Prevalence Of Obstructive Sleep Apnea In Children Research Articles

Association of Obstructive Sleep Apnea With Unanticipated Admission Following Nonotolaryngologic Pediatric Ambulatory Surgery.

Approximately 2% of ambulatory pediatric surgeries require unanticipated postoperative admission, causing parental dissatisfaction and suboptimal use of hospital resources. Obstructive sleep apnea (OSA) occurs in nearly 8% of children and is known to increase the risk of perioperative adverse events in children undergoing otolaryngologic procedures (eg, tonsillectomy). However, whether OSA is also a risk for unanticipated admission after nonotolaryngologic surgery is unknown. The objectives of this study were to determine the association of OSA with unanticipated admission after pediatric nonotolaryngologic ambulatory surgery and to explore trends in the prevalence of OSA in children undergoing nonotolaryngologic ambulatory surgery. We used the Pediatric Health Information System (PHIS) Database to evaluate a retrospective cohort of children (<18 years) undergoing nonotolaryngologic surgery scheduled as ambulatory or observation status from January 1, 2010, to August 31, 2022. We used International Classification of Diseases codes to identify patients with OSA. The primary outcome was unanticipated postoperative admission lasting ≥1 day. Using logistic regression models, we estimated the odds ratio (OR) and 95% confidence intervals (CIs) for unanticipated admission comparing patients with and without OSA. We then estimated trends in the prevalence of OSA during the study period using the Cochran-Armitage test. A total of 855,832 children <18 years underwent nonotolaryngologic surgery as ambulatory or observation status during the study period. Of these, 39,427 (4.6%) required unanticipated admission for ≥1 day, and OSA was present in 6359 (0.7%) of these patients. Among children with OSA, 9.4% required unanticipated admission, compared to 5.0% among those without. The odds of children with OSA requiring unanticipated admission were more than twice that in children without OSA (adjusted OR, 2.27; 95% CI, 1.89-2.71; P < .001). The prevalence of OSA among children undergoing nonotolaryngologic surgery as ambulatory or observation status increased from 0.4% to 1.7% between 2010 and 2022 (P trends < .001). Children with OSA were significantly more likely to require unanticipated admission after a nonotolaryngologic surgery scheduled as ambulatory or observation status than those without OSA. These findings can inform patient selection for ambulatory surgery with the goal of decreasing unanticipated admissions, increasing patient safety and satisfaction, and optimizing health care resources related to unanticipated admission.

Obstructive sleep apnea syndrome in children as a multi-disciplinary problem (a review)

Aim. To analyze the data of modern scientific literature about the etiology, risk factors, pathogenesis, diagnosis and treatment of obstructive sleep apnea (OSA) in children. Results. The prevalence of OSA in children is about 1–5 %, with a peak incidence between the ages of 2 and 6 years. The main risk factors for OSA include adenotonsillar hypertrophy, obesity, and craniofacial anomalies. Nocturnal and daytime symptoms are clinically distinguished. Nocturnal ones include snoring, mouth breathing, pauses in breathing, restless sleep, enuresis and sweating; daytime symptoms are nasal obstruction, mouth breathing, morning headache, drowsiness, violation in attention concentration and hyperactivity. Nocturnal polysomnography is the gold standard for the diagnosis of OSA, in the absence of which the use of screening systems is possible, in particular – cardiorespiratory monitoring. The apnea/hypopnea index ≥1 per hour is considered a diagnostic criterion for mild OSA in children and differs from that in adults ≥5. Among the most effective treatments for OSA are adenoidectomy, CPAP therapy, intranasal corticosteroids, leukotriene receptor antagonists, and lifestyle modification in obesity is obvious. Conclusions. The problem of OSA syndrome is underestimated, and the vigilance of physicians as well as diagnostic opportunities of treatment and prevention facilities in Ukraine are quite low. Nocturnal polysomnography or screening diagnostic methods (cardiorespiratory monitoring) should be used in case of suspected OSA. Therapeutic measures for apnea are primarily aimed at eliminating etiological and risk factors. The presence of OSA in children with adenoids is an absolute indication for their removal.

Prevalence and Risk Factors for Rapid Eye Movement-Related Obstructive Sleep Apnea in Children.

ObjectivesDifferent pathophysiological mechanisms and the distribution of respiratory events among rapid eye movement (REM) and non-rapid eye movement (NREM) sleep modulate the effect of obstructive sleep apnea (OSA). We aimed to study the prevalence and risk factors for REM-related OSA in children.Study DesignRetrospective, cross-sectional study.MethodsWe recruited 366 children with OSA confirmed by polysomnography (PSG) over a 5-year period. REM-related OSA is defined by an obstructive apnea-hypopnea index (OAHI) in the REM sleep ≥2× than during NREM sleep.ResultsThe prevalence of REM-related OSA in children was 50.3%. Children with REM-related OSA were more likely to be female (P = 0.042), and had lower prevalence of adenotonsillar hypertrophy (P = 0.043) compared with children with other OSA subtypes. Children with REM-related OSA slept longer in the supine position (P = 0.003), had shorter duration of NREM1 sleep (P = 0.018), lower nadir SpO2 (P = 0.005), and a higher oxygen desaturation index 3% (ODI3%) (P = 0.014), and lower arousal index (P = 0.034) compared with other OSA subtypes. Female gender and supine sleep was the independent risk factors for REM-related OSA.ConclusionThe prevalence of REM-related OSA was 50.3%. OAHIREM should be considered as an important parameter in future clinical research studies done in children with OSA.

Prevalence of obstructive sleep apnea in children with laryngomalacia and value of polysomnography in treatment decisions

ObjectivesChildren with laryngomalacia may present with obstructive sleep apnea (OSA). The role of polysomnography (PSG) in treatment decision making for laryngomalacia is not well defined. We aimed to investigate the prevalence of OSA in children with laryngomalacia and the role of PSG in treatment decision. MethodsRetrospective medical record review of children with laryngomalacia, confirmed by direct laryngoscopy, during a period of 3 years. Demographic data, presenting symptoms, severity classification, comorbidities and pre- and postoperative PSG data were retrieved and analyzed. Data are expressed as a median (25th – 75th percentile). ResultsForty-six patients were with diagnosed laryngomalacia between March 2016 and April 2019. A complete data set was available for 44 patients, 24 males and 20 females. The median age at the time of PSG was 12 weeks (6.3–29.8). Thirty-four children (77.4%) were diagnosed with concomitant OSA. A diagnosis of OSA changed the severity classification and treatment decision in 24 cases (54.5%). Twenty-three patients underwent supraglottoplasty, five patients were treated with continuous positive airway pressure (CPAP) and nine patients had both treatments. Seven patients received conservative treatment. The obstructive apnea/hypopnea index decreased from 8.9 events/hour (4.4–12.1) to 2.4 events/hour (1.5–4.4) after supraglottoplasty (p = 0.009). ConclusionsA diagnosis of OSA was established in 77.4% of patients with larygomalacia The presence of OSA may increase the severity of symptoms in laryngomalacia, leading to a transition from watchful-waiting to active intervention with CPAP therapy or supraglottoplasty. Supraglottoplasty is a safe and effective surgical procedure for laryngomalacia. When performed in the setting of laryngomalacia with concomitant OSA, it also significantly improves OSA symptomatology.

Obstructive Sleep Apnea in Children With Beckwith-Wiedemann Syndrome.

Beckwith-Wiedemann syndrome (BWS) is a rare pediatric overgrowth disorder that includes a spectrum of clinical findings including macroglossia, especially in those with loss of methylation at the imprinting control region (IC2 LOM) on chromosome 11. Children with BWS can have very severe obstructive sleep apnea (OSA), but the prevalence of OSA in this population is poorly understood, as is the relationship between OSA and the BWS genotype/phenotype. We hypothesized that there would be a high prevalence of OSA in children with BWS, and that OSA would be more severe in children with IC2 LOM. Medical records from children evaluated from March 2015 through January 2018 were reviewed for results from polysomnography, genetic testing, and clinical assessment. A total of 26 children with BWS not previously treated for OSA underwent polysomnography, genetic testing, and clinical assessment. Median (range) age was 5 months (3 days to 33 months). Most children, 20 (76.9%), had an obstructive apnea-hypopnea index (OAHI) > 2 events/h. Median (range) OAHI was 4.4 events/h (0 to 56.1 events/h). OAHI was significantly greater in participants younger than 6 months compared with those older than 6 months (P = .008). Those with IC2 LOM did not have a greater OAHI (P = .61) than those with other genetic causes of BWS, but OAHI had a strong positive correlation with BWS clinical score (Spearman rho = .54, P = .004). There is a high prevalence of OSA in children with BWS with macroglossia. Younger children with BWS and those with more phenotypic features may be at greatest risk of OSA.

Obstructive Sleep Apnoea in Children and Adolescents with Ehlers-Danlos Syndrome

Background: In Ehlers-Danlos syndrome (EDS), a group of monogenic disorders affecting connective tissues, obstructive sleep apnoea (OSA) is highly prevalent in adults. The prevalence of OSA in children with EDS is unknown. Objectives: This prospective cross-sectional study aimed at determining the prevalence of OSA in paediatric EDS patients. Methods: Children with EDS (n = 24) were recruited from the Children’s Hospital Zurich and matched to healthy controls. Participants completed home respiratory polygraphy and questionnaires (Sleep-Related Breathing Disorder Scale [SRBD], Epworth Sleepiness Scale [ESS], and Child Health Questionnaire [CHQ]). The American Academy of Sleep Medicine criteria were applied for OSA diagnosis (obstructive apnoea-hypopnoea index [oAHI] ≥1/h). Conditional logistic regression was used to compare the prevalence of OSA and to adjust for possible confounding. Results: OSA was found in 42% of paediatric EDS patients and in 13% of matched controls (OR = 4.5, 95% CI = 0.97–20.83, p = 0.054). The median oAHI was higher in EDS patients than in controls (0.77/h, IQR = 0.19–1.76, vs. 0.24/h, IQR = 0.0–0.60, p < 0.001 adjusted for age, sex, and BMI z-score). EDS patients had lower scores in most CHQ scales and higher SRBD and ESS scores than controls (0.26, IQR = 0.1–0.35, vs. 0.07, IQR = 0–0.19, p = 0.004); 7 ± 4 vs. 5 ± 4, p = 0.033, respectively). Conclusion: OSA is a previously underestimated EDS-related complication increasing disease burden.

Otolaryngologic management of Down syndrome patients: what is new?

The management of children with Down syndrome as it pertains to the otolaryngologist continues to evolve. Obstructive sleep apnea (OSA) has dominated the recent literature, but other topics including hearing loss, swallowing, and perioperative considerations are also reported. The prevalence of OSA in children with Down syndrome ranges from 57 to 73% in certain cohorts, and, whereas adentonsillectomy can decrease Apnea-Hypopnea Index, up to 80% may have persistent OSA. Surgical techniques involving reduction of the base of tongue are effective for those who fail adenotonsillectomy, and it is expected that drug-induced sleep endoscopy may improve outcomes. New technology is also on the horizon that can assist with diagnosis and treatment including computational modelling and upper airway stimulation. Children with Down syndrome may not respond to medical management of eustachian tube dysfunction as well as normally developing children. In addition, there is a high prevalence of inner ear anomalies, increasing the risk for sensorineural hearing loss. Questions remain pertinent to the otolaryngologist regarding the ideal management of children with Down syndrome. Additional studies are necessary, to optimize understanding and treatment of this complex population, in particular as opportunities develop with technological advances.

Pediatric Obstructive Sleep Apnea in High-Risk Populations: Clinical Implications

Certain common medical conditions are associated with a higher risk of pediatric obstructive sleep apnea (OSA). A lower threshold for screening is therefore indicated for such patient cohorts. In this article, we briefly discuss the high prevalence of OSA in children born prematurely, and in those with Down syndrome, craniofacial disorders, and neuromuscular disorders. Primary care providers should have an increased index of suspicion for OSA in these children, considering the neurocognitive disability that occurs in these high-risk groups when OSA is left untreated. [Pediatr Ann. 2017;46(9):e336-e339.].

0873 OBSTRUCTIVE SLEEP APNEA IN CHILDREN WITH BECKWITH-WIEDEMANN SYNDROME

Beckwith-Wiedemann syndrome (BWS) is a rare pediatric overgrowth and cancer predisposition disorder that results in a spectrum of clinical findings. In children with BWS, macroglossia is particularly prominent in those with hypomethylation of the IC2 region of chromosome 11. Infants and children with BWS can have very severe obstructive sleep apnea (OSA), but the prevalence of OSA in this population is poorly understood, as is the relationship between OSA and the BWS genotype/phenotype. We hypothesized that there would be a high prevalence of OSA in children with BWS, and that OSA would be more severe in children with IC2 mutations due to more significant macroglossia. Children with BWS at Children’s Hospital of Philadelphia undergo polysomnography as part of their multidisciplinary evaluation. Medical records from children evaluated from 2006 through November 2016 were reviewed for results from polysomnography, genetic testing, and clinical assessment. Wilcoxon signed-rank test was used to compare apnea hypopnea index (AHI) between age groups. 223 children with BWS were evaluated. Of those, 21 children with BWS who had not previously had treatment for OSA and underwent polysomnography, genetic testing, and clinical assessment were included in the analysis. Median (range) age was 14.7 months (3 days to 6 years) at the time of polysomnography. 11 (52.3%) had an AHI >5/hour. In the cohort, median (range) AHI was 5.5/hour (0 to 80.9/hr). There was a trend toward greater AHI in participants less than 12 months old compared with those 12 months and older (p=0.051). Those with IC2 mutation did not have a greater AHI (p=0.75). There is a high prevalence of OSA in BWS. Infants with BWS may be at the greatest risk for OSA compared to older children. More research is needed to determine the role of genetic factors and macroglossia in OSA in children with BWS. KL2 TR001879, Parker B. Francis Foundation, KO8 CA193915, The Alex’s Lemonade Stand Foundation, St. Baldrick’s Foundation

Is obstructive sleep apnea syndrome in children season dependent?

The most common cause of obstructive sleep apnea (OSA) in children is an enlargement of tonsils and/or adenoids. Previous studies have shown that the size of adenoids and tonsils is influenced by upper respiratory tract infections and exposure to allergens. The rate of exposure to bacteria, viruses, and allergens fluctuates from season to season. Therefore, we hypothesized that the rate of polysomnograms positive for OSA may vary according to season. The objective of this study is to determine whether the prevalence of OSA in children, as determined by polysomnography, is affected by the season during which the study was performed. We retrospectively reviewed polysomnography tests of 296 children, ages 0-12years, referred for suspected OSA. We compared the Obstructive Apnea Hypopnea Index (OAHI) between the seasons and the rates of abnormal tests in each season according to the degree of severity. The mean OAHI did not significantly differ among the seasons (winter, 3.0 ± 5.0; spring, 3.0 ± 4.9; summer, 4.0 ± 6.3; fall, 3.4 ± 5.7, p = 0.183). When dividing the OAHI by levels of severity, no seasonality was found in moderate (winter, 13.8%; spring, 6.7%; summer, 11.7%; fall, 14.1%, p = NS) and severe OSA (winter, 8.8%; spring, 11.2%; summer, 10%; fall, 7.8%, p = NS). There was a small increase in the frequency of mild OSA diagnoses in the summer compared to the other seasons. In this study, season does not appear to affect the rate of diagnosis of significant OSA in children. Re-evaluation during a different season is unlikely to provide different results and may postpone surgery unnecessarily.

134 Obstructive Sleep Apnea, Hypertonus and Adipositas

Obstructive sleep apnea (OSA) is characterized by prolonged partial and/or intermittent complete (apnea) or partial (hypopnea) upper airway obstructions. The disruption of normal ventilation can be associated with hypoxemia and...