Pediatric Obstructive Sleep Apnea Hypopnea Research Articles

Predictive factors of persistent/recurrent pediatric obstructive sleep apnea-hypopnea syndrome after adenotonsillectomy.

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The impact of surgical intervention on peripheral blood T lymphocyte subsets and natural killer cell activity in pediatric obstructive sleep apnea hypopnea syndrome (OSAHS).

This study aimed to investigate the impact of surgical intervention on peripheral blood T lymphocyte subsets and natural killer (NK) cell activity in pediatric patients with obstructive sleep apnea hypopnea syndrome (OSAHS). A total of 36 OSAHS children, 32 children with tonsillar hypertrophy, and 30 healthy children were enrolled. Clinical data and polysomnography (PSG) results were collected. Peripheral blood samples were analyzed for T lymphocyte subsets, NK cells, and cytokine levels including Th1 (IFN-γ, IL-2, TNF-α), Th2 (IL-4, IL-10), and Th17 (IL-17). At baseline, OSAHS children exhibited lower LSaO2 levels and higher AHI values compared to healthy children. They also showed decreased percentages of CD3 + T cells, CD4 + T cells, NK cells, and elevated CD8 + T cells and CD4+/CD8 + ratio. Levels of IFN-γ, IL-2, TNF-α, IL-4, and IL-17 were significantly lower in OSAHS children. Post-surgery improvements were observed in LSaO2, AHI, and immune markers at 3 months and 6 months. Pearson's correlation analysis revealed significant associations between LSaO2, AHI, and peripheral blood immune parameters at baseline and 6 months post-surgery. Surgical intervention in pediatric OSAHS influences peripheral blood T lymphocyte subsets and NK cell activity. Early intervention and monitoring of immune function are crucial for the recovery and healthy development of affected children.

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

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

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

Childhood obstructive sleep apnea (OSA) is a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns in children.1 OSA is one of the most serious sleep-disordered breathing (SDB) diseases in children. Because of its high prevalence and serious long-term complications, increasing numbers of families are affected by OSA. In 2012, the American Academy of Pediatrics (AAP) clinical practice guidelines reported that the prevalence of pediatric OSA was 1.2%–5.7%2; in 2010, the prevalence of pediatric OSA in Hong Kong was 4.8%.3 In contrast to OSA in adults, the main cause of upper airway obstruction in children is adenoid and/or tonsil hypertrophy. Obesity, craniofacial malformation, neuromuscular diseases, and other factors may also contribute to the onset of pediatric OSA.4 Without timely diagnosis and effective intervention, pediatric OSA can lead to a series of serious complications, such as maxillofacial dysplasia, behavioral abnormalities, learning disabilities, growth restriction, neurocognitive impairment, endocrine metabolic disorders, hypertension, and pulmonary hypertension; it can also increase the risk of cardiovascular events in adulthood.5, 6, 7, 8 Therefore, early detection and early diagnosis of pediatric OSA, as well as early intervention to correct this problem, are important considerations for improving patient prognosis. There have been some controversies in the clinical diagnosis and treatment of pediatric OSA in China, which have restricted clinical diagnosis and treatment strategies, while hindering progress regarding diagnosis and treatment. The diagnosis and treatment of pediatric OSA is increasingly hampered by the absence of multi-disciplinary cooperation and guidelines. The numbers of pediatric OSA diagnosis and treatment guidelines and expert consensuses are very limited, both in China and worldwide.1,2,5,9, 10, 11, 12, 13 The draft guidelines for diagnosis and treatment of pediatric obstructive sleep apnea hypopnea syndrome issued in 2007 were mainly established on the basis of expert consensus.1 In the past 10 years, there has been a lack of multi-disciplinary evidence-based diagnosis and treatment guidelines for pediatric OSA in China. Thus, evidence-based clinical practice guidelines are urgently needed. The purpose of the present guidelines is to standardize the clinical diagnosis and treatment decision-making concerning pediatric OSA in China, provide scientific evidence for the diagnosis and treatment of pediatric OSA, promote multi-disciplinary integration, guide clinical practice for relevant medical staff, and ensure the use of a scientific approach for management of pediatric OSA. Table 1 is the list of abbreviations. Table 1 List of abbreviations.

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

Childhood obstructive sleep apnea (OSA) is a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns in children.1 OSA is one of the most serious sleep-disordered breathing (SDB) diseases in children. Because of its high prevalence and serious long-term complications, increasing numbers of families are affected by OSA. In 2012, the American Academy of Pediatrics (AAP) clinical practice guidelines reported that the prevalence of pediatric OSA was 1.2%–5.7%2; in 2010, the prevalence of pediatric OSA in Hong Kong was 4.8%.3 In contrast to OSA in adults, the main cause of upper airway obstruction in children is adenoid and/or tonsil hypertrophy. Obesity, craniofacial malformation, neuromuscular diseases, and other factors may also contribute to the onset of pediatric OSA.4 Without timely diagnosis and effective intervention, pediatric OSA can lead to a series of serious complications, such as maxillofacial dysplasia, behavioral abnormalities, learning disabilities, growth restriction, neurocognitive impairment, endocrine metabolic disorders, hypertension, and pulmonary hypertension; it can also increase the risk of cardiovascular events in adulthood.5, 6, 7, 8 Therefore, early detection and early diagnosis of pediatric OSA, as well as early intervention to correct this problem, are important considerations for improving patient prognosis. There have been some controversies in the clinical diagnosis and treatment of pediatric OSA in China, which have restricted clinical diagnosis and treatment strategies, while hindering progress regarding diagnosis and treatment. The diagnosis and treatment of pediatric OSA is increasingly hampered by the absence of multi-disciplinary cooperation and guidelines. The numbers of pediatric OSA diagnosis and treatment guidelines and expert consensuses are very limited, both in China and worldwide.1,2,5,9, 10, 11, 12, 13 The draft guidelines for diagnosis and treatment of pediatric obstructive sleep apnea hypopnea syndrome issued in 2007 were mainly established on the basis of expert consensus.1 In the past 10 years, there has been a lack of multi-disciplinary evidence-based diagnosis and treatment guidelines for pediatric OSA in China. Thus, evidence-based clinical practice guidelines are urgently needed. The purpose of the present guidelines is to standardize the clinical diagnosis and treatment decision-making concerning pediatric OSA in China, provide scientific evidence for the diagnosis and treatment of pediatric OSA, promote multi-disciplinary integration, guide clinical practice for relevant medical staff, and ensure the use of a scientific approach for management of pediatric OSA. Table 1 is the list of abbreviations. Table 1 List of abbreviations.

Analysis of polysomnography results between pre- and post-operation in pediatric obstructive sleep apnea hypopnea syndrome patients

Objective: To determine the objective effects of adenotonsillectomy on pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) through analyzing the polysomnography (PSG) results between pre and post-operation. Methods: A total of 56 pediatric OSAHS patients were included who underwent adenoidectomy or/and tonsillectomy and completed PSG follow-up from January 1, 2017 to March 31, 2018. All the pediatric patients who underwent adenoidectomy or/and tonsillectomy during the research period were arranged to take a preoperative PSG study. Patients who were diagnosed OSAHS would be encouraged to complete a follow-up PSG study ranged from1 to 3 months after surgery. The parameters of respiration and sleep architecture of PSG were compared and analyzed. The paired student t test was used to compare preoperative and postoperative mean values. The unpaired student t test was used to compare quantitative variables among different groups. The rank sum test was used if the data were abnormal distribution. Results: Totally 238 patients completed preoperative PSG study, 62 patients were diagnosed as pediatric OSAHS, 56 eligible patients finished post-operative PSG. Hypopnea was the majority in all type of respiratory events in 56.45% (35/62) subjects, while central apnea as the majority in 29.03% (18/62) subjects who can also get significant CAI decrease after surgery. However, obstructive apnea as the majority only exist in 14.52% (9/62) subjects. The short-term cure rate of pediatric OSAHS was 85.71% (48/56). The postoperative AHI, MAI, CAI, HI, ODI, LoSpO(2), percentage of stage I sleep and arousal index were significantly decreased, however, the OAI was no statistical decrease. The percentage of stage Ⅱ and rapid eye movement (REM) sleep were significantly increased, while no significant change in percentage of slow wave sleep and sleep efficiency(t=2.32, P=0.017). Conclusions: Pediatric OSAHS manifest different characteristics of respiratory events from that of adults. Adenotonsillectomy can significant decrease respiratory events and improve sleep architecture, however, there are still some patients who can't be completely relieved with adenotonsillectomy.

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.

Differential evaluation of diagnostic criteria for pediatric obstructive sleep apnea hypopnea syndrome

Objective:To evaluate the difference of accessing pediatric sleep symptoms and living qualities between 3 diagnostic criteria: American Thoracic Society (ATS), International Classification of Sleep Disorder (ICSD-3), domestic Urumqi criterion (Draft); To investigate the relationship of PSG parameters and quality of life scale OSA-18. Method:Children with snoring who received PSG in Capital Medical University Beijing Tongren Hospital were recruited from Jan 2016 to Apr 2017. Subjects were diagnosed and grouped to SS, ICSD, ATS&ICSD (ATS&ICSD1, ATS&ICSD2) according to 3 criteria: ATS (AHI>5 or OAI>1), ICSD-3 (OAHI≥1) and Urumqi (AHI>5 or OAI>1, with LSaO₂<92%). Subjects' height, weight as well as quality of life scale OSA-18 were recorded. Result:Five hundred and fifteen children were finally included (Male: 350 cases, Female: 165 cases). There were 315, 70 and 130 children in group SS, ICSD, ATS&ICSD respectively. Weights and BMI of ICSD and ATS&ICSD were significantly higher than those of SS (P<0.05), and dysplasia scale of ATS&ICSD was higher than SS (P<0.05); after adjusting height, weight and BMI, sub-scores of sleep disorder were statistically different between 3 groups (P<0.05). Numbers and indexes of respiratory events other than central apneas and hypopneas in group SS, ICSD and ATS&ICSD were increased sequentially and statistically different (P<0.05); numbers and indexes of respiratory events other than mixed apneas in ATS&ICSD2 were significantly higher than that of ATS&ICSD1 (P<0.05). Conclusion:OAHI≥1/h combined with LSaO₂<92% should be used as pediatric OSAHS diagnostic criterion.

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.

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.

Discussion on the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome

To explore the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS). A total of 386 children with OSAHS were enrolled from June 2008 to April 2011.Ninety children with adenoid and tonsil ≤ degree III (group A) were randomly divided into A1 subgroup and A2 subgroup, while 22 of 296 (group B) children aged less than 3 years old with degree IV adenoid and(or) tonsil were divided into B1 subgroup, and the other 274 of 296 children with degree IV adenoid and (or) tonsil were divided into B1 subgroup, B2 subgroup and B3 subgroup. The adenoid, tonsil size examination and nasal endoscopic examination scores were performed before treatment, 3 months and 6 months after treatment. Drug therapy included oral antibiotics, mometasone furoate as a nasal spray, leukotriene receptor antagonist (LTRAs), mucoactive medications. Conservative treatment meant drug therapy plus negative pressure of sputum aspiration.Surgical treatment meant coblation adenotonsillectomy. A1 subgroup received drug therapy for 3 months; A2 and B1 subgroup received conservative treatment for 3 months; B2 subgroup received coblation adenotonsillectomy after 3 days conservative treatment and postoperative drug therapy for 2 weeks; B3 subgroup received coblation adenotonsillectomy after 2 weeks conservative treatment and postoperative drug therapy for 3 months. The adenoid and tonsil size of A2 subgroup decreased at 3 months after treatment (Wald χ² were 10.584 and 8.366, respectively, P < 0.05), no significant re-increase was found at 6 months, and no decrease was found in the A1 subgroup (P > 0.05). The nasal endoscopic examination scores decreased in both A1 and A2 subgroup at 3 months after the treatment (F = 403.420, P < 0.05), but it was found re-increase in A1 subgroup at the 6 months (P < 0.05), no significant re-increase was found in the A2 subgroup. The polysomnography (PSG) monitor of A2 subgroup was 100.0% normal at 3 months after treatment, while the A1 subgroup was only 43.2% (χ² = 36.189, P < 0.05). B2 and B3 subgroups cured after coblation adenotonsillectomy, but no decrease of the adenoid and tonsil size was found in B1 subgroup (P > 0.05). The nasal endoscopic examination scores of B1, B2 and B3 subgroups showed significant decrease after the treatment, but re-increase was found in both B1 and B2 subgroups at the 6 months (F = 1 614.244, P < 0.05), no significant re-increase was found in the B3 subgroup. The PSG monitor of B3 subgroup was 100.0% normal at 3 months after treatment, B2 subgroup 73.4%, and B1 subgroup only 57.4% (χ² = 90.846, P < 0.05). The treatment method of children with OSAHS should be selected according to the age, condition of disease, and size of the adenoid and tonsil. Adenoid and tonsil ≤ degree III should select conservative treatment; while for degree IV adenoid and (or) tonsil, surgical treatment should be primary choice. Conservative treatment can reduce the risk of perioperative and adequate postoperative drug therapy can help prevent recurrence after surgery.

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.

Pediatric tonsil size: Objective vs subjective measurements correlated to overnight polysomnogram

Objective To compare subjective and objective tonsil size measurements (weight, volume, intertonsillar distance) along with simple pharyngeal measurements in the prediction of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) severity. Study Design Prospective case series. Subjects and Methods Tonsil size (0-4+) and Mallampati/Friedman palate position were subjectively measured. During adenotonsillectomy, tonsil size was objectively measured along with simple pharyngeal dimensions. Spearman rank correlation coefficients were calculated and forward and reverse stepwise multivariate regression modeling was used to assess the prediction of preoperative OSAHS severity as determined by polysomnogram (PSG). Evaluation of possible outlier influence was also performed. Results Thirty-four pediatric patients (median age, 4; range, 2-9) were included. Objective tonsil weight (Spearman's ρ = 0.6143, P = 0.0002), tonsil volume (ρ = 0.4960, P = 0.0039), and intertonsillar distance (ρ = −0.7559, P < 0.0001) were strongly correlated with subjective tonsil size but not with age, body mass index (BMI), or preoperative apnea-hypopnea index (AHI). Regression modeling demonstrated that only measured tonsil weight (β = 1.43, P = 0.003), age (β = −3.21, P = 0.001), and hard palate length (β = 0.979, P = 0.003) were significant predictors of the preoperative AHI (R 2 = 0.5358). Evaluation of possible outliers indicated tonsil weight was the most robust predictor of preoperative AHI. Conclusion Subjective tonsil size measurements correlate well with objective tonsil volume measurements. However, only objective tonsil measurements were significantly predictive of objective PSG-measured OSAHS severity.

小児閉塞性睡眠時呼吸障害の診断―臨床症状に基づく診断の精度の検討―

The decision to perform adenotonsillectomy or tonsillectomy for treatment of pediatric Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) is often based solely on clinical history such as snoring, sleep apnea or sleep disturbance, not on an objective evaluation. To determine the accuracy of clinical diagnosis of OSAHS in children, we performed overnight objective measurements in 35 patients (1.9-12 years old: 21 boys and 14 girls) who presented at our clinic from January 1997 to December 2000. An oxygen desaturation index (ODI)>5/h or minimal oxygen saturation (min SaO2)<90% were the defining criteria for OSAHS. Only 22 of 35 patients who had clinical diagnosis of OSAHS met the criteria. The remaining 13 patients were diagnosed as having simple snoring. There was no significant differences in age, gender, obesity, tonsil size and adenoid hypertrophy between OSAHS and the simple snoring patients group. OSAHS in children cannot be reliably distinguished from simple snoring by clinical diagnosis alone.

Contribution of Drug Induced Sleep Endoscopy of Pediatric Obstructive Sleep Apnea Hypopnea Syndrome

Contribution of Drug Induced Sleep Endoscopy of Pediatric Obstructive Sleep Apnea Hypopnea Syndrome