Pediatric OSA Research Articles

Navigating ChatGPT's Alignment with Expert Consensus on Pediatric OSA Management

ObjectiveThis study aimed to evaluate the potential integration of artificial intelligence (AI), specifically ChatGPT, into healthcare decision-making, focusing on its alignment with expert consensus statements regarding the management of persistent pediatric obstructive sleep apnea. MethodsWe analyzed ChatGPT's responses to 52 statements from the 2024 expert consensus statement (ECS) on the management of pediatric persistent OSA after adenotonsillectomy. Each statement was input into ChatGPT using a 9-point Likert scale format, with each statement entered three times to calculate mean scores and standard deviations. Statistical analysis was performed using Excel. ResultsChatGPT's responses were within 1.0 of the consensus statement mean score for 63% (33/52) of the statements. 13% (7/52) were statements in which the ChatGPT mean response was different from the ECS mean by 2.0 or greater, the majority of which were in the categories of surgical and medical management. Statements with ChatGPT mean scores differing by more than 2.0 from the consensus mean highlighted the risk of disseminating incorrect information on established medical topics, with a notable variation in responses suggesting inconsistencies in ChatGPT's reliability. ConclusionWhile ChatGPT demonstrated a promising ability to align with expert medical opinions in many cases, its inconsistencies and potential to propagate inaccuracies in contested areas raise important considerations for its application in clinical settings. The findings underscore the need for ongoing evaluation and refinement of AI tools in healthcare, emphasizing collaboration between AI developers, healthcare professionals, and regulatory bodies to ensure AI's safe and effective integration into medical decision-making processes.

Orthodontic perspectives of obstructive sleep apnea

OSA is defined as a condition in which there is repetitive partial or complete collapse of the pharynx during sleep. An apnea is defined as an almost complete (at least 90%) cessation of airflow, and hypopnea is defined as a reduction in nasal pressure amplitude of at least 50% and/ or a reduction in thoracoabdominal movement of 50% or more for a minimum of 10 seconds. Often, patients first seek an otorhinolaryngologic (ENT) evaluation rather than presenting to a sleep center. Normal sleep involves air passing through and going directly down to the lungs. With an obstructed airway, the structures in the back of the throat (the tongue, the tonsils, and/or adenoids) occlude the airway due to an inadequate motor tone of the tongue and/or airway dilator muscles, and thus, prevent the air from passing. The aetiology is multifactorial, and the main risk factors in children include adenotonsillar hypertrophy, obesity, neuromuscular disorders and craniofacial anomalies. Adenotonsillar hypertrophy is the most commonly reported aetiological factor. Therefore, the treatment of choice for paediatric OSA is adenotonsillectomy. In adulthood, the use of oral appliances is a treatment option in the management of OSA

The usefulness of transcervıcal ultrasonography for the predıctıon of obstructıve sleep apnea ın chıldren

ABSTRACT Objective It was aimed to investigate the role of tonsil ultrasonography(USG) in the diagnosis of pediatric OSAS. Methods Before tonsillectomy (±adenoidectomy) for OSAS, all patients tonsil USG and polysomnography (PSG) tests were performed. Tonsil volume was measured preoperatively with the Brodsky tonsil grading scale and by postoperative water displacement test. Results In total, 47 patients were included in the study. We observed a positive correlation between tonsil volumes measured by preoperative USG and water displacement test postoperatively. There was a statistically significant correlation between tonsil sizes measured by tonsil USG, PSG AHI and questionnaire scores(p < .05). Conclusion Preoperative tonsil USG may be helpful test in children with suspected OSAS.

Sleep-Disordered Breathing and Associated Comorbidities among Preschool-Aged Children with Down Syndrome.

Children with Down syndrome (DS) are at high risk of sleep-disordered breathing (SDB). The American Academy of Pediatrics recommends a polysomnogram (PSG) in children with DS prior to the age of 4. This retrospective study examined the frequency of SDB, gas exchange abnormalities, co-morbidities, and surgical management in children with DS aged 2-4 years old at Seattle Children's Hospital from 2015-2021. A total of 153 children underwent PSG, with 75 meeting the inclusion criteria. The mean age was 3.03 years (SD 0.805), 56% were male, and 54.7% were Caucasian. Comorbidities included (n, %): cardiac (43, 57.3%), dysphagia or aspiration (24, 32.0%), prematurity (17, 22.7%), pulmonary (16, 21.3%), immune dysfunction (2, 2.7%), and hypothyroidism (23, 30.7%). PSG parameter data collected included (mean, SD): obstructive AHI (7.9, 9.4) and central AHI (2.4, 2.4). In total, 94.7% met the criteria for pediatric OSA, 9.5% met the criteria for central apnea, and 9.5% met the criteria for hypoventilation. Only one child met the criteria for hypoxemia. Overall, 60% had surgical intervention, with 88.9% of these being adenotonsillectomy. There was no statistically significant difference in the frequency of OSA at different ages. Children aged 2-4 years with DS have a high frequency of OSA. The most commonly encountered co-morbidities were cardiac and swallowing dysfunction. Among those with OSA, more than half underwent surgical intervention, with improvements in their obstructive apnea hypopnea index, total apnea hypopnea index, oxygen saturation nadir, oxygen desaturation index, total arousal index, and total sleep duration. This highlights the importance of early diagnosis and appropriate treatment. Our study also suggests that adenotonsillar hypertrophy is still a large contributor to upper airway obstruction in this age group.

Association of clinical indicators in TMJ, craniofacial, occlusal, and upper airway changes with symptoms of pediatric obstructive sleep apnea and mouth-breathing

ABSTRACT Objective To assess the association between self-reported symptoms of pediatric OSA and clinical signs in MB children. Methods Seventy-three MB children aged 7–14 years answered an interview questionnaire on OSA symptoms in childhood, focusing on chewing, nasal, and sleep disturbances. MB children were checked for changes on the craniofacial, occlusion, TMJ, upper airway, and body posture by a multi-disciplinary team, consisting of medical residents, dental, and psychology postgraduate students. Multiple logistic regression analysis verified the association between clinical signs and self-reported symptoms. Results Reported symptoms of chewing disturbance as TMD noise, muscle pain, and morning headache were significantly associated with the presence of lip incompetence and Class II malocclusion. Sleep disturbances as snoring, waking up at night, daytime sleepiness, and sleeping with the mouth open were significantly associated with the presence of hypertrophic tonsils and obstructive Mallampati score. Conclusion Symptoms of pediatric OSA were found in mouth-breathing children, which should be carefully investigated in order to prevent OSA in the future.

Comparison of classical method and microdebrider technique for adenoidectomy in pediatric patients with obstructive sleep apnea.

The aim of this study was to evaluate the safety and efficacy of microdebrider adenoidectomy on sleep-disordered breathing among pediatric patients with OSA. In the microdebrider group (Group I), there were 30 Japanese OSA patients consisting of 26 boys and 4 girls. For comparison, we had 15 children (13 boys and 2 girls) who underwent classical adenoidectomy (Group II). Patients in Group I were selected from a pool of 95 pediatric Japanese OSA patients and were matched by age, preoperative AHI, and Kaup index with those in Group II.Parameters such as the amount of residual adenoid tissue, bleeding, duration of the procedure, and sleep-related metrics were compared between the two groups. A significant improvement in postoperative AHI was observed in Group I (p<0.05). The prevalence of AHI <1 was significantly higher in Group I compared with Group II (p<0.05). Additionally, the amount of postoperative residual adenoid was significantly less in Group I (3/30 of Grade 3 and 4 adenoid size) than in Group II (7/15, p<0.05). Furthermore, a reduction in postoperative AHI was proportionally associated with a decrease in residual adenoid. The newly developed microdebrider adenoidectomy technique for pediatric OSA patients with adenotonsillar hypertrophy demonstrated greater accuracy and efficacy in ameliorating sleep apnea symptoms compared with the standard adenoidectomy approach.

0780 Pediatric OSA Assessment Tool to Predict Severity of Sleep Disordered Breathing

0780 Pediatric OSA Assessment Tool to Predict Severity of Sleep Disordered Breathing

Changes in the nasopharyngeal and oropharyngeal microbiota in pediatric obstructive sleep apnea before and after surgery: a prospective study

ObjectiveTo explore the changes and potential mechanisms of microbiome in different parts of the upper airway in the development of pediatric OSA and observe the impact of surgical intervention on oral microbiome for pediatric OSA.MethodsBefore adeno-tonsillectomy, we collected throat swab samples from different parts of the oropharynx and nasopharynx of 30 OSA patients and 10 non-OSA patients and collected throat swab samples from the oropharynx of the above patients one month after the adeno-tonsillectomy. The 16 S rRNA V3–V4 region was sequenced to identify the microbial communities. The correlation analysis was conducted based on clinical characteristics.ResultsThere was a significant difference of alpha diversity in different parts of the upper airway of pediatric OSA, but this difference was not found in children with non-OSA. Beta diversity was significantly different between non-OSA and pediatric OSA. At the genus level, the composition of flora in different parts is different between non-OSA and pediatric OSA. The correlation analysis revealed that the relative abundance of Neisseria was significantly correlated with obstructive apnea hypopnea index. Furthermore, the functional prediction revealed that pathways related to cell proliferation and material metabolism were significantly different between non-OSA and pediatric OSA. Besides, the adeno-tonsillectomy has minimal impact on oral microbiota composition in short term.ConclusionThe changes in upper airway microbiome are highly associated with pediatric OSA. The relative abundance of some bacteria was significantly different between OSA and non-OSA. These bacteria have the potential to become new diagnostic and early warning biomarkers.

Upper airway outcomes on pediatric OSA after interceptive orthodontic treatment with RME - rapid maxillary expansion: a clinical study

Upper airway outcomes on pediatric OSA after interceptive orthodontic treatment with RME - rapid maxillary expansion: a clinical study

Investigating the association between pediatric OSA and orofacial motor skills

Investigating the association between pediatric OSA and orofacial motor skills

Upper airway outcomes on pediatric OSA after interceptive orthodontic treatment with MAD twin block appliance: a clinical study

Upper airway outcomes on pediatric OSA after interceptive orthodontic treatment with MAD twin block appliance: a clinical study

Clinical decision support for primary care pediatric OSA detection

Clinical decision support for primary care pediatric OSA detection

Management of Persistent, Post-adenotonsillectomy Obstructive Sleep Apnea in Children: An Official American Thoracic Society Clinical Practice Guideline.

Background: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Although adenotonsillectomy is first-line management for pediatric OSA, up to 40% of children may have persistent OSA. This document provides an evidence-based clinical practice guideline on the management of children with persistent OSA. The target audience is clinicians, including physicians, dentists, and allied health professionals, caring for children with OSA. Methods: A multidisciplinary international panel of experts was convened to determine key unanswered questions regarding the management of persistent pediatric OSA. We conducted a systematic review of the relevant literature. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to rate the quality of evidence and the strength of the clinical recommendations. The panel members considered the strength of each recommendation and evaluated the benefits and risks of applying the intervention. In formulating the recommendations, the panel considered patient and caregiver values, the cost of care, and feasibility. Results: Recommendations were developed for six management options for persistent OSA. Conclusions: The panel developed recommendations for the management of persistent pediatric OSA based on limited evidence and expert opinion. Important areas for future research were identified for each recommendation.

Effects of twin-block appliance on upper airway parameters in OSA children with class II malocclusion and mandibular retrognathia: a CBCT study.

Correction of class II mandibular retrognathic skeletal malocclusion with twin-block appliance resulted in a significant increase in upper airway volume, MCA, anteroposterior and lateral distances of the MCA at the level of the oropharynx, MCA at the level of the hypopharynx and upper airway length, and a significant decrease in AHI, but it had no effect on nasopharynx parameters. • CBCT imaging has been shown to be an effective and precise diagnostic tool for analyzing the upper airways and craniofacial structures. • Twin block appliance may be an effective treatment modality in children with OSA. • Minimal cross-sectional area of upper ways may be the most relevant potential parameter when explaining how the upper airway anatomy plays role of in the pathogenesis of pediatric OSA. • Twin block appliance induced favorable changes in upper airway morphology (oropharynx area mainly) and respiratory parameters in OSA children with class II malocclusion.

Characteristics of the Attentional Network in Children with Sleep-Disordered Breathing.

To explore the characteristics of the attentional network and related factors in children with sleep-disordered breathing (SDB). A total 228 children (200 children aged 6-10 years with snoring or mouth breathing, admitted to our hospital from May 2020 to July 2022, and 28 healthy children recruited from the community as the control group) were enrolled. All participants underwent polysomnography (PSG) and completed the ADHD rating scale and child version of the Attention Network Test. According to their SDB history and obstructive apnea hypopnea index (OAHI), the participants were divided into control (n = 28), primary snoring (PS; n = 67) and obstructive sleep apnea (OSA; n = 133) groups. The OSA and PS groups were younger than controls (P < 0.05). The proportion of boys was higher in the OSA than control group (P < 0.05). Body mass index was higher in the OSA than control and PS groups (P < 0.01). Attention deficit and hyperactive impulsivity scores were independently associated with the OAHI (P < 0.001). The efficiency of the alerting network was higher in the OSA than in controls (P = 0.020), but was not correlated with OAHI after adjusting for age, sex and SDB history duration (P > 0.05). Children with OSA have impaired attention, characterized by excessive alerting network activation. However, alerting network efficiency did not change linearly with disease severity. More research is needed to elucidate the neural mechanisms underlying attention deficits in pediatric OSA.

The role of epiglottopexy for pediatric OSA

The role of epiglottopexy for pediatric OSA

Integrative traditional Chinese medicine treatment for children with obstructive sleep apnea

PurposeObstructive sleep apnea (OSA) is a chronic disease that affects 1%–6% of children. Our study aims to explore the effectiveness and clinical characteristics of integrative Traditional Chinese Medicine (ITCM) for pediatric OSA. Materials and methodsIn this retrospective cohort study, we assessed differences of polysomnography (PSG) parameters and clinical characteristics between 2009 and 2020. Children <12 years old diagnosed with OSA (n = 508) were included and were categorized into ITCM cohort, western medicine (WM) cohort ,and surgery cohort. Outcomes were apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and body mass index (BMI). ResultsThere were 56 (11%), 324 (63.8%), and 128 (25.2%) patients in the ITCM, WM, and surgery cohorts. Among 17, 26, and 33 patients in the ITCM, WM, and surgery cohorts underwent follow-up PSG studies, respectively. In the ITCM follow-up cohort, AHI were significantly reduced (9.59 to 5.71, p < 0.05). BMI significantly increased in the WM follow-up cohort (19.46 to 20.50, p < 0.05) and the surgery follow-up cohort (18.04 to 18.85, p < 0.01). Comparing ITCM to WM cohort, a significant difference was found between the changes in RDI (ITCM: −6.78, WM: 0.51, p < 0.05) after treatment. Among ITCM follow-up cohort, the most prescribed TCM formula was Forsythia and Laminaria Combination. The most prescribed TCM herb was Ephedrae Herba. ConclusionsITCM therapy can significantly reduce RDI and control BMI. We identified potential TCM treatments for pediatric OSA. Further study of the pharmacological mechanisms and clinical efficacy is warranted.

0050 Pediatric OSA and neurodevelopment

Abstract Introduction Pediatric OSA and its associated sleep disorders occur in up to 7% of children. Whereas the sequelae of the disease are well characterized, the underpinnings of its phenotypes are poorly understood. This is mainly because of a lack of comprehensive model of the disease in the young. Here I present the neurobehavioral phenotype of pediatric OSA utilizing a preclinical murine model. Methods This proposal represents a departure from prior models and is embedded in the sculpting of the IH model. 1) Human polysomnographic data: We studied human data in children with OSA 2) Murine oximetry data: we create murine oximetry curves 3) Cross Species Curve Fitting: We cross fit those across species 4) Optimization of hypoxic gas throughputs: We then optimized this for the hypoxia chamber we are using Results We examined 4 behavioral tasks over a number of time periods to establish the temporality needed for hippocampal task ablation, as the hippocampus is the center of learning and memory in mammals. 2 tasks were hippocampal dependent: a) Novel object recognition b) Object place recognition. 2 tasks were hippocampal independent: 1) Hot plate: 2) OFA. We utilized 3 time periods initially: exposure from p14 to p23 (9 days acute), to p35 (21 days intermediate), and p70 (56 days, chronic). There was no deterioration in hippocampal tasks from p14 to p35, however at p70 we noted task ablation. We therefore systematically worked backwards, until we discovered the 'tipping point' where hippocampal task ablation is observed is p49 (35 days of exposure). Prior to this, we note no task ablation, however after this time point, hippocampal task ablation is preserved. Conclusion We have demonstrated a tractable, temporal model for pediatric OSA over a systematic set of time points to show when hippocampal deficits from the OSA stimulus manifest phenotypically. We have further isolated these deficits to the hippocampus of developing mice, which is the mammalian center of learning, memory, and retrieval. Support (if any) Arvind has previously received support from AASM and BCM OOR. He is currently supported by 1K08HL161263-01 from NHLBI.

Effect of different head-high lateral extubation on adverse reactions in the peri-extubation period of pediatric OSAS surgery under general anesthesia

BackgroundChildren with OSAS are prone to various airway complications during tracheal extubation after tonsillectomy and adenoidectomy due to oropharyngeal secretions and oozing blood. However, few studies have examined the effect of position on airway complications after tracheal extubation in children with OSAS. The aim of this study was to investigate the appropriate position for extubation in children with OASA.MethodsA total of 459 children aged 3–14 years with OSAS who underwent tonsillectomy and adenoidectomy were recruited for this study. All children were treated with the same surgical approach and standard anesthesia methods of induction of anesthesia, tracheal intubation and maintenance of anesthesia. At the end of surgery, the children were delivered to the post anesthesia care unit and randomly divided into three groups: Group A: Head-high 0° in lateral position; Group B: Head-high 15° in lateral position; Group C: Head-high 30° in lateral position. The main outcomes of this study were the pulse oxygen saturation (SpO2) and the Sedation-Agitation Scale (SAS) scores of the children after extubation, the outflow of oral-nasal secretions and the respiratory complications. Secondary outcomes were blood pressure, heart rate, end-respiratory carbon dioxide, respiratory rate, and post-operative awakening time of the children in three groups.ResultsData from a total of 423 children were statistically analyzed, 141 in Group A, 142 in Group B, and 140 in Group C. The main results showed a significant decrease in choking response after extubation in Group B (46.5%) and Group C (40.7%) compared to Group A (60.3%) (P < 0.05). The SAS score for postoperative agitation was higher in Group A (4.6 pm 0.9) than in Group B (4.4 pm 0.7) and Group C (4.3 pm 0.6) (P < 0.05). Also the SpO2 after extubation was higher in Group B (97.2%) and Group C (97.1%) than in Group A (95.8%) (P < 0.05). In contrast, there was no difference in the occurrence of respiratory complication and postoperative agitation in children between Group B and Group C (all P > 0.05). In addition, there was no difference in the amount of oral-nasal secretions among the children in the three groups (all P > 0.05).ConclusionThe head-high 15° lateral position and head-high 30° lateral position can reduce the incidence of airway complications and agitation and provide safe and comfortable extubation conditions for children during the peri-extubation period after tonsillectomy and adenoidectomy, which has certain clinical guidance value.Trial registrationRegistration Number: NO.ChiCTR2200055835(20,01,2022) https://www.chictr.org.cn

Nursing Professionals’ Role in the Comprehensive Management of Obstructive Sleep Apnoea: A Literature Review

Background: obstructive sleep apnoea is a common and burdensome condition, characterised by obstruction of the airway during sleep at the level of the pharynx, which may occur with symptoms or without any symptoms. The most common place for obstructive sleep apnoea management is in specialised sleep units. Aim: to identify what is known about nurses’ role in comprehensive management of obstructive sleep apnoea, and to determine the effectiveness of nurse-led interventions as well as the cost effectiveness of management of obstructive sleep apnoea in primary care settings. Methods: a scoping review was carried out by searching PubMed/Medline, CINAHL, Scopus, Cochrane Database of Systematic Reviews and ScienceDirect. The study findings were synthesised using a thematic analysis approach. Results: In this review, 12 articles were included, and three key themes emerged, namely the role of nurses in the diagnosis of obstructive sleep apnoea, role of nurses in the follow up and support of obstructive sleep apnoea patients, and role of nurses in the management of obstructive sleep apnoea in primary care and the cost-effectiveness. Conclusion: Nurses can play a critical role in obstructive sleep apnoea. There are many ways in which nurses can contribute, including screening, assessment, diagnosis, promotion of therapy adherence, and following up with patients, including monitoring for any side effects associated with the CPAP machine, such as irritation of the face. Additionally, nurses can provide patient education and coordinate with other health care providers. Nursing interventions such as patient education have been demonstrated to be highly effective in promoting adherence to PAP therapy in both sleep units and primary care settings. Based on the findings of this review, the primary care model is more cost-effective than the sleep unit model in the management of obstructive sleep apnoea patients. The role of nurses in managing Obstructive Sleep Apnoea in both paediatric and adult populations shares similarities, but also includes differences that should be carefully considered and explored. In this review, one article only explored the role of nurses in paediatric OSA care. Thus, there is a need to identify the potential role of nursing in the comprehensive management of paediatric obstructive sleep apnoea, as well as to explore alternative cost-effective approaches that include primary care settings.