Pediatric Obstructive Sleep Apnea Hypopnea Syndrome Research Articles

The efficacy of different treatment approaches for pediatric OSAHS patients with mandibular retrognathia: study protocol for a multicenter randomized controlled trial

BackgroundPediatric obstructive sleep apnea/hypopnea syndrome (OSAHS) is a multifactorial syndrome caused by many risk factors, such as craniofacial anomalies, adenotonsillar hypertrophy, obesity, and airway inflammation. Although new treatment patterns have recently been proposed, treatment methods for children remain particularly challenging and controversial. This randomized controlled trial was designed to investigate the efficacy of adenotonsillectomy and/or orthodontic treatment for children who have mild OSAHS with mandibular retrognathia.MethodsA sample of 352 children with mild OSAHS and mandibular retrognathia, who are aged between 7 and 10 years, will be enrolled in the study. They will be randomized into four groups: the drug treatment group, the surgical treatment group, the orthodontic treatment group, or the surgery and postoperative orthodontic group. After randomization the children will receive treatments within 4 weeks. Outcome assessment will take place at the following points: (1) baseline, (2) 7 months after the treatment starting point, (3) 12 months after the treatment starting point, and (4) 24 months after the treatment starting point. The primary endpoint of the trial is the mean change in obstructive apnea/hypopnea index. Other endpoints will consist of the lowest oxygen saturation, apnea index, and hypopnea index assessed by polysomnography, subjective symptoms (assessed by the OSA-20 questionnaire), cephalometric measurements, and morphologic analysis of the upper airway.DiscussionThe results of this study will provide valuable evidence for the merits and long-term efficacy of different treatment approaches and contribute to facilitating the multidisciplinary treatment of pediatric OSAHS.Trial registrationClinicalTrials.gov: NCT03451318. Registered on 2 March 2018 (last update posted 19 April 2018).

Evaluation of retinal vasculature before and after treatment of children with obstructive sleep apnea-hypopnea syndrome by optical coherence tomography angiography.

To evaluate the effect of adenoidectomy on the brains of children with obstructive sleep apnea-hypopnea syndrome (OSAS) through observation of the alteration of retinal perfusion by optical coherence tomography angiography (OCTA). Sixty-two children with OSAS (124 eyes; 5.94 ± 1.64years old; 53.2% boys) were enrolled in this study. Their retinal vascular network density indices, including vascular diameter (VD), vascular area density (VAD), vessel skeleton density (VSD), vessel perimeter index (VPI) on the macular superficial/deep capillary plexus (SCP/DCP), and the size of the foveal avascular zone (FAZ) were analyzed by OCTA before treatment and at 1month after the adenoidectomy. After the adenoidectomy, the values of VD, VAD, VSD, and VPI in the SCP/DCP of the parafovea were significantly increased (p < 0.01). The FAZ was significantly diminished in the SCP (t = 4.50, p < 0.05) and increased in the DCP (t = - 4.43, p < 0.05). The peripapillary indices in the SCP/DCP were not significantly changed (p > 0.05). By improvement of hypoxia, the response of the parafoveal vessels was more sensitive than that of the peripapillary region in children with OSAS. Therefore, OCTA may be an ideal method to evaluate the changes of the retinal vascular system, which could be an effective parameter for the early evaluation of adenoidectomy on cases of pediatric OSAS.

Risk factors associated with obstructive sleep apnea-hypopnea syndrome in Chinese children: A single center retrospective case-control study.

Pediatric obstructive sleep apnea-hypopnea syndrome is caused by multiple factors. The present study aimed to investigate the potential risks of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) and their correlation with the disease severity. A total of 338 pediatric patients with OSAHS (polysomnography (PSG) diagnosis) were enrolled between June 2008 and October 2010. These pediatric patients were divided into mild, moderate and severe subgroups according to the obstructive apnea index (OAI) and/or apnea hypoventilation index (AHI). A total of 338 pediatric patients with vocal nodules who were without obstruction of the upper respiratory tract were enrolled as the control group. The patients were analyzed retrospectively. The average number of upper respiratory tract infections each year and tonsil hypertrophy, adenoid hypertrophy, positive serum tIgE, chronic sinusitis, nasal stenosis, craniofacial features and obesity were significantly higher in OSAHS compared with controls (P<0.01). The parameters the average number of upper respiratory tract infections each year (OR: 1.395, 95% CI: 1.256–1.550), adenoid hypertrophy (OR: 8.632, 95% CI: 3.990–18.672), tonsil hypertrophy (OR: 9.138, 95% CI: 4.621–18.073), nasal stenosis (8.023, 95% CI: 3.633–17.717) and chronic sinusitis (OR: 27.186, 95% CI: 13.310–55.527) were independent factors of pediatric OSAHS (P<0.01). The distribution of chronic sinusitis, nasal stenosis, craniofacial features and obesity indicated a gradual increasing trend in the severity of OSAHS (P<0.01). Number of upper respiratory tract infections per year, adenoid hypertrophy, tonsil hypertrophy, chronic sinusitis, nasal stenosis, infections, allergic reactions, craniofacial features and obesity may be potential risk factors of pediatric OSAHS.

Clinical Predictors of Pediatric Obstructive Sleep Apnea Syndrome.

To develop an adequate model using reliable clinical and physical factors to predict pediatric obstructive sleep apnea/hypopnea syndrome (OSAS). Complete anthropometric measurements including BMI z score, tonsil size grading, and updated Friedman tongue position (uFTP) were evaluated. Subjective assessments of clinical symptoms/signs, including snoring visual analog scale (VAS), nasal obstruction, and mouth breathing, were recorded. Eighty-eight children (57 boys and 31 girls, mean age = 9.0 years) were confirmed to have OSAS by comprehensive polysomnography (PSG). When the aforementioned variables were analyzed individually, the results indicated that snoring VAS, nasal obstruction, mouth breathing, and BMI z score were reliable predictors of apnea/hypopnea index (AHI/h) values (correlation coefficient r = 0.386, P < .001; r = 0.416, P < .001; r = 0.255, P = .02; and r = 0.243, P = .02, respectively). When all significant factors were included in the stepwise multiple linear regression analysis, the final predictive model is: Pediatric AHI = 0.108 + 0.103 snoring VAS + 0.894 nasal obstruction + 0.207 BMI z score ( F = 4.06, P = .01). The proposed noninvasive, simple, inexpensive, and easy to perform screening tool could be used to predict pediatric OSAS. An abnormal calculated AHI may prompt clinical physicians to conduct further PSG diagnostics and treatment.

Exploration of transoral robotic surgery in the treatment of pediatric obstructive sleep apnea-hypopnea syndrome

Transoral robotic surgery (TORS) is a relatively new technique in the treatment of pediatric obstructive sleep apnea-hypopnea syndrome, which has been shown to be safe and feasible. TORS provides a minimally invasive, visualization method, which brings an unprecedented breakthrough in the treatment of pediatric obstructive sleep apnea-hypopnea syndrome. In this paper, the application and development prospect of TORS in the treatment of pediatric obstructive sleep apnea-hypopnea syndrome will be reviewed.

Value of pulse oximetry watch for diagnosing pediatric obstructive sleep apnea/hypopnea syndrome

Objective: To evaluate the clinical value of pulse oximetry watch (POW) for diagnosing pediatric Obstructive sleep apnea/hypopnea syndrome (OSAHS).Methods: We selected 32 children (boys: 25, 4–16 years old) who came to the hospital for diagnosing OSAHS from July to October 2016. Polysomnography (PSG) and POW were used simultaneously and recorded the apnea hypopnea index (AHI), LSpO2, and ODI4. Pearson analysis, t test, and receiver-operating characteristic (ROC) were used to analyze the correlation between PSG-AHI and other indicators, the diagnosis accordance rate, and the sensitivity and specificity of POW, respectively.Results: According to PSG-AHI, 32 children were divided into two groups: primary snoring (n = 5) and OSAHS (n = 27). There was no significant difference between PSG-ODI4 and POW-ODI4 (p > .05). A statistically significant correlation between PSG-AHI and POW-ODI4 was found (r = .719, p < .001). When PSG-AHI >1, 5, 10, 15, and 20 events/h, the area under the curve (AUC) was 0.685 (p > .05), 0.733, 0.798, 0.922, and 0.929 (p < .05), respectively. There were high levels of sensitivity (83.33%) and specificity (92.31%) in the OSAHS with AHI >20 events/h level, whereas the sensitivity and specificity were unacceptable (<75%) at the level of AHI >1, 5, 10, and 15 events/h.Conclusions: POW cannot replace PSG to diagnose pediatric OSAHS because of low sensitivity and specificity, but can be used for screening severe OSAHS in children.

Factors related to pediatric obstructive sleep apnea-hypopnea syndrome in children with attention deficit hyperactivity disorder in different age groups.

This study aimed to retrospectively investigate the factors related to pediatric obstructive sleep apnea–hypopnea syndrome (OSAHS) with attention deficit hyperactivity disorder (ADHD) in children younger than 6 years and those older than 6 years.A total of 437 children who were hospitalized due to OSAHS between January 2014 and December 2014 were retrospectively reviewed. The children were further divided into OSAHS group and OSAHS + ADHD group. The general characteristics, OSA-18 quality of life, intention-hyperactivity score, and polysomnographic parameters (apnea–hypopnea index and the lowest oxygen saturation) were collected and compared between groups.There were 298 boys and 139 girls with the male to female ratio of 2.14:1. ADHD was found in 146 children including 105 boys and 41 girls with the male to female ratio of 2.56:1. Of these children, 31.62% and 35.46% had concomitant ADHD in children aged 4 to 5 years and those aged 6 to 11 years, respectively. In children aged 4 to 5 years, the incidence of allergic rhinitis was significantly higher (P = .016) and the adenoid hypertrophy was more severe (P = .001) in those with concomitant ADHD. In children aged 6 to 11 years, the tonsil hypertrophy was more severe in those with concomitant ADHD (P = .019). In children with concomitant ADHD, OSA-18 score was higher than in those with OSAHS alone (P < .001). Higher frequency of respiratory events (P < .001) and more severe hypoxia (P < .001) were found in children with concomitant ADHD than in those with OSAHS alone.As high as 30% of OSAHS children have concomitant ADHD, and the incidence of ADHD in OSAHS children is increasing over age. Boys are more likely to develop OSAHS and incidence of ADHD in OSAHS boys is higher than in OSAHS girls. In addition, risk factors of ADHD also vary between age groups. The ADHD is related to the severity of allergic rhinitis and adenoid hypertrophy in children aged 4 to 5 years, and to the severity of tonsil hypertrophy in children aged 6 to 11 years. Hypoxia may be an important factor causing ADHD. OSAHS should be treated as early as possible to reduce the incidence of ADHD in children.

Exploring the spectral information of airflow recordings to help in pediatric Obstructive Sleep Apnea-Hypopnea Syndrome diagnosis.

This work aims at studying the usefulness of the spectral information contained in airflow (AF) recordings in the context of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) in children. To achieve this goal, we defined two spectral bands of interest related to the occurrence of apneas and hypopneas. We characterized these bands by extracting six common spectral features from each one. Two out of the 12 features reached higher diagnostic ability than the 3% oxygen desaturation index (ODI3), a clinical parameter commonly used as screener for OSAHS. Additionally, the stepwise logistic regression (SLR) feature-selection algorithm showed that the information contained in the two bands was complementary, both between them and with ODI3. Finally, the logistic regression method involving spectral features from the two bands, as well as ODI3, achieved high diagnostic performance after a bootstrap validation procedure (84.6±9.6 sensitivity, 87.2±9.1 specificity, 85.8±5.2 accuracy, and 0.969±0.03 area under ROC curve). These results suggest that the spectral information from AF is helpful to detect OSAHS in children.

Relationship between children's obstructive sleep apnea hypopnea syndrome and nasal diseases

To explore the relationship between children obstructive sleep apnea hypopnea syndrome (OSAHS) and nasal diseases. Three hundred and thirty-eight cases of pediatric OSAHS confirmed by polysomnography (PSG) had been enrolled as the treatment group, and divided into mild subgroup, moderate subgroup and severe subgroup according to the obstructive apnea index (OAI) and apnea hypoventilation index (AHI). The other two hundred and seven pediatric vocal cord nodule cases without OSAHS had been randomly selected as the control group. The retrospective analysis of upper respiratory tract infection frequency per year, expression levels of total IgE (tIgE) and allergen-specific IgE (sIgE), results of electronic nasopharyngoscope test and nasal sinus CT scans had been performed in all the pediatric cases. The data were analyzed by SPSS 17.0. The upper respiratory tract infection frequency per year, ratio of cases with positive results of tIgE, ratio of cases with nasosinusitis, ratio of cases with narrow nasal cavity in the experiment group were respectively 8.7 ± 5.7, 60.9%, 79.9% and 50.0%, while those in the control group were respectively 4.4 ± 2.6, 32.8%, 12.1% and 6.3%, with significant difference between groups (t = 7.578,χ(2) value was 41.943, 237.704, 110.322, all P < 0.01). The multiple regression analysis indicated that, nasosinusitis and narrow nasal cavity were the two major risk factors of pediatric OSAHS (OR1 = 16.008, OR2 = 4.671, all P < 0.01), with combined effects (OR = 113.430, P < 0.01) . The rank test analysis in term of risk factors of severity of OSAHS had indicated that, prevalence of nasosinusitis and narrow nasal cavity were increased as rising severity of OSAHS (χ1(2) = 21.571, χ2(2) = 17.304, all P < 0.01). Infection and allergy are risk factors of pediatric OSAHS. Nasosinusitis and narrow nasal cavity are two major risk factors of pediatric OSAHS, which have positive relationship with the severity of OSAHS.

Modified Adenotonsillectomy to Improve Cure Rates for Pediatric Obstructive Sleep Apnea

To compare the efficacy of adenotonsillectomy (T&A) with and without pharyngoplasty (tonsillar pillar closure) in the treatment of pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS). Randomized single-blind controlled study. Tertiary care center. Sixty pediatric patients with a clinical diagnosis of OSAHS presenting between January 2009 and December 2010 were enrolled and randomized to undergo either standard T&A (n = 30) or T&A with pharyngoplasty (n = 30). Surgical cure was defined as apnea-hypopnea index (AHI) <5 plus OSA-18 health-related quality-of-life (HRQL) score <60. Other outcomes included postsurgical AHI and minimum oxygen saturation (SpO(2)) improvement, changes in OSA-18 scores at 1 month, and postsurgical days to resume normal diet and activity. Three patients from each group did not undergo surgery. Of the 54 patients treated, 8 from the pharyngoplasty group and 2 from the standard group were lost to follow-up. Intention-to-treat analysis revealed no difference in cure rate between groups (standard 60%, pharyngoplasty 56.6%, P = .793). Limiting analysis to those patients with complete data, a higher, but not significantly increased, cure rate with pharyngoplasty was noted (72% vs 89.5%, P = .155). Greater OSA-18 improvement (P = .036) and greater (although nonsignificant) AHI improvement and earlier return to normal function were noted with pharyngoplasty. The addition of pharyngoplasty to traditional adenotonsillectomy did not significantly improve OSAHS cure rates as measured by sleep testing and HRQL, although a nonsignificant increase in cure rate was observed in those who completed the study protocol. An unexpectedly high rate of patient dropout rendered the study statistically underpowered and therefore inconclusive.

Knowledge and attitude of clinicians to pediatric obstructive sleep apnea hypopnea syndrome

To investigate the knowledge and attitude of clinicians in the departments of pediatrics and otolaryngology to pediatric obstructive sleep apnea hypopnea syndrome (OSAHS), since in China, the clinicians in these two departments had closest relationship with the diagnosis and treatment of OSAHS in children. A validated questionnaire from USA which was the obstructive sleep apnea knowledge and attitudes questionnaire in children (OSAKA-KIDS) was used and permission by original author. The questionnaire was mailed to ENT doctors and pediatricians in 43 public hospitals in Shandong province. OSA-KIDS in Chinese version was re-tested by 30 physicians, r = 0.92. Totally, 391 valid questionnaires (87.7%) were returned. Average of correct rate (x(-) ± s) in 18 knowledge items was 64.1% ± 19.1%. Cronbach's α coefficient was 0.76. There was no difference between ENT doctors and pediatrics in total knowledge score. However, there was significant difference in below 2 questions: ENT doctors had more correction in answer "nearly 2% of children have OSAHS" and pediatrics had more correction in answer "pediatric OSAHS may be associated with pulmonary hypertension". Only 24.3% clinicians correctly know the degree of snoring (mild to severe) was not correlated with the severity of obstructive apnea in children. Only 16.1% could correctly answer the question about cardio-respiratory monitor could not reliably detect both central and obstructive apnea in infant. Cronbach's α coefficient was 0.72 in 5 items which was about importance of disease and self-evaluation in confidence. While more than 90% clinicians stated that "As a clinical disorder OSAHS is important or very, extremely important". However, among them, only about 36% felt confident in identifying or managing children with OSAHS. Total knowledge score about OSAHS was not different by gender or specialty (P > 0.05), but more knowledge was associated with more positive attitudes overall (P < 0.05) and more elder in age or longer years in practice (r = 0.384, P < 0.0001). It should be paid more effort to elevate the knowledge and attitude about pediatric OSAHS in pediatricians and otolaryngologists.