Sleep Apnea In Children Research Articles

Tobacco smoke exposure as a risk factor for obstructive sleep apnea in children.

The most common respiratory disturbance in sleeping children is obstructive sleep apnea syndrome (OSAS). Passive smoking is one of factors predisposing to OSAS. The aim of this study was to determine the correlations between exposure to tobacco smoke (passive smoking) and development of respiratory disorders in children during sleep. One hundred and sixty school-aged children (6-18years) were included in the study. The inclusion criterion was exposure to tobacco smoke at home (n=90). The control group were school-aged children who had had no contact with tobacco smoke at home (n=70). Exclusion criteria were obesity and children with impaired patency of the nose. Each child had a polygraphic examination performed at home. The children and their parents completed a questionnaire to assess the level of child's exposure to tobacco smoke. The study ran from December 15, 2012 to February 26, 2016. OSAS was observed in 12% of children with an apnea-hypopnea index >1.5 (<13years of age) and an apnea-hypopnea index >5 (for children >13years), and with diurnal and nocturnal symptoms. Children exposed to tobacco smoke presented more apnea-hypopnea events (n=17) than the control group (n=3; P<0.001). In the group exposed to tobacco smoke the following issues were noted: concentration problems (38.9%), tiredness/lethargy (46.7%), and irritability/hyperactivity (36.7%). No statistically significant differences were found in waking up, snoring, or sleep apnea. OSAS occurs more often in children exposed to tobacco smoke and these children demonstrate concentration problems, tiredness, and irritability/hyperactivity to a greater extent than control group.

Auto-titrating CPAP for the treatment of obstructive sleep apnea in children.

In-laboratory titration polysomnography (PSG) is standard to determine optimal therapeutic continuous positive airway pressure (CPAP) in children with obstructive sleep apnea (OSA). The use of auto-titrating CPAP devices (autoCPAP) as an alternative to CPAP titration has not been well studied in children. We hypothesized that autoCPAP-derived pressures (PMEAN, PPEAKMEAN, P90) would be similar to titration PSG pressure (PPSG). This is a retrospective study of children with OSAS initiated on autoCPAP between 2007 and 2017, who used autoCPAP for at least 2 h/night and who had adequate titration PSG were included in the analysis. AutoCPAP-derived pressures were obtained from use downloads and compared with PPSG. PPSG predictive factors were analyzed by median regression. Nonparametric methods were used for analysis. Of 110 children initiated on autoCPAP, 44 satisfied the inclusion criteria. Age (median (interquartile range)) was 13.01 (9.98-16.72) years, and 63.6% were obese. PPSG median (interquartile range) was 8 (7-11) cmH₂O, mean autoCPAP-derived pressure (PMEAN) was 6.2 (5.6-7.6) cmH₂O, peak mean pressure (PPEAKMEAN) was 9.4 (7.7-11.1) cmH₂O, and average device pressure ≤ 90% of the time (P90) was 8.1 (7.2-9.7) cmH₂O. AutoCPAP-derived pressures correlated with PPSG (P < .05). PMEAN was lower than the other 3 pressures (P < .0002). Median regression analysis demonstrated that after adjusting for patient characteristics such as age, sex, and obesity status, autoCPAP-derived pressures remained significant predictors of PPSG (P < .05). There were no significant interactions between these patient characteristics and autoCPAP-derived pressures. This study demonstrates that autoCPAP-derived pressures correlate with the titration PSG-derived pressures. These results indicate that autoCPAP can be used in the pediatric population and can determine pressures that are close to the titration pressures.

Parental concern as an indicator of the severity of Obstructive Sleep Apnea in children

IntroductionAn accepted screening question for Obstructive Sleep Apnea (OSA) in children is “Does your child snore”. However, this has no correlation to severity. The purpose of this study is to evaluate a simple 2-item questionnaire that reflects the degree of parental concern to predict the severity of Obstructive Sleep Apnea (OSA) in children as measured by Polysomnography (PSG). MethodsProspective analysis of parental concern regarding their children referred for PSG due to suspected OSA. Parents of all study children completed the brief Parental Concern Scale (PCS) questionnaire that we devised and the validated Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder questionnaire (PSQ-SRBD). The PCS consisted of 1 question on the need for surgery and 1 question on concerns about the child's breathing. Both questionnaires were compared to PSG results. ResultsNinety-five children (mean age 4.2 ± 2.5 years, 52% males, mean body mass index z score 0.45 ± 1.8) were recruited. Twenty-three children (24%) had moderate-severe OSA and were referred for adenotonsillectomy. Correlations were found between the need for surgery score and the apnea-hypopnea index (r = 0.22, P = .029), as well as the mean SpO2 levels (r = −0.24, P = .02). The likelihood for the diagnosis of moderate-severe OSA by PSG increased as parental ranking for the need for surgery increased (P = .003). The need for surgery score was the only predictor for moderate-severe OSA (P = .039). ConclusionQuerying parents on their perception of their child's need for surgery is a practical, and easy-to-use tool that can help the clinician in prioritizing referral to PSG.

1237 Positional central sleep apnea in a child: not always obstructive

Abstract Introduction Spinal cord compression at the craniocervical junction can cause central sleep apnea (CSA) in children, due to mechanical disruption of respiratory control centers. Polysomnography (PSG) pre/post surgical decompression is indicated to evaluate treatment response. Report of Case A 5-year-old with Wolf-Hirschhorn syndrome, developmental delay, partial agenesis of the corpus callosum, hypotonia, incomplete segmentation of C1 with subluxation leading to stenosis, cleft palate, and obstructive sleep apnea (OSA) presented for post-surgical PSG. Prior PSGs revealed oAHI 55/hr and 7/hr, cAHI 3/hr and 2/hr at 1 and 10 months of age, respectively. At 46 months, patient underwent suboccipital decompression at C1 for severe craniocervical stenosis. Post-operative PSG revealed emergence of CSA with cAHI 8/hr and stability of OSA with an oAHI 8/hr. Positional analysis revealed worsening in lateral position (lateral cAHI 10.6/hr, supine cAHI 4.6/hr). Central events were up to 33 seconds long with nadir desaturation of 76% in lateral position compared to 20 seconds and nadir 88% in supine position. Head CT and MRI showed incomplete ossification of the C1 vertebra with subluxation of the left lateral mass leading to absence of CSF flow at the craniocervical junction. Repeat decompression and fixation is planned by neurosurgery; in the interim supine sleep was recommended and family declined BiPAP. Conclusion In our case, CSA worsened with left lateral positioning and improved with supine positioning. Lateral positioning likely increased subluxation of the left lateral mass seen on CT/MRI, and eased subluxation in supine sleep causing position-dependent dynamic impingement of the respiratory control centers at the level of subluxation. The absence of findings prior to decompression may reflect increased instability after decompression or increased stenosis with growth. Our case highlights the importance of positional analysis for central as well as the more conventional obstructive sleep apnea to understand pathogenesis and guide therapy.

Feasibility study of determining a risk assessment model for obstructive sleep apnea in children based on local findings and clinical indicators

ObjectiveTo test a feasible and reliable model for diagnosing obstructive sleep apnea (OSA) in children, based on the clinically relevant parameters, in comparison to a polysomnography. MethodsA total of 94 children with the suspected underlying OSA were included in the analyses. An association between clinical parameters (modified Mallampati score, tonsil size, adenoid size, age, gender, and body mass index) and apnea-hypopnea index (AHI) obtained following an overnight polysomnography was assessed, and significant variables were incorporated in the logistic regression model. Also, the sensitivity and specificity calculations of the model with the inclusion of ROC curve analysis were performed. ResultsAll tee local clinical parameters were significantly associated with AHI (P < 0.001). The most significant correlation with AHI was shown with the modified Mallampati score (r = 0.723), following with tonsil size (r = 0.673), and adenoid size (r = 0.502). The sensitivity of the tested model was 84%, and specificity was 74%. ConclusionThis study derived a model based on the local clinical findings that significantly overlapped with the results of an overnight polysomnography, in diagnosing OSA in children.

Sleep patterns and problems among children with 22q11 deletion syndrome.

BackgroundTo delineate sleep habits and problems in children with 22q11.2 deletion syndrome (22q11DS).MethodsThirty children, age 1–15 (mean 6.8) years, participated in the study, which was an internet‐based anonymous survey of parents of children with 22q11DS administered via the 22q11.2 Foundation. The main outcome was the Childhood Sleep Habits Questionnaire (CSHQ).ResultsScores on the CSHQ demonstrated clinically significant sleep problems in 29 of the 30 children. When compared with previously reported normative values for typically developing children of the same age, children with 22q11DS had significantly greater sleep problems. Only 30% of children had previously undergone sleep study. While about half of children had tried a medication for sleep, it usually was not felt to be helpful. In contrast, parents reported that behavioral interventions, such as consistent bedtime routine and appropriate sleep environment, were helpful. This is one of the first studies to specifically address sleep problems other than obstructive sleep apnea in children with 22q11DS.ConclusionsThe findings suggest children with 22q11DS may have a higher risk of experiencing clinical sleep problems, compared to typically developing children. Consideration of additional screening and treatment of sleep disorders in children with 22q11DS is warranted.

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision.

Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care.

Effect and mechanism of miRNA on obstructive sleep apnea in children

Exosomal microRNAs (miRNAs) have attracted increasing interest as biomarkers for the diagnosis of numerous human diseases; however, little is known about exosomal miRNAs in regard to pediatric obstructive sleep apnea syndrome (OSAS). The aim of this study was to identify exosomal miRNAs involved in OSAS and to determine their relative functions. Serum exosomal miRNA-expression patterns in pediatric OSAS patients and healthy donors were analyzed comprehensively via RNA sequencing, and differently expressed miRNAs were verified using quantitative reverse transcription polymerase chain reaction. The effect of the miRNAs on cell culture was measured by flow cytometry. Results revealed that 364 and 464 miRNAs were identified in normal and OSAS exosomes, respectively. Moreover, exosomal miR-664a-3p, miR-210, miR-21-3p, and miR-107 were significantly more downregulated in exosomes from OSAS than in those of healthy controls. These downregulated miRNAs were mainly involved in functions involving cell cycle, immune response, and cell proliferation and adhesion as well as pathways associated with mitogen-activated protein kinase, Wnt, and mammalian target rapamycin signaling. Furthermore, miR-107 promoted the arrest of the adenoid lymphocyte cycle at the G2/M phase. These data revealed several potential exosomal miRNA biomarkers and their associated functions and pathways. This study advanced the knowledge of OSAS exosome biology to facilitate the development of OSAS-specific exosome-based diagnostics and therapeutics.

New treatments for obstructive sleep apnea in children.

Obstructive sleep apnea (OSA) has a prevalence of up to 5% in children and 50% in obese children. OSA is associated with various comorbidities in the general population and in the perioperative period. In this review, we will provide background of OSA and insights into the available treatment options both surgically and medically. Unlike adults, most pediatric OSA is treated with adenotonsillectomy. Continuous positive airway pressure therapy is the commonly used medical treatment. Management of pediatric OSA is multidisciplinary. We will discuss the surgical options and medical options of managing pediatric OSA.

Obstructive sleep apnea in children with down syndrome - Prevalence and evaluation of surgical treatment

IntroductionThe prevalence of obstructive sleep apnea (OSA) in the pediatric population with Down syndrome (DS) is reported to be 45–76%. The criterion “gold” standard for diagnosing OSA is polysomnography (PSG). First-hand surgical treatment is adenotonsillectomy (ATE), and another option is adenopharyngoplasty (APP). The aims of this study were to determine the OSA prevalence among children with DS who had undergone PSG and to evaluate and compare the efficiency and results of ATE and APP treatments. Methods and materialsChildren <18 years old with DS who underwent PSG at Karolinska University Hospital were included in this retrospective cohort study. Medical records were examined for patient age, sex, medical comorbidity diagnoses, and OSA treatment, and the results from PSG and the quality of life questionnaire OSA-18 were registered. The prevalence and degree of OSA were calculated. Results from a nonsystematic subgroup that underwent postoperative PSG and the OSA-18 were compiled to evaluate surgical efficiency. Pre- and postoperative results from APP and ATE patients were compared. ResultsIn the study, 138 DS children were included. The OSA prevalence was 82.6%, and 39.9% had severe OSA, with a median (range) apnea hypopnea index (AHI) of 7.6 (0–104). Other comorbidity diagnoses were found for ear disease in 60%, circulatory disease in 51% and endocrine disease in 39% of patients. A nonsystematic subgroup of 33 patients underwent postoperative PSG, with a residual prevalence of moderate or severe OSA of 63.6%. Among the ATE and APP patients with pre- and postoperative PSG (n = 20), no difference between the groups was shown, but the values were significantly improved as a whole: the median AHI changed from 21.1 to 12.4 and the median OSA-18 rating changed from 54.0 to 35.0. ConclusionsIn this population of children with DS, the OSA prevalence was over 80%, wherefore continued screening and treatment are strongly supported. Uncertain surgical efficiency was indicated, and no significant difference in the results for ATE and APP was shown. When interpreting the results, it should be taken into consideration that the frequency of postoperative PSG was low and nonsystematic and that the groups were unequal and small.

Low-Quality Evidence Supports the Use of Mandibular Advancement Appliances in Managing Obstructive Sleep Apnea in Children

Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis. Yanyan M, Min Y, Xuemei G. Sleep Med 2019;60:145-51. Funding support was granted by the National Natural Science Foundation of China and from the Seeding Grant for Medicine and Engineering Science of Peking University. Systematic review and meta-analysis.

Cognition After Early Tonsillectomy for Mild OSA.

It remains uncertain whether treatment with adenotonsillectomy for obstructive sleep apnea in children improves cognitive function. The Preschool Obstructive Sleep Apnea Tonsillectomy and Adenoidectomy study was a prospective randomized controlled study in which researchers evaluated outcomes 12 months after adenotonsillectomy compared with no surgery in preschool children symptomatic for obstructive sleep apnea. A total of 190 children (age 3-5 years) were randomly assigned to early adenotonsillectomy (within 2 months) or to routine wait lists (12-month wait, no adenotonsillectomy [NoAT]). Baseline and 12-month assessments included cognitive and behavioral testing, medical assessment, polysomnography, and audiology. The primary outcome was global IQ at 12-month follow-up, measured by the Woodcock Johnson III Brief Intellectual Ability (BIA). Questionnaires included the Pediatric Sleep Questionnaire, Parent Rating Scale of the Behavioral Assessment System for Children-II, and Behavior Rating Inventory of Executive Function, Preschool Version. A total of 141 children (75.8%) attended baseline and 12-month assessments, and BIA was obtained at baseline and 12-month follow-up for 61 and 60 participants in the adenotonsillectomy versus NoAT groups, respectively. No cognitive gain was found after adenotonsillectomy compared with NoAT, adjusted for baseline; BIA scores at 12-month follow-up were as follows: adenotonsillectomy, 465.46 (17.9) versus NoAT, 463.12 (16.6) (mean [SD]). Improvements were seen for polysomnogram arousals and apnea indices and for parent reports of symptoms (Pediatric Sleep Questionnaire), behavior (Behavior Assessment System for Children behavioral symptoms, P = .04), overall health, and daytime napping. Structured testing showed no treatment-attributable improvement in cognitive functioning of preschool children 12 months after adenotonsillectomy compared with NoAT. Improvements were seen after adenotonsillectomy in sleep and behavior by using polysomnogram monitoring and parental questionnaires.

Anti-inflammatory medications for obstructive sleep apnoea in children.

Anti-inflammatory medications for obstructive sleep apnoea in children.

Diagnosis and treatment of mouth breathing in children

Mouth breathing in children are increasingly concerned by the physicians and the society. Incompetent lip closure can be classified as oral habit and pathological mouth breathing. Pathologic mouth breathing due to hypertrophy of adenoids and tonsils is often the cause of obstructive sleep apnea in children, which may lead to craniofacial deformities and other consequences. At present, there are many problems in the definition, diagnosis and treatment of mouth breathing, which need to be clarified. Key words: Mouth breathing; Child; Diagnosis; Risk management

Home-based Screening for Obstructive Sleep Apnea in Children

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Adenotonsillectomy for the Treatment of Obstructive Sleep Apnea in Children with Prader-Willi Syndrome: A Meta-analysis.

Adenotonsillectomy outcomes in obstructive sleep apnea (OSA) treatment among children with Prader-Willi syndrome (PWS) remain unclear. This study aimed to elucidate the effectiveness of adenotonsillectomy in OSA treatment among children with PWS. PubMed, MEDLINE, Embase, and Cochrane Review up to February 2019. The registry number of the protocol published on PROSPERO was CRD42015027053. Two authors independently searched the relevant database. Polysomnography outcomes in these children were examined, including net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum and mean oxygen saturation, the overall success rate for a postoperative AHI <1, and the overall success rate for a postoperative AHI <5. Six studies with 41 patients were analyzed (mean age, 5.0 years; 55% boys; mean sample size, 6.8 patients). All children had PWS and received adenotonsillectomy for the treatment of OSA. The AHI was 13.1 events per hour (95% CI, 11.0-15.1) before surgery and 4.6 events per hour (95% CI, 4.1-5.1) after surgery. The mean change in the AHI was a significant reduction of 8.0 events per hour (95% CI, -10.8 to -5.1). The overall success rate was 21% (95% CI, 11%-38%) for a postoperative AHI <1 and 71% (95% CI, 54%-83%) for a postoperative AHI <5. Some patients developed velopharyngeal insufficiency postoperatively. Adenotonsillectomy was associated with OSA improvement among children with PWS. However, residual OSA was frequently observed postoperatively in these patients.

Adenotonsillectomy for pediatric obstructive sleep apnea: how to predict those at risk for postoperative complications.

CITATIONConnolly HV, Tomaselli LT, McKenna Benoit MK. Adenotonsillectomy for pediatric obstructive sleep apnea: how to predict those at risk for postoperative complications. J Clin Sleep Med. 2020;...

Incidence and predictor of obstructive sleep apnea in children with adenotonsillar hypertrophy and normal/inconclusive overnight oximetry: a prospective study

Incidence and predictor of obstructive sleep apnea in children with adenotonsillar hypertrophy and normal/inconclusive overnight oximetry: a prospective study

Polysomnographic assessment of the prevalence of obstructive sleep apnoea in children and young people with epilepsy living in Scotland

Polysomnographic assessment of the prevalence of obstructive sleep apnoea in children and young people with epilepsy living in Scotland

The diagnostic accuracy of type IV portable sleep monitors versus polysomnography for obstructive sleep apnea in children: a systematic review

The diagnostic accuracy of type IV portable sleep monitors versus polysomnography for obstructive sleep apnea in children: a systematic review