OSA In Children Research Articles

Pediatric obstructive sleep apnea diagnosis: leveraging machine learning with linear discriminant analysis.

The objective of this study was to investigate the effectiveness of a machine learning algorithm in diagnosing OSA in children based on clinical features that can be obtained in nonnocturnal and nonmedical environments. This study was conducted at Beijing Children's Hospital from April 2018 to October 2019. The participants in this study were 2464 children aged 3-18 suspected of having OSA who underwent clinical data collection and polysomnography(PSG). Participants' data were randomly divided into a training set and a testing set at a ratio of 8:2. The elastic net algorithm was used for feature selection to simplify the model. Stratified 10-fold cross-validation was repeated five times to ensure the robustness of the results. Feature selection using Elastic Net resulted in 47 features for AHI ≥5 and 31 features for AHI ≥10 being retained. The machine learning model using these selected features achieved an average AUC of 0.73 for AHI ≥5 and 0.78 for AHI ≥10 when tested externally, outperforming models based on PSG questionnaire features. Linear Discriminant Analysis using the selected features identified OSA with a sensitivity of 44% and specificity of 90%, providing a feasible clinical alternative to PSG for stratifying OSA severity. This study shows that a machine learning model based on children's clinical features effectively identifies OSA in children. Establishing a machine learning screening model based on the clinical features of the target population may be a feasible clinical alternative to nocturnal OSA sleep diagnosis.

The effect of continuous positive airway pressure on obstructive sleep apnea in children with syndromic craniosynostosis

BackgroundObstructive sleep apnea (OSA) is common in children with syndromic craniosynostosis (SC). However, objective data on the treatment of OSA in children with SC remain inadequate. This study aimed to explore the efficacy of continuous positive airway pressure (CPAP) in the management of OSA in children with SC.MethodsA retrospective study was performed in children with SC and OSA diagnosed by polysomnography (PSG), which was defined as an apnea hypopnea index (AHI) ≥ 1. Patients were included if they were treated with CPAP and had baseline PSG and follow-up sleep studies. Clinical and demographic data were collected from all enrolled subjects.ResultsA total of 45 children with SC and OSA were identified, with an average age of 6.8 ± 4.7 years. Among them, 36 cases had moderate to severe OSA (22 with severe OSA) and received CPAP therapy followed by post-treatment sleep studies. Notably, there was a significant reduction in the AHI observed after CPAP treatment (3.0 [IQR: 1.7, 4.6] versus 38.6 [IQR: 18.2, 53.3] events/h; P < 0.001).ConclusionsCPAP is effective and acceptable in treating severe OSA in children with SC.

A Scoping Review of Clinical Approach and Personalized Management of Obstructive Sleep Apnea

Abstract Obstructive sleep apnea (OSA) is common yet frequently underdiagnosed. It not only impairs the sleep quality but also associated with multiple comorbidities. This review article aims at providing an update on the diagnosis and management of OSA through a personalized approach. The prevalence of OSA is more in males than premenopausal females (almost 3:1–5:1) and this equalises after menopause. History taking in OSA should focus not only on symptoms such as snoring, choking, dryness of mouth, and daytime somnolence but also on comorbidities. Various options and levels of polysomnography are currently available and newer options being explored to make OSA assessment more simpler, accessible, and feasible. Traditional approach included assessment of oropharyngeal anatomy, pulmonary system, and anthropometry. Alternatively, personalized approach involves scoring based on Pcrit, Arousal threshold, Loop gain and Muscle responsiveness (PALM Scale) scale and offering customized options for the management. In addition to newer modalities in surgical approach to OSA, promising results have been noted with medical therapy with Solriamfetol and Dronabinol. OSA in children has been linked with various comorbidities and is notably different from adult OSA. With the increasing literature on various endophenotypes of OSA, the onus is on the physician to evaluate the patient and categorize appropriately for personalized treatment.

The management of residual OSA post-adenotonsillectomy in children with down syndrome: The experience of a large tertiary sleep service

IntroductionObstructive Sleep Apnoea (OSA) is common in children with Down Syndrome (DS). Adenotonsillectomy is regarded as first line treatment for OSA but does not always lead to resolution of symptoms in this group of children. Management of residual OSA is variable with no existing recommendations to guide clinical practice. AimTo describe the experience of a large tertiary sleep service in managing residual OSA in children with DS following upper airway surgery (adenotonsillectomy, adenoidectomy or tonsillectomy). MethodsA retrospective study of children who were under evaluation at the Queensland Children's Hospital sleep medicine department between October 2013 to April 2022 for residual OSA, after upper airway surgery was undertaken. Results148 children with DS who underwent polysomnography for evaluation of OSA were identified. 100 were included in this study and of these, 77 underwent adenotonsillectomy, 19 adenoidectomy, and 4 tonsillectomy. Post-surgical PSG data of all 100 children showed residual mixed sleep disordered breathing in 68 children. 41 were recommended CPAP following surgery, while 21 underwent further surgery. ConclusionsResidual OSA was confirmed to be highly prevalent in children with DS who had already undergone upper airway surgery for OSA. This study identified that CPAP is possible to establish in most children with DS and can be used to manage residual OSA in this population. Approximately one-third of this group were able to discontinue therapy at a median duration of 18 months, suggesting resolution of disease with time can occur in some children.

0815 Utilization of Telemedicine visits in a Pediatric Sleep Center and the Effect on PAP Adherence Rates

Abstract Introduction Although positive airway pressure (PAP) is an effective treatment for OSA, adherence is often suboptimal. Consistent follow up is needed to address barriers to adherence; however, in-person clinic attendance in our center has been low and was further reduced during the COVID-19 pandemic. Suboptimal adherence may result in cessation of reimbursement by insurance, leaving OSA untreated. Untreated OSA in children can lead to behavior and learning problems, impaired growth and cardiovascular complications. Due to the decrease in show rates, in-home telemedicine visits were offered in lieu of in-person visits. Methods A retrospective chart review was performed for children with OSA seen in the pediatric sleep clinic from March 2020 and October 2022. Subjects were excluded from analysis if they did not transition to telemedicine. Telemedicine visits were conducted in the same manner as in-person visits. PAP usage after telemedicine was compared to in-person visits. Adherence was reported as percent of total usage and percent of usage greater than four hours (U&amp;gt;4h) per night. Results Three hundred nineteen charts were reviewed of whom the majority were male (69.9%). The median age (interquartile range) at PAP initiation was 12 years (7-15). Seventy eight subjects were included in the analysis. Mean U&amp;gt;4h and total usage decreased when subjects transitioned from in-person to telemedicine visits (4.18% ± 26.7, p=0.17 (3.08% ± 22.5, p=0.23), respectively. These differences were not significant. 36 subjects (46%) had &amp;lt; ± 5% change in total adherence, 23 (29%) had &amp;gt; 5% increase in total adherence, and 19 (24%) had &amp;gt; 5% decrease. When comparing change in U&amp;gt;4h, 29 (37%) subjects had &amp;lt; ± 5% change in adherence, 22 (28%) had &amp;gt; 5% decrease, and 27 (35%) had &amp;gt; 5% increase in adherence. Conclusion There were no statistically significant differences in adherence rates between telemedicine and in-person visits. Adherence improved in some children on transition from in-person to telemedicine visits. Utilization of in-home telemedicine visits may be a useful alternative for some children treated with PAP. Further studies are needed to determine which specific patient populations may benefit most from in-home telemedicine visits. Support (if any)

0800 Pediatric PSG Flagging Etiologies and Impact on Clinical Timeline

Abstract Introduction There is a paucity of literature regarding “flagged PSGs”, a term used to triage emergent PSGs for expedited scoring and reporting. Given the morbidity and multi organ-system dysfunction of untreated OSAS in children, it is extremely important to identify and treat expediently. The aim of this study was to review flagged PSGs at a tertiary level pediatric sleep center, including management and intervention timelines. Methods This is an IRB-approved retrospective chart review of flagged PSGs (N=266) over a three-year period (2019-2022) at a pediatric sleep center. PSGs were flagged based on laboratory protocols and provider discretion. Demographic, clinical, and PSG data were obtained from EMR. Results Patients with flagged studies were white (49.2%), non-Hispanic (87.2%), males (66.9%) with (mean ± SD) age (6.9 ± 6.0) years and BMI of (23.3 ± 11.6) kg/m2, respectively. Reasons for flagging studies were repetitive brief oxygen desaturations &amp;lt; 80% (46.6%), sustained desaturations &amp;lt; 85% (32.3%), sustained EtC02 &amp;gt;60mmHg (5.6%), or other concerning events (15.5%). Most common comorbidity was pulmonary (41.4%), followed by genetic (30.5%), cardiac (23.3%), and neuromuscular (11.7%). 23.3% children were obese. 30.1% had prior airway surgeries; most commonly being adenotonsillectomy (70.0%). Mean Apnea-hypopnea index was 47.2 ± 36.1 events/hr. 35% children had hypoxemia and 36.8 % had hypoventilation. Time duration from flagging study to finalized report, surgical, or medical intervention was 4.3 ± 6.0, 78.2 ± 105 and 26.6 ± 93.0 days, respectively. Medical (40.6%) and surgical (37.9%) intervention were similar in frequency; however, children &amp;lt; 8 were more likely to undergo surgery (p&amp;lt; 0.001). Most frequent surgical intervention was adenotonsillectomy (82.1%). Patients with AHI&amp;gt;30 had less time between PSG and surgical intervention (65.3 ± 96.7 days vs 112 ± 119 days, p=0.04). Conclusion Most frequent reason for flagging PSG was repetitive brief desaturations. Time to surgical intervention was longer than medical intervention; however, they occurred in similar frequency. Pandemic staffing shortages and PAP machine recalls impacted both interventions. Patients with higher disease severity experienced quicker scoring, report finalization, and surgical intervention. Future directions include establishing protocols between sleep laboratory and surgical teams, assess the impact of this and further streamline care. Support (if any)

A Literature Review Applying the Social-Ecological Framework for Black Children with OSA

Aim&#x0D; The purpose of this literature review is to compile an up-to-date overview of the academic literature on the parental detection of OSA in children and its subsequent diagnosis and treatment. The existing literature serves as evidence for this phenomenon, which is explored using the social ecological model as a framework for inquiry.&#x0D; &#x0D; Methodology&#x0D; A literature search was performed using PubMed and Google Scholar between July and August 2020 and July 2022 to assess the various factors affecting parental detection of obstructive sleep apnea in their children. Different combinations of keywords such as “health disparities”, “racial disparities”, “racial differences”, “implicit bias”, “pediatric OSA”, “adult OSA”, “pediatric obstructive sleep apnea”, “pediatric sleep health”, “OSA treatment”, “OSA diagnosis”, “OSA detection” and “parental experiences” were used to find relevant studies and reviews.&#x0D; Results&#x0D; OSA knowledge is important for detection by parents, family members, and teachers who are constantly around children. They are the main interpersonal supports that detect OSA and prevent delay in detection. The community support roles are health care providers and specialists that can monitor the progression of OSA and ensure adequate treatment. Additionally, the access of children to care can act as a barrier of OSA treatment.&#x0D; Conclusions&#x0D; Black children experience pediatric OSA severity more than their white counterparts based on the factors outlined in the socio-ecological framework.&#x0D;

Diagnosis of obstructive sleep apnea in children based on the XGBoost algorithm using nocturnal heart rate and blood oxygen feature

PurposeObstructive sleep apnea (OSA) is a serious type of obstructive sleep-disordered breathing (SDB) that can cause a series of adverse effects on children's cardiovascular, growth, cognition, etc. The gold standard for diagnosis is polysomnography (PGS), which is used to assess the prevalence of OSA by obtaining the apnea-hypopnea index (AHI), but this diagnosis method is expensive and needs to be performed in a specialized laboratory, making it difficult to be of benefit to children with suspected OSA on a large scale. Our goal was to use a machine learning method to identify children with OSA of varying severity using data on children's nighttime heart rate and blood oxygen data. MethodsThis study included 3139 children who received diagnostic PSG with suspected OSA. Age, sex, BMI, 3 % oxygen depletion index (ODI), average nighttime heart rate and fastest heart rate were used as predictive features. Data sets were established with AHI ≥ 1, AHI ≥ 5, and AHI ≥ 10 as the diagnostic criteria for mild, moderate and severe OSA, and the samples of each data set were randomly divided into a training set and a test set at a ratio of 8:2. An OSA diagnostic model was established based on the XGBoost algorithm, and the ability of the machine learning model to diagnose OSA children with different severities was evaluated through different classification ability evaluation indicators. As a comparison, traditional classifier Logistic Regression was used to perform the same diagnostic task. The SHAP algorithm was used to evaluate the role of these features in the classification task. ResultsWe established a diagnostic model of OSA in children based on the XGBoost algorithm. On the test set, the AUCs of the model for diagnosing mild, moderate, and severe OSA were 0.95, 0.88, and 0.88, respectively, and the classification accuracy was 90.45 %, 85.67 %, and 89.81 %, respectively, perform better than Logistic Regression classifiers. ODI is the most important feature in all classification tasks, and a higher fastest heart rate and ODI make the model tend to classify samples as positive. A high BMI value caused the model to tend to classify samples as positive in the mild and moderate classification tasks and as negative in the classification task with severe OSA. ConclusionUsing heart rate and blood oxygen data as the main features, a machine learning diagnostic model based on the XGBoost algorithm can accurately identify children with OSA at different severities. This diagnostic modality reduces the number of signals and the complexity of the diagnostic process compared to PSG, which could benefit children with suspected OSA who do not have the opportunity to receive a diagnostic PSG and provide a diagnostic priority reference for children awaiting a diagnostic PSG.

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 impact of obstructive sleep apnea on growth in patients with syndromic and complex craniosynostosis: a retrospective study

Given the high prevalence of OSA in children with syndromic and complex craniosynostosis (SCC) and the consequences of untreated OSA, it is important to assess their nutritional status and growth. Yet, literature regarding growth in children with SCC remain scarce. Therefore, this study aimed to (1) illustrate the growth pattern in SCC, (2) determine the impact of OSA on this growth pattern, and (3) evaluate the effect of surgical treatment of OSA on growth over time. A retrospective study was performed in children with SCC, who were treated at the Dutch Craniofacial Center (Rotterdam, Netherlands). Growth variables (height, weight, weight-for-age standard-deviation-score (SDS), weight-for-height SDS, and height-for-age SDS) and degree of OSA (obstructive apnea–hypopnea index) were assessed. Of the 153 children with SCC, 38 (25%) were acutely malnourished at some point during follow-up, of whom 21 had disease-related acute malnutrition. Children with moderate-severe OSA had significant lower weight-for-height SDS compared to children without OSA (p = 0.0063). Growth parameters (weight-for-age SDS, weight-for-height SDS, height-for-age SDS) in children with SCC without OSA were not impaired as they did not differ from the normal healthy population, with exception of the patients with Saethre-Chotzen syndrome (SCS) who had a significantly lower SDS for height-for-age. Conclusion: Children with SCC have a substantial chance of developing acute malnutrition at some point during growth. Additionally, in children with moderate-severe OSA, a significant lower SDS for weight-for-height is present, indicating the importance of assessing the weight and growth pattern in children who are clinically suspected for OSA.What is Known:• Obstructive sleep apnea is seen in up to two-thirds of the children with syndromic and complex craniosynostosis.• Presence of obstructive sleep apnea is associated with intracranial hypertension and an increased risk of metabolic, cardiovascular, and neurocognitive consequences later in life. Untreated obstructive sleep apnea may lead to impaired growth and weight gain, which can result in growth failure.What is New:• Craniosynostosis patients with moderate-severe obstructive sleep apnea had significant lower weight-for-height standard deviation scores (SDS), compared to children without obstructive sleep apnea. • Children with syndromic and complex craniosynostosis without OSA did not significantly differ from the normal healthy population in regard to weight-for-age SDS, weight-for-height SDS, and height-for-age SDS.

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 1mm 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 (2.90mm:2.59mm) at canine and 1.37:1 (3.98mm:2.91mm) 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.

0545 Metabolic Variables and the severity of Obstructive Sleep Apnea in non-obese children

Abstract Introduction Obstructive sleep apnea (OSA) can be associated with abnormal metabolic variables that may impact the overall health of the child into adulthood. Prior studies have focused on understanding the relationship of obesity, OSA, and metabolic alterations. Understanding the relationship of OSA and metabolic alterations in normal-weight children would improve understanding of the health impact of OSA in and of itself. The Objective of this study was to evaluate the association of OSA and metabolic variables, including lipid levels, blood glucose, and HbA1c in normal-weight children with OSA. Methods Prospective, case-control study performed at a tertiary care children’s hospital. Normal-weight children, aged 2-12 years, undergoing overnight polysomnography (PSG) for assessment of sleep disordered breathing were selected for participation in the study. Laboratory testing for lipid levels, fasting glucose, HbA1c were completed and analyzed relative to the PSG findings. Results A total of 61 patients with a mean age of 4.7±2.5 years were analyzed. Thirty-four (55.7%) patients were male, and 27 (44.3%) were female. The mean body mass index (BMI) z score was 0.5±1.2, and all patients were non-obese (BMI z score &amp;lt;85th percentile). Total cholesterol, fasting blood glucose, HbA1c levels were significantly higher in patients with OSA when compared to those with No-OSA (p&amp;lt;0.01). There was incremental worsening of blood glucose and HbA1c levels with greater severity of OSA. The apnea-hypopnea index (AHI) was positively and significantly correlated with blood glucose and HbA1c (p&amp;lt;0.001). Multiple linear regression analysis showed that the AHI was a predictor of blood glucose (p&amp;lt;0.001) and HbA1c (p&amp;lt;0.001) levels independent of age, gender, total sleep time, and BMI z score. Conclusion Increasing severity of OSA in non-obese children was associated with worsening levels of cholesterol, blood glucose, and HbA1c. This points to the importance of addressing the issue of OSA in children given the potential impact of these elevated levels on the overall health of the child. Support (If Any) None

Preliminary experience of surgical treatment for torus tubarius hypertrophy in children

Objective: To assess the incidence of symptomatic torus tubarius hypertrophy (TTH) in recurred OSA in children, and to explore the preliminary experience of partial resection of TTH assisted with radiofrequency ablation. Methods: From January 2004 to February 2020, 4 922 children, who diagnosed as OSA and received adenotonsillectomy at the Department of Otolaryngology, The 4th Medical Center of the PLA General Hospital, were retrospectively reviewed. There were 3 266 males and 1 656 females, the age ranged from 1 to 14 years old(median age of 5.0 years). Twenty-two cases were identified with recurrence of OSA syndrome, and the clinical data, including sex, age of primary operation, age of recurrence and presentation, and opertation methods were analyzed. Follow-up was carried out by outpatient visit or telephone. Graphpad prism 5.0 software was used for statistical analysis. Results: Twenty-two cases were identified as recurred OSA and received revised surgery in 4 922 cases. Among these 22 cases, 11 cases were diagnosed as TTH resulting in an incidence of 2.23‰(11/4 922), 1 case was cicatricial adhesion on tubal torus (0.20‰, 1/4 922), 10 cases were residual adenoid combined with tubal tonsil hypertrophy (2.03‰, 10/4 922). Median age of primary operation was 3.0 years (range:2.4 to 6.0 years) in 11 TTH cases. Recurrent interval varied from 2 months to 5.5 years (2.4±1.9 years) after first operation. Age of revised partial resection of TTH was 7.0±2.7 years (range: 4.0 to 12.0 years). Average time interval between primary operation and revised operation was 3.5±2.1 years (range: 0.5 to 6.0 years). Individualized treatments were carried out based on partial resection of TTH assisted with radiofrequency ablation. All of 11 cases received satisfied therapeutic results without nasopharyngeal stenosis occured. Twenty-two cases were followed up for 1.6 to 13 years (median follow-up time was 6.2 years). Conclusions: TTH contributed to recurred OSA in child. TTH might be misdiagnosed as tubal tonsil hypertrophy. Partial resection of TTH assisted with radiofrequency ablation was a safty and effective treatment.

Trends in Diagnosing Obstructive Sleep Apnea in Pediatrics.

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, especially with the emergence of wearable technology. In this article, we aim to look at the presentation, physical exam, screening questionnaires and current different modalities used to aid in the diagnosis of OSA in children.

The outcome of managing sleep apnea in children with cerebral palsy

BackgroundObstructive sleep apnea (OSA) is not an uncommon finding in the pediatric age group patients with cerebral palsy (CP).ObjectiveWe aimed to evaluate the frequency of occurrence of OSA in children with CP and the most appropriate surgical procedures used in these patients.Study designA prospective study was carried out on 67 children with OSA, 36 of whom suffer from CP. The data included the presenting complaint, any coexisting illnesses, preoperative and postoperative polysomnography results, the primary surgical procedure performed, age at the time of surgery, number of postoperative hospitalization days in the ICU, and presence of postoperative respiratory disorders.ResultsIn all, 40 (59.7%) children underwent adenotonsillectomy for initial treatment of OSA. Our results reported that the clinical manifestations were more significant in the CP-affected children. We documented a significant decrease in the mean value of the apnea hypoxia index in all included children postoperatively. However, there was no significant difference in apnea hypoxia index postoperatively among children in both groups. Nine (17.4%) children had an adenoidectomy alone and 18 (26.86%) children had tonsillectomy alone as their initial procedure. Neither uvulopalatopharyngoplasty nor tracheostomy was performed as an initial procedure. The mean follow-up was set for 24 months. Eighty-six percent of these children have not required any further surgery. Of the six children who have undergone further surgery, one required a revision adenoidectomy, and two underwent a tonsillectomy and uvulectomy 2 months after the initial adenoidectomy. Four CP children later required a tracheotomy for severe hypoxia.ConclusionOSA is a more frequent occurrence in CP children as compared with their healthy counterparts. They ultimately had significant improvement in their clinical presentations postoperatively, thus improving their quality of life.

Expression and clinical significance of IL-33 and its receptor ST2 in children with obstructive sleep apnea syndrome.

BackgroundObstructive sleep apnea syndrome (OSAS) is characterized by a majority population of respiratory sleep disorders, which consists of simple snoring as well as increased upper airway resistance syndrome. Adenoid hypertrophy has been suggested as the main cause of OSAS in children. The role of interleukin-33 (IL-33) and its receptor suppressor of tumorigenicity 2 (ST2) in a variety of pediatric allergic diseases has been confirmed. We hypothesized that IL-33/ST2 path way might play a pivotal role in the pathogenesis of adenoid hypertrophy-associated OSAS in children.MethodsA total of 40 children undergoing adenoidectomy due to OSAS in the Otolaryngology of Tianjin Children’s Hospital were selected as the study participants. The quantity of IL-33 and ST2 positive cells in adenoids was detected by immunohistochemical (IHC) streptavidin-peroxidase conjugate (SP) method.ResultsThe IL-33 positive cells were mainly distributed in the submucosa epithelium and vascular endothelium, and expressed in the nucleus and cytoplasm. Meanwhile, ST2 positive cells were primarily observed in the mucosa and expressed in the nucleus and cytoplasm, with a little expression of intercellular substance. There was a positive correlation between the proportion of adenoids in the posterior nostril diameter and the number of IL-33 positive cells. The expression of IL-33 in adenoids was positively correlated with the level of ST2 (r=0.809, P=0.000). The expression of IL-33 in adenoids was positively correlated with the level of eosinophil granulocyte (r=0.859, P=0.000). Moreover, the expression of ST2 in adenoids was positively correlated with the level of eosinophil granulocyte (r=0.814, P=0.000). The number of IL-33 positive cells was significantly higher in the moderate hypoxemia group than that in the mild hypoxemia group (P<0.05). There was no significant difference in the number of ST2 positive cells between the moderate hypoxemia group and mild hypoxemia group (P>0.05).ConclusionsBoth IL-33 and its receptor ST2 were expressed in adenoids of OSAS children. The severity of airway obstruction caused by adenoid hypertrophy was positively correlated with the expression of IL-33.

WRISTOX2 is a reliable tool to diagnose obstructive sleep apnoea syndrome

IntroductionOvernight pulse oximetry is an alternative to polysomnography (PSG) in diagnosing obstructive sleep apnoea syndrome, but its sensitivity is reported to be low. AimsTo determine the (a) diagnostic accuracy, interobserver reliability and reliable oxygen desaturation index of 4% (ODI4) score at diagnosing obstructive sleep apnoea syndrome in children and (b) correlation between the apnoea hypopnoea index (AHI) with ODI4 and oxygen nadir between both PSG and oximetry. MethodsThis cross-sectional study included children aged 1–18 years old, undergoing a fully attended overnight PSG for suspected obstructive sleep apnoea syndrome. The Nonin 3150 WristOx2 ™ [Fig. 2] was worn simultaneously during the PSG. Poor oximetry recordings were excluded. Pulse oximetry was scored using the McGill Oximetry Score (MOS) whereby a score of 2–4 was positive for OSAS. Specificity, sensitivity, positive predictive values (PPV), negative predictive values (NPV) and interobserver reliability of the WristOx2 were calculated. ResultsOne hundred and sixty-two children with a mean (SD) age of 9.3 (±3.5) years (range 2 years 6 months old - 17 years old) were included after excluding 18 children (poor oximetry data [n = 16] and incomplete PSG [n = 2]). Interobserver agreement of the WristOx2 was 0.8763 (95% CI:0.80, 0.95). WristOx2 had a sensitivity 50%, specificity 96.7%, PPV 96% and NPV 53% at diagnosing OSAS. ODI4 ≥ 2 events/hour in oximetry had a sensitivity of 97.6% and negative predictive value of 85.7% at diagnosing OSA. ConclusionOvernight pulse oximetry with the Nonin 3150 WristOx2 ™ is an accurate and reliable tool in diagnosing significant OSAS in children.

Long-term stability of hypoglossal nerve stimulation for the treatment of obstructive sleep apnea in children with Down syndrome

ImportanceObstructive sleep apnea (OSA) occurs in 55–97% of people with Down syndrome (DS). Even after adenotonsillectomy, residual OSA often persists into adulthood due, in part, to tongue base collapse. Implantable hypoglossal nerve stimulators are being investigated in children and young adults with DS and persistent, moderate to severe OSA. However, the long-term necessity for such an intervention—especially as patients mature and voltage adjustment becomes warranted—has not been previously reported in the pediatric DS population. ObjectiveTo assess the long-term need for implantable hypoglossal nerve stimulators and the necessity for voltage adjustment in children and young adults with Down syndrome. DesignThis is a case series from an ongoing clinical trial assessing safety and efficacy of hypoglossal nerve stimulation among 42 children and young adults with DS and persistent OSA, despite adenotonsillectomy and trialed positive airway pressure (PAP) therapy. We focus here on the first 4 participants who have undergone implantation by age 13 and have completed at least 44 months of follow-up. Participants4 participants (2 male, 2 female; ages 10–13 years) with DS and persistent, severe OSA (AHI > 10 events/h) underwent hypoglossal nerve stimulator implantation and were followed for 44–58 months. SettingParticipants completed in-lab sleep studies at baseline (before implantation), 1 year postoperatively, and 44–58 months postoperatively. During their most recent follow-up, 2 participants completed split-night sleep studies in which assessment was done with the device both on and off. InterventionsHypoglossal nerve stimulator implantation. Main outcomes and measuresStability in titrated and untitrated OSA as measured by the apnea–hypopnea index (AHI); growth measures including BMI; and quality of life as measured by the OSA-18 questionnaire. ResultsCompared to baseline, all 4 participants maintained reductions of at least 50% in AHI over the course of follow-up. At recent follow-up, two participants had persistent, moderate OSA despite stimulation therapy. The other two participants achieved 100% reductions in AHI with stimulation therapy; when they underwent split-night sleep studies, the severe OSA persisted with the device turned off. Improvement in OSA-18 quality of life scores was observed in three of the four participants. Conclusionand Relevance: Hypoglossal nerve stimulation continues to effectively control OSA in children with DS as they mature, while their underlying untitrated OSA appears to persist into adulthood. Trial registrationclinicaltrials.gov Identifier: NCT2344108.

Unscheduled health care visits in children with obstructive sleep apnea and the impact of positive airway pressure therapy

PURPOSE: Untreated OSA in children leads to health complications and unscheduled acute health care visits. We aimed to determine the frequency of unscheduled health care visits and costs in children with OSA and the impact of PAP therapy. METHODS: We linked the sleep database at the Children’s Hospital of Eastern Ontario, in Ottawa, Canada, with provincial health administrative data between April 1, 2009 and March 31, 2013. We compared mean annual unscheduled health care visits in a cohort of children 0 − 7 years old with OSA who were eligible for PAP therapy to matched controls without OSA. We further compared unscheduled visits and costs 12 months after starting PAP in this same cohort. RESULTS: We matched 45 children with untreated OSA with 90 controls. Children with OSA had a higher mean number of emergency department visits (1.18/year vs 0.63/year, p < 0.01) and hospital admissions (0.62/year vs. 0.14/year, p < 0.01) compared to controls. The mean number of emergency department visits (1.13/year vs. 0.86/year, −0.27 mean difference, 95%CI −0.71, 0.17), hospitalizations (0.76/year vs 0.55/year, −0.2 mean difference, 95%CI =-.57, 0.17), and mean annual health care costs did not change significantly after initiation of PAP therapy. CONCLUSIONS: We observed that children with untreated OSA have a higher frequency of unscheduled acute health care visits, but the initiation of PAP did not significantly reduce this.

632 Family History of Children Diagnosed with Obstructive Sleep Apnea

Abstract Introduction Limited evidence suggests a familial association of OSA. It is not known how often children who require positive airway pressure (PAP) devices have a family member with OSA or that requires PAP. It is felt that PAP adherence in children is affected by PAP adherence in parents. We wanted to explore the relationship of OSA in children requiring PAP to OSA in immediate family members as well as the association of obesity and adherence between children and family members. Methods Caregivers of children who utilize PAP devices at home were invited to complete an electronic questionnaire regarding family history of OSA. Descriptive statistics were utilized to summarize results. Results The study was completed by 75 participants. The majority of children were male (64%, 48/75), black (47%, 35/75) and non-Hispanic (88%, 66/75). The mean age was 11.8 years (median 13) and mean BMI was 32.8 (median 29.8). The mean AHI on the diagnostic polysomnogram was 28.4 events per hour (median 15.3). Mean adherence to PAP &amp;gt; 4 hours per night was 56.5 (Median 68.2). Most, 87% (65/75), have other underlying medical problems. Twenty-four percent (18/75) have a biological father with OSA of whom 61% (11/18) are considered moderately/extremely obese. Of mothers, 13% (10/75) have OSA and 70% (7/10) are obese. Overall, 29% (22/75) had either a paternal (11%, 8/75) or maternal (19%, 14/75) grandfather with OSA of which 36% (8/22) are obese. For grandmothers, 31% (23/75) have OSA and 22% (5/23) are obese with more being paternal (19%, 14/75) compared to maternal (12%, 9/75). Of the 73 total family members reported to have OSA, 86% (63/73) use PAP and most (65%, 41/63) use it for &amp;gt; 4 hours every night. Few participants had siblings with OSA. Conclusion There were more fathers with OSA than mothers, but mothers were reported to be obese more often. Grandparents were reported to have OSA but were reported to be obese less often than parents. Maternal grandparents with OSA were reported to be obese more than paternal grandparents. The majority of family members with OSA who use CPAP report nightly use. Support (if any):