Treatment of obstructive sleep apnea in children: do we really know how?

Kosair Children's Hospital Sleep Medicine and Apnea Center, Department of Pediatrics, University of Louisville School of Medicine, USA.
Sleep Medicine Reviews (Impact Factor: 9.14). 03/2003; 7(1):61-80. DOI: 10.1053/smrv.2001.0256
Source: PubMed

ABSTRACT Obstructive sleep apnea syndrome (OSAS) is a frequent, albeit underdiagnosed problem in children. If left untreated, OSAS may lead to substantial morbidities affecting multiple target organs and systems. The immediate consequences of OSAS in children include behavioral disturbance and learning deficits, pulmonary hypertension, as well as compromised somatic growth. However, if not treated promptly and early in the course of the disease, OSAS may also impose long-term adverse effects on neurocognitive and cardiovascular function, thereby providing a strong rationale for effective treatment of this condition. This review provides a detailed description of the current treatment modalities for pediatric OSAS, and uncovers the potential limitations of the available data on these issues. Furthermore, we postulate that OSAS will persist relatively often after tonsillectomy and adenoidectomy, and that critical studies need to be conducted to identify such patients and refine the clinical management algorithm for pediatric OSAS.

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    ABSTRACT: Obstruction of the upper airway during sleep occurs frequently in children. The incidence of sleep disordered breathing, which includes habitual snoring, ranges from 3.2-12%, and the incidence of true obstructive sleep apnea (OSA) has been reported between 0.7 and 10.3%. 1-3 Some investigators think that despite the increased recognition of these disorders, they still may be under diagnosed. 4 The consequences of not treating these children are significant. 5 OSA and airway insufficiency during sleep are associated with complications ranging from daytime somnolence and behavioral disturbances to pulmonary hypertension and cor pulmonale. Children with sleep disordered breathing present commonly for general anesthesia, both for operations related to the airway, and for unrelated operations. OSA and other abnormalities of breathing during sleep may alter the optimal management of the anesthetic and of postoperative care in both situations, so it is important for the anesthesiologist to understand the pathophysiology of these syndromes. Definitions Obstructive sleep apnea syndrome: a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction that disrupts normal ventilation during sleep and normal sleep patterns. 3 Primary snoring: episodes of upper airway obstruction that result in increased airway resistance, but are not accompanied by apneic periods of greater than 10 seconds duration, frequent arousals from sleep or abnormalities in gas exchange. A polysomnogram must be obtained to confirm the diagnosis of OSA, and to distinguish it from less serious sleep disordered breathing and primary snoring. 1,3,6 These may not be easy to differentiate on the basis of a history of noisy breathing alone, and documentation of lack of airflow, oxygen desaturation, and paradoxical chest wall motion are necessary. Oximetry alone is not a sensitive discriminator; although the positive predictive value of cyclic periods of desaturation was high, the negative predictive value was low, so negative results did not rule out OSA. 7 Clinical scoring schemes are useful to screen children with a history of noisy breathing and suggestive symptoms to determine who should undergo further evaluation, and can discern the severe cases from the normal children, but are unable to sort out the vast group in the middle with moderate symptoms. 8 The polysomnogram consists of measurements of: • airflow (capnometry or thermistor) • chest wall motion (respiratory inductive plethysmography or other methods) • oxygenation (continuous pulse oximetry) • sleep staging (EEG, electromyography) • ECG In some cases, where gastroesophageal reflux is part of the differential diagnosis, esophageal pH is added.
  • Procedia Computer Science 01/2014; 29:557-564.

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