight for age Z-sores, height for age Z-sores, weight for height Z-sores and BMI Z-score in the OSA group 6 months after the operation were significantly increased, but no significant difference was detected between the OSA and the control group. The changes of BA and chronological age in the OSA group were significantly different from those in the control group. Two years after AT, BA between the two groups was no longer significantly different. Preoperative serum OC in the OSA group was lower than that in the control group, but increased to normal levels 6 months after AT. Correlation analysis showed serum OC levels were negatively correlated with apnea hyponea index, obstructive apnea index, arousal index, and lowest oxygen saturation. After AT, bone growth and development in children with OSA recovered gradually, and the serum OC levels decreased to the normal level. Therefore, preventive measures and positive treatments should be applied to minimize the negative effects of OSA in children.

Investigation of resectability degree for adenoidal surgery in OSA children with the method of computational fluid dynamics

Conclusion: From aspect of fluid dynamics, expanding patients’ nasopharyngeal coronal-sectional area to 48.3–54.7% of normal area will bring the airflow velocity back to normal in adenoidal hypertrophy children. It might provide a suggestion for adenoidectomy range selection and whether total resection is necessary.Objectives: To evaluate the nasopharyngeal airflow characteristics in pediatric OSA patients with adenoidal hypertrophy, and to explore the proper resection range for adenoidectomyMethod: Nine OSA patients and four normal children were recruited. The CT scans of their upper airway were collected and used to construct three dimensional models for fluid dynamics analysis. Using computational fluid dynamics, indices such as velocity, pressure, and coronal-sectional area were calculated.Results: Compared with the normal, the OSA children showed three characteristics in nasopharyngeal: the airflow velocity was significantly higher (p < 0.05), the coronal-sectional area was significantly smaller (p < 0.01), while pressure showed no difference (p > 0.05). In a study of the relationship between velocity and coronal-sectional area, this study investigates different coronal-sectional areas from 30–300 mm2. It was found that, when patients’ nasopharyngeal coronal-sectional area was expanded over 155–170 mm2, namely 48.3–54.7% of normal area, airflow velocity in nasopharyngeal showed no difference than normal.

小児 OSA に対するcoblation adenoidectomy —手術のポイントと手術成績—

小児 OSA に対するcoblation adenoidectomy —手術のポイントと手術成績—

Diagnosis and treatment of children with sleep apnea

Sleep apnea includes obstructive sleep apnea, central sleep apnea and mixed sleep apnea.Obstructive sleep apnoea syndrome(OSAS) is affecting up to 5.7% of children, which hss adverse impact on growth, development cognitive and behavioral outcomes, and untreated OSAS increases cardiovascular risk, so paying closer attention to childhood OSAS early diagnosis and treatment seems more important.First-line treatment in OSAS children is adenotonsillectomy, although other treatment options available include continuous positive airways pressure, anti-inflammatory therapies, airway adjuncts and orthodontic appliances.Central sleep apnea may be related to respiratory regulation center immaturity or dysplasia.Central sleep apnea may be hereditary or acquired.Therefore, the treatment of central sleep apnea should be focused on primariy etiology. Key words: Sleep apnea; Sleep apnea syndrome; Obstructive sleep apnoea syndrome

Positive airway pressure therapy in OSA children at Ramathibodi Hospital

Positive airway pressure therapy in OSA children at Ramathibodi Hospital

Clinical manifestations of pediatric obstructive sleep apnea syndrome: Clinical utility of the Chinese-version Obstructive Sleep Apnea Questionaire-18.

Childhood obstructive sleep apnea syndrome (OSA) affects not only the children's physical health, but also their mental development, behavioral problems and learning difficulties. Therefore, an early diagnosis is important. However, the assessment tools of polysomnography are demanding. The Obstructive Sleep Apnea Questionnaire-18 (OSA-18) is designed to screen OSA and has good reliability and validity. The goal of this study was to validate the Chinese version of the OSA-18, to analyze the frequency of symptoms and find the most common symptoms of OSA in Taiwanese children. We validated the OSA-18 in an ethnic Chinese group and compared the treatment outcomes to show the sensitivity of the questionnaire. The caregivers completed the questionnaire twice at an interval of 4 weeks to test reliability. In the validation study, we included 88 OSA children. The OSA-18 and follow-up polysomnography were performed before and 6 months after adenotonsillectomy. Results showed the excellent test-retest reliability (r = 0.84**) of the OSA-18. There was a statistically significant correlation between the OSA-18 and, respectively, the Apnea-Hypopnea Index (r = 0.29*), and the Hypopnea Index (r = 0.29*). Quality of life showed a significant correlation with the Apnea Index (r = 0.43**), central apnea count (r = 0.50***), and mixed apnea count (r = 0.36*). The cut-off point of the OSA-18 total scores for detecting pediatric OSA in children aged 6-12 years was 66. The common symptoms of pediatric OSA were poor attention span, loud snoring, caregiver worried about child's health, difficulty awakening, and mouth breathing. Our results show that the Chinese version of the OSA-18 is a reliable and valid instrument. The questionnaire also showed improvement in the quality of life of OSA children post-adenotonsillectomy.

Th17/Treg balance in children with obstructive sleep apnea syndrome and the relationship with allergic rhinitis

ObjectiveThis study aims to explore the role of the Th17 to Treg cell ratio in children with OSA and its relationship with allergic rhinitis. MethodsThe study included 127 children diagnosed with OSA by polysomnography (PSG) testing and 29 children without OSA. The 127 children with OSA were divided into the following groups: OSA with moderate adenoidal hypertrophy (n=47), OSA with severe adenoidal hypertrophy (n=49), and OSA complicated by allergic rhinitis (AR) (n=31). The adenoids of the 29 children without OSA were mildly hypertrophic. We measured the number of Th17 and Treg cells, the levels of related serum cytokines in cellular secretions, and the expression of key transcription factors in both the peripheral blood and adenoid tissue. The Th17/Treg ratio was calculated and analyzed between groups. The numbers of Th17 and Treg cells were measured by flow cytometry; the secreted IL-17, IL-10, and TGF-β were measured by ELISA; and the expression levels of RORγt and Foxp3 were measured by RT-PCR. ResultsCompared with the control group, OSA children exhibited a significant increase in the number of peripheral Th17 cells, Th17-related cytokine secretion (IL-17), and RORγt mRNA levels, whereas they exhibited a decrease in the number of Treg cells, Treg-related cytokine secretions (IL-10, TGF-β) and Foxp3 mRNA levels. The Th17/Treg ratio was higher (p<0.05) in the OSA groups than in the control group. The Th17/Treg ratio was correlated with the size of the adenoids. We also found that the Th17/Treg balance in OSA patients was complicated by allergic rhinitis; the increase was significantly larger in the AR group (p<0.05, p=0.021) than in OSA groups without AR. These results were observed in both the peripheral blood and local adenoid tissue. ConclusionThe Th17/Treg imbalance may increase the risk of developing OSA, and AR may promote the development of the disease. These results provide an alternative explanation for OSA pathogenesis that warrants additional research and presents new directions for the prevention and treatment of OSA in children.

Pupillometric findings in children with obstructive sleep apnea

BackgroundObstructive sleep apnea (OSA) leads to intermittent hypoxia, activation of the sympathetic nervous system, and eventually cardiovascular morbidity. Alterations in autonomic nervous system (ANS) tone and reflexes are likely to play major roles in OSA-associated morbidities, and have been identified in a subset of children with OSA. ObjectivesTo evaluate whether pupillometry, a noninvasive and rapid bedside test for the assessment of autonomic nervous system dysfunction (ANS), would detect abnormal ANS function in children with OSA. MethodsChildren ages 2–12 years underwent polysomnography (PSG), and were divided based on PSG findings into two groups; Habitual Snorers (HS; AHI < 1 h/TST, n = 17) and OSA (AHI > 1 h/TST, n = 49), the latter then sub-divided into AHI severity categories (>1 but <5, >5 but <10, and >10 h/TST). Pupillometric measurements were performed during the clinic visit in a dark room using an automated pupillometer device. ResultsA total of 66 subjects with a mean age of 7.3 ± 2.6 years were recruited. There were no statistically significant differences between any of the groups, even when comparing severe OSA (n = 15) and HS in any of the measures related to pupillary reflexes. However, mild, yet significant increases in systolic blood pressure and morning plasma norepinephrine levels were detected in the severe OSA group. ConclusionAlthough ANS perturbations are clearly present in a proportion of children with OSA, particularly those with severe disease, pupillary responses do not appear to provide a sensitive method for the detection of ANS dysfunction in OSA children.

Plasma renin levels and renin–blood pressure relationship in normal-weight and overweight children with obstructive sleep apnea and matched controls

BackgroundObstructive sleep apnea (OSA) has been increasingly linked to elevated blood pressure (BP) and hypertension. Repeated night-time hypoxia in OSA is associated with activation of two critical mechanisms of BP control: the autonomic nervous system and the renin–angiotensin system (RAS). The effects of OSA on the RAS are not well understood, especially in children. We hypothesized that children with OSA have elevated renin levels and abnormal relationships between BP and renin. MethodsPolysomnography was conducted in 173 children to diagnose OSA (apnea–hypopnea index [AHI] >1 event/h) and control (AHI ≤1 event/h) groups. Age- and gender-specific z-scores for body mass index (BMI) were calculated to divide subjects into obese (BMI ≥95%), overweight (BMI ≥85% and <95%) and normal-weight (BMI <85%) groups. Morning BP was measured with an automatic sphygmomanometer and venous blood samples were collected for measurements of plasma renin, after overnight polysomnography. ResultsPlasma renin levels were not significantly different in all four groups after adjustment of age, gender, and race. Significantly negative associations between renin and BP were present only in the normal-weight control group and were absent in the other three groups. ConclusionPlasma renin levels were not significantly increased in children with OSA compared to controls for both normal-weight and overweight subjects. The absence of normal, negative renin–BP relationships in both overweight and OSA children suggests a dysfunction of the RAS, which could be a mechanism for increased BP and the development of hypertension.

Salivary biomarkers of obstructive sleep apnea syndrome in children

The present pilot study was performed to evaluate the HPA axis and ANS activity by measuring salivary cortisol and α-amylase diurnal trajectory and production, respectively, in mild or moderate-to-severe (MS) OSA-affected, but otherwise healthy, children. Moreover, a correlative analysis was performed between the salivary biomarker concentrations and the PSG variables characterizing the OSA severity. We studied 27 consecutive OSA patients (13 mild OSA; 14 MS OSA) and seven healthy children who were enrolled as controls by collecting salivary samples and measuring cortisol and α-amylase levels using enzyme-linked bioassays. Compared with controls, both mild and MS OSA children showed: (1) increased salivary cortisol diurnal production, (2) maintenance of the physiological circadian activity of the HPA axis, and (3) no changes in α-amylase diurnal trajectory and production. In addition, morning salivary cortisol concentrations was negatively associated with the disease severity in the MS OSA group. OSA is associated with dysregulation of the HPA axis activity in children, the latter potentially underlying some of the adverse consequences of the disease.

Inflammatory markers and obstructive sleep apnea in obese children: the NANOS study.

Introduction. Obesity and obstructive sleep apnea syndrome (OSA) are common coexisting conditions associated with a chronic low-grade inflammatory state underlying some of the cognitive, metabolic, and cardiovascular morbidities. Aim. To examine the levels of inflammatory markers in obese community-dwelling children with OSA, as compared to no-OSA, and their association with clinical and polysomnographic (PSG) variables. Methods. In this cross-sectional, prospective multicenter study, healthy obese Spanish children (ages 4–15 years) were randomly selected and underwent nocturnal PSG followed by a morning fasting blood draw. Plasma samples were assayed for multiple inflammatory markers. Results. 204 children were enrolled in the study; 75 had OSA, defined by an obstructive respiratory disturbance index (RDI) of 3 events/hour total sleep time (TST). BMI, gender, and age were similar in OSA and no-OSA children. Monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1) levels were significantly higher in OSA children, with interleukin-6 concentrations being higher in moderate-severe OSA (i.e., AHI > 5/hrTST; P < 0.01), while MCP-1 levels were associated with more prolonged nocturnal hypercapnia (P < 0.001). Conclusion. IL-6, MCP-1, and PAI-1 are altered in the context of OSA among community-based obese children further reinforcing the proinflammatory effects of sleep disorders such as OSA. This trial is registered with ClinicalTrials.gov NCT01322763.

Role of adenotonsillectomy in OSAS children and behavioural disturbance

AimThe main aim of this study was to assess the presence of behavioural disturbances in child with OSAS before and after adenotonsillectomy (AT). BackgroundIn children adenotonsillar hypertrophy is associated with increased probability of OSAS. Children with OSAS present neurobehavioral disorders like attention deficit and hyperactivity, learning disabilities and daily attitudes due to excessive sleepiness. Materials and methods195 consecutive young patients suffering from OSAS and recurrent throat infections (control group) underwent AT. All underwent clinical evaluation, polysomnography, Behaviour Assessment System for Children questionnaire (BASC-2), for parents evaluation of behavioural disturbances and nasal functionality tests (before and 6 months after surgery). ResultsSnoring and nocturnal apnoea were no more present in almost all. In OSAS group before AT 12 children were normal, 4 children were borderline and 2 were clinically significant at the BASC-2. After AT 16 children were normal, 2 children were borderline and none was clinically significant according to the same questionnaire. In the control group 9 children were normal and 1 was borderline both before and after AT. ConclusionAdenoids/tonsils hypertrophy and nasal hypoventilation are frequent causes of snoring and OSAS. AT improves significantly both snoring/apnoeas and OSAS children's behavioural disturbances. Polysomnography cannot be carried out routinely due to the lack of specialised centres and because of its excessive cost. Nasal functionality tests can be useful for the differential diagnosis between sleep apnoea syndrome and other noises.

Time course of EEG slow-wave activity in pre-school children with sleep disordered breathing: A possible mechanism for daytime deficits?

Daytime deficits in children with sleep disordered breathing (SDB) are theorized to result from hypoxic insult to the developing brain or fragmented sleep. Yet, these do not explain why deficits occur in primary snorers (PS). The time course of slow wave EEG activity (SWA), a proxy of homeostatic regulation and cortical maturation, may provide insight. Clinical and control subjects (N=175: mean age 4.3±0.9 y: 61% male) participated in overnight polysomnography (PSG). Standard sleep scoring and power spectral analyses were conducted on EEG (C4/A1; 0.5-<3.9Hz). Univariate ANOVA's evaluated group differences in sleep stages and respiratory parameters. Repeated-measures ANCOVA evaluated group differences in the time course of SWA. Four groups were classified: controls (OAHI ≤ 1 event/h; no clinical history); PS (OAHI ≤ 1 event/h; clinical history); mild OSA (OAHI=1-5 events/h); and moderate to severe OSA (MS OSA: OAHI>5 events/h). Group differences were found in the percentage of time spent in NREM Stages 1 and 4 (p<0.001) and in the time course of SWA. PS and Mild OSA children had higher SWA in the first NREM period than controls (p<0.05). All SDB groups had higher SWA in the fourth NREM period (p<0.01). These results suggest enhanced sleep pressure but impaired restorative sleep function in pre-school children with SDB, providing new insights into the possible mechanism for daytime deficits observed in all severities of SDB.

Ambulatory blood pressure monitoring in children with obstructive sleep apnea and primary snoring

ObjectiveTo evaluate the systemic blood pressure (BP) during daytime and nighttime in children with sleep breathing disorders (SBD) and compare parameters of BP in children with diagnosis of obstructive sleep apnea syndrome (OSA) to those one with primary snoring (PS). MethodsChildren, both genders, aged from 8 to 12 years, with symptoms of SBD realized an overnight polysomnography followed by a 24h recording of ambulatory BP. ResultsAll subjects presented with a history of snoring 7 nights per week. Children who have apnea/hipoapnea index ≥ four or a apnea index ≥ one presented a mean BP of 93±7mmHg and 85±9mmHg diurnal and nocturnal respectively whereas children who have a apnea/hipoapnea < four or a apnea index < one presented 90±7mmHg and 77±2mmHg. Eight children out of fourteen, from OSA group, lost the physiologic nocturnal dipping of the blood pressure. Among OSA children 57% were considered non-dippers. Two (16%) have presented absence of nocturnal dipping among children with primary snoring. The possibility of OSA children loosing physiologic blood pressure dipping was 6.66 higher than the possibilities of patients from PS group. DiscussionOur results indicate that children with sleep apnea syndrome exhibit a higher 24h blood pressure when compared with those of primary snoring in form of decreased degree of nocturnal dipping and increased levels of diastolic and mean blood pressure, according to previous studies in literature. OSA in children seems to be associated to the development of hypertension or other cardiovascular disease.

Plasma IGF-1 levels and cognitive dysfunction in children with obstructive sleep apnea

Background Pediatric OSA is associated with substantial morbidity in cognitive function. However, for any given OSA severity level, altered cognitive performance may or may not be present. Since IGF-1 is neuroprotective, we hypothesized that higher systemic IGF-1 levels may identify children at lower susceptibility for cognitive morbidity. Methods Consecutive habitually snoring and non-snoring children ages 5–7 years were recruited from the community, and underwent overnight polysomnography, and neurocognitive testing and a blood draw the next morning. Snoring children were divided into OSA or no OSA, and OSA children were further subdivided into those with ⩾2 abnormal cognitive subtests and into those with normal cognitive scores. Plasma levels of IGF-1 were also measured using ELISA. Results Among snoring children without OSA, circulating IGF-1 was 910 ± 110 pg/mL compared with 1070 ± 240 pg/mL in those with OSA ( p < 0.01). However, IGF-1 was 540 ± 70 pg/mL in children with OSA and cognitive deficits, compared to 1370 ± 170 μg/L in children with OSA and normal cognitive scores ( p < 0.001). Conclusions IGF-1 levels are higher in children with OSA, particularly in those who do not manifest neurocognitive deficits, suggesting that the magnitude of the IGF-1 response elicited by OSA may play a significant protective role against the neurocognitive dysfunction associated with OSA.

Nocturnal body position in sleeping children with and without obstructive sleep apnea

To assess whether body position during sleep differs among children with obstructive sleep apnea (OSAS) and controls, and to assess the effects of body position, obesity, and tonsillar size on respiratory disturbance. Four hundred and thirty consecutive children with polysomnographically demonstrated OSAS. And 185 age-, gender-, and ethnically matched children (Controls) were compared. The effect of sleep body position on respiratory disturbance was examined in OSAS, and also in relation to obesity and tonsillar size. Children with OSAS spent more time in the supine position than Controls (P<0.01), with less time spent in the side position (P<0.005). Obstructive apnea and hypopnea index (AHI) was similar in the three sleep-related positions, but apnea index (AI) was significantly greater (4.6 +/- 0.7/hr TST) in the supine position than in the side position (2.7 +/- 0.3/hr TST; P<0.001) or prone position (3.3 +/- 0.5/hr TST; P<0.01). Tonsillar size was not a contributing factor to positional differences in AI or AHI. Obese OSAS children had increased prone position (20.4 +/- 2.0%TST vs. non-obese: 10.9 +/- 2.5%TST; P<0.05), and displayed increased AHI and AI while supine. Non-obese OSAS increased AHI in prone or side positions compared to supine (P<0.01), with no significant differences in position-dependent AI. Children with OSAS spend more time sleeping supine and less time on the side. Obese children with OSAS are more likely to sleep prone, suggesting that this position may promote upper airway patency in the presence of obesity. Although tonsillar size is not associated with positional differences in breathing, the presence or absence of obesity markedly modifies the effect of body position on respiratory disturbance.