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: 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: OBJECTIVE: The present study was carried to examine the hypothesis that the severity of obstructive sleep apnea (OSA) in a clinical referral population of children would manifest seasonal variability in their polysomnographic findings. METHODS: The study population comprised consecutive children referred for evaluation of habitual nighttime snoring, parentally witnessed apnea during sleep, and difficult or noisy breathing during sleep. A total of 554 children were identified as eligible and underwent full-night polysomnography (PSG). Monthly fluctuation patterns in PSG measures were assessed in 2 age groups (<6 and ≥6 years old). RESULTS: In the younger group, the lowest AHI was found in the month of August (9.5±1.7/hrTST) while December emerged as the month with the lowest AHI for the older group (8.7±2.3/hrTST). The highest AHI was in January (24.8±7.5/hrTST) in the group ≥6 years old, and in March (32.7±6.9/hrTST) in the younger group. CONCLUSION: Seasonal changes are present in children with clinically symptomatic OSA and differ among younger and older children, with global trends toward improved AHI during summer, especially in younger children. Future studies should be conducted to define a "correction factor" for the month of PSG assessment that will enable accurate decision making when evaluating symptomatic children with habitual snoring.International journal of pediatric otorhinolaryngology 12/2012; 77(2). DOI:10.1016/j.ijporl.2012.11.016 · 1.32 Impact Factor
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2012; 8(5):477-9. DOI:10.5664/jcsm.2134 · 2.83 Impact Factor