Treatment Of Sleep-disordered Breathing In Children Research Articles

Sleep in pediatric neuromuscular disorders

Sleep disordered breathing (SDB) is prevalent among children with neuromuscular disorders (NMD). The combination of respiratory muscle weakness, altered drive, and chest wall distortion due to scoliosis make sleep a stressful state in this population. Symptomatology can range from absent to snoring, nocturnal awakenings, morning headaches, and excessive daytime sleepiness. Sequelae of untreated SDB includes cardiovascular effects, metabolic derangements, and neurocognitive concerns which can be compounded by those innate to the NMD. The clinician should have a low threshold for obtaining polysomnography and recognize the nuances of individual disorders due to disproportionately impacted muscle groups such as hypoventilation in ambulating patients from diaphragm weakness. Non-invasive or invasive ventilation are the mainstay of treatment. In this review we explore the diagnosis and treatment of SDB in children with various NMD.

Obstructive sleep disordered breathing in children - an important problem in the light of current European guidelines.

Obstructive sleep-disordered breathing (SDB) is a common clinical problem. An unrecognized and untreated SDB is a serious threat for an intensively developing organism of a child. The consequences of SDB include cardiovascular and neurological complications, growth disorders and enuresis. Therefore, SDB in children becomes an important subject of many scientific investigations, publications, and congresses. In 2015 the European Respiratory Society Task Force published a document concerning the conclusions about the diagnostics and treatment of SDB in children and youth from 2 to 18 years of age (Fig. 1). The scientific data from 362 publications were presented in a condensed form of "seven steps", very useful in diagnosing and treatment planning (1). The authors underline the limited number of reliable evidence about SDB: prospective studies, randomized double-blinded studies with placebo. The presented evidence was categorized depending on their quality according to the classification of the American Academy of Neurology (ANN) into classes I - IV. Previously, in 2012, the guidelines of the American Academy of Pediatrics on obstructive sleep apnea syndrome (OSAS) in children with tonsillar hypertrophy and/or obesity were published (2, 3) and they were a valuable diagnostic and therapeutic compendium. The European guidelines discussed in this article result from the progress of knowledge in recent years, they cover the subject broadly, consider rare and difficult cases and present the spectrum of potential therapeutic actions. The aim of the guidelines is a better recognition of SDB, a systematization of diagnosis and treatment at every stage of medical care, including the causes of this disorder and its complications.

Sleep-Related Breathing Disorder, Cognitive Functioning, and Behavioral-Psychiatric Syndromes in Children.

Childhood sleep disordered breathing (SDB) is strongly associated with a range of cognitive and behavioral disturbances, including some psychiatric diagnoses. Despite this, the majority of children with symptoms of SDB go unrecognized, even though simple screening could identify children in need of further evaluation. Definitive evidence showing that SDB causes cognitive and behavioral impairment has yet to emerge, although a randomized controlled trial evaluating neuropsychological and health outcomes of treatment for SDB in children is currently underway.

Pediatric sleep apnea-need for multidisciplinary approach

Sleep disordered breathing (SDB) in children is a frequent disease with a prevalence varying from 1–5%. It is distinct from adults with respect to ideology, gender distribution, clinical manifestation, and treatment. Adenotonsillar enlargement is the most common cause of SDB in children. The diagnosis of SDB requires the use of special sensors such as nasal pressure transducer and esophageal pressure monitoring. The treatment of SDB in children includes amelioration of symptoms, normal cranio-facial growth and prevention of adult SDB. Adenotonsillectomy (AT) is the first line treatment of otherwise healthy children and also the initial treatment for children with multifactorial SDB. The success of AT as defined by reduction of AHI below 1 varies between 30 and 50% in various studies. A number of clinical factors such as nasal allergy, narrow and high hard palate, retro-position of mandible, enlargement of nasal inferior turbinates, high Mallampatti scale score, long face syndrome, age more than 8 years at the time of AT, and pretreatment apnea- hypopnea index (AHI) were associated with poor outcome. An impairment of nasal breathing due to adenotonsillar enlargement results in abnormal development of maxilla-mandibular skeleton resulting in narrowed upper airway. Surgery should be performed in young children as early as possible. Majority of patients have residual disease which requires additional treatment with orthodontic procedures such as rapid maxillary expansion (RME) and nasal CPAP. A multidisciplinary approach to evaluation and management of these children may lead to better treatment outcome.

Portable Monitoring and the Diagnosis of Obstructive Sleep Apnea

Sleep disordered breathing (SDB) in children is a frequent disease with a prevalence varying from 1–5%. It is distinct from adults with respect to ideology, gender distribution, clinical manifestation, and treatment. Adenotonsillar enlargement is the most common cause of SDB in children. The diagnosis of SDB requires the use of special sensors such as nasal pressure transducer and esophageal pressure monitoring. The treatment of SDB in children includes amelioration of symptoms, normal cranio-facial growth and prevention of adult SDB. Adenotonsillectomy (AT) is the first line treatment of otherwise healthy children and also the initial treatment for children with multifactorial SDB. The success of AT as defined by reduction of AHI below 1 varies between 30 and 50% in various studies. A number of clinical factors such as nasal allergy, narrow and high hard palate, retro-position of mandible, enlargement of nasal inferior turbinates, high Mallampatti scale score, long face syndrome, age more than 8 years at the time of AT, and pretreatment apnea- hypopnea index (AHI) were associated with poor outcome. An impairment of nasal breathing due to adenotonsillar enlargement results in abnormal development of maxilla-mandibular skeleton resulting in narrowed upper airway. Surgery should be performed in young children as early as possible. Majority of patients have residual disease which requires additional treatment with orthodontic procedures such as rapid maxillary expansion (RME) and nasal CPAP. A multidisciplinary approach to evaluation and management of these children may lead to better treatment outcome.

Differential effects of sleep disordered breathing on polysomnographic characteristics in preschool and school aged children

Childhood sleep disordered breathing (SDB) peaks in the preschool years. We aimed to compare the effects of SDB on polysomnographic characteristics between preschool and school aged children. One hundred and fifty-two preschool (3-5 y) and 105 school-aged (7-12 y) children, referred for assessment of SDB, plus controls (39, 3-5 y and 34, 7-12 y) with no history of snoring underwent overnight polysomnography. Subjects were grouped by their obstructive apnea hypopnea index (AHI) into those with primary snoring, mild obstructive sleep apnea (OSA), and moderate/severe OSA. The effects of SDB severity on sleep architecture and respiratory characteristics were compared between the age cohorts using quantile regression. There was an average reduction in median sleep efficiency of 3.5% (p=0.004) and an average increase in median WASO of 2% (p=0.08) between the age cohorts across the severity groups, with sleep efficiency falling and WASO increasing with increasing SDB severity in the school-aged, but not the preschool, cohort. There was an average difference in median central AHI of 0.6 events/h (p<0.001) between the age cohorts across the severity groups, with the 3-5 y old cohort but not the 7-12 y old cohort having more central apneas with increasing SDB severity. We have demonstrated clinically important, age-related differences in sleep architecture in children with SDB. Preschool children with SDB maintain sleep efficiency and awaken fewer times throughout the night than do school aged children with a comparable severity of SDB, but experience more central apneas. This may have implications for the outcomes and treatment of SDB in children of different ages.

Cyanotic breath‐holding spells in children respond to adenotonsillectomy for sleep‐disordered breathing

Children with breath-holding (BH) spells may demonstrate sleep-disordered breathing (SDB) during polysomnography. We studied five young children with cyanotic spells retrospectively and found both SDB and a response to adenotonsillectomy. We therefore proceeded with a prospective investigation of treatment for SDB in children with comorbid cyanotic spells. Nineteen children with cyanotic BH spells were identified and enrolled in the prospective study. Parents chose either treatment or observation. Fourteen children underwent complete SDB evaluation and treatment trials while five selected observation only (control group). Sleep and sleep-surgery specialist evaluation and polysomnography revealed the presence of a narrow upper-airway and an abnormal respiratory disturbance index in all 14 children. Nasal CPAP was not successful, but adenotonsillectomy performed near 14 months of age eliminated SDB. BH spells were eliminated 1 month after surgery, while they persisted to the end of the study (24 months of age) in the control group. In conclusion, the presence of cyanotic BH should prompt investigation and polysomnography for possible SDB. Independent treatment of SDB may hasten resolution of BH spells in these cases.