Nocturnal polysomnographic characteristics of habitually snoring children initially referred to pediatric ENT or sleep clinics.
ABSTRACT To determine clinical and polysomnographic characteristics of children initially referred by primary care physicians (PCP) to either otolaryngology or sleep clinics for a history of habitual snoring.
Retrospective review of clinical characteristics and nocturnal polysomnograms (PSG) of snoring children referred initially to otolaryngologists by PCP (i.e., ENT) compared to a cross matched population of snoring children initially referred to a pediatric sleep center (i.e., SLEEP).
Sixty-eight ENT referred children were cross-matched to 68 SLEEP children. ENT referred children were found to have significantly larger tonsillar size compared to SLEEP children (tonsil size score 3.1 vs. 2.5, p value <0.01). Despite larger tonsillar size, there were no differences observed in the number of children with clinically significant obstructive sleep apnea syndrome (OSAS) with an obstructive apnea hypopnea index (OAHI)5/h TST (40 ENT vs. 38 SLEEP children). Furthermore, SLEEP children with OSAS exhibited more severe sleep related breathing disturbances compared to ENT children (obstructive apnea index: 5.0 vs. 1.5 /h TST, p value <0.01; mean oxygen saturation nadir [76.3% vs. 87.0%, p<0.01]). Finally, in 28 ENT referred children vs. 30 SLEEP the OAHI was <5/h TST.
Children referred by ENT are not more likely to be diagnosed with OSAS than snoring children directly referred to a pediatric sleep clinic by their pediatricians. The only difference in the referral decision between ENT and SLEEP seems to be tonsil size. Furthermore, PSG revealed a large percentage of children in whom surgical indication for AT is not obvious, thus suggesting that PSG is useful in determining the management of snoring children initially referred to ENT. Finally, SLEEP referred children diagnosed with OSAS exhibited increased indices among selected parameters indicative of sleep-disordered breathing.
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ABSTRACT: IntroductionSnoring and sleep-disordered breathing (SDB) are frequent pediatric conditions. Although allergies and respiratory viruses have been pathophysiologically implicated in these conditions, their seasonal distribution has not been examined.Methods The records of all children participating in a prospective, cross-sectional community-based research study that included a questionnaire on snoring frequency and loudness and an overnight sleep study were retrospectively assessed for seasonal patterns based on the day the children were evaluated.ResultsA total of 1,051 children were included with a mean age of 7 years. There were no seasonal differences in the number of children evaluated or in their demographic characteristics. However, the odds of increased snoring frequency and loudness were significantly higher in spring and summer and lowest in fall (P < 0.001). However, the mean AHI was highest and the nadir SaO2 was lowest in winter and spring compared to summer and fall (P < 0.001 and P < 0.03, respectively).Conclusion Snoring and the severity of SDB exhibit distinct and essentially non-overlapping patterns of seasonal variation, with peaks in spring–summer for snoring and peaks in winter-spring for SDB severity. These findings suggest that both seasonal viral and allergen burdens may contribute to SDB severity and may prompt differing clinical referral patterns throughout the year. Pediatr. Pulmonol. 2011; 46:581–586. © 2011 Wiley-Liss, Inc.Pediatric Pulmonology 06/2011; 46(6):581 - 586. DOI:10.1002/ppul.21408 · 2.30 Impact Factor
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ABSTRACT: Obstructive sleep apnea is highly prevalent in children and usually initially treated by adenotonsillectomy. Non-surgical alternatives for mild OSA primarily consisting of anti-inflammatory approaches have emerged, but their efficacy has not been extensively assessed. A retrospective review of clinically and polysomnographically diagnosed OSA patients treated between 2007-2012 was performed to identify otherwise healthy children ages 2 to 14 years fulfilling the criteria for mild OSA who were treated with a combination of oral montelukast (OM) and intranasal corticosteroid (ICS) for 12 weeks (Tx), with continued OM in a subset for 6-12 months. A total of 3,071 children were diagnosed with OSA, of whom 836 fulfilled mild OSA criteria and 752 received Tx. Overall, beneficial effects occurred in >80% with non-adherence being documented in 61 children and T&A being ultimately performed in 12.3%. Follow-up polysomnography in a subset of 445 patients showed normalization of sleep findings in 62% while 17.1% showed either no improvement or worsening of their OSA. Among the latter, older children (>7 years; OR: 2.3; 95% CI: 1.43-4.13; p<0.001) and obese children (BMI z score >1.65; OR: 6.3; 95% CI: 4.23-11.18; p<0.000001).) were significantly more likely to be non-responders. A combination of ICS and OM as initial treatment for mild OSA appears to provide an effective alternative to T&A, particularly in younger and non-obese children. These results support implementation of multicenter randomized trials to more definitively establish the role of Tx in pediatric OSA.Chest 02/2014; 146(1). DOI:10.1378/chest.13-2288 · 7.13 Impact Factor
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ABSTRACT: Systematically review the biomedical literature for data comparing clinical, subjective tonsil size (0-4+ scale) to objectively measured obstructive sleep apnea syndrome (OSAS) using polysomnography (PSG). PubMed database. A comprehensive PubMed MeSH search was conducted to identify articles comparing subjective tonsil size to objectively measured OSAS. Inclusion criteria included pediatric patients only, sample size greater than 5, and sufficient data to extract for analysis. Exclusion criteria included patients with obesity or craniofacial syndromes. Twenty articles were included in the final data set. The mean sample size was 161 (range, 32-700) and grand mean age was 6.7 (range, 2.7-11.7). Case series (evidence based medicine [EBM] level 4) was the predominant study design (16 studies). Eleven of 20 studies concluded there was an association between subjective tonsil size and objective OSAS, whereas 9 did not. Varying statistical techniques were used including simple diagnostic tables (k = 8), linear or logistic regression (k = 19), correlation (k = 5), and analysis of variance (k = 2). A customized quality assessment of each study was performed. Studies showing no association between tonsil size and OSAS had a higher quality score than studies showing an association (3.22 vs 2.36, P = .0317). The association between subjective pediatric tonsil size using 0-4+ scale and objective OSAS severity is weak at best. High-quality studies suggest no association. Providers must recognize the limitations of using tonsil size in clinical decision making.Otolaryngology Head and Neck Surgery 06/2011; 144(6):844-50. DOI:10.1177/0194599811400683 · 1.72 Impact Factor