Obstructive sleep apnea in children: Do intranasal corticosteroids help?
Obstructive sleep apnea (OSA) is a common condition of childhood, and is associated with significant morbidity. Prevalence of the condition peaks during early childhood, due in part to adenoidal and tonsillar enlargement within a small pharyngeal space. The lymphoid tissues regress after 10 years of age, in the context of ongoing bony growth, and there is an associated fall in the prevalence of OSA. Obstruction of the nasopharynx by adenoidal enlargement promotes pharyngeal airway collapse during sleep, and the presence of large tonsils contributes to airway obstruction. Administration of systemic corticosteroids leads to a reduction in the size of lymphoid tissues due to anti-inflammatory and lympholytic effects. However, a short course of systemic prednisone has been demonstrated not to have a significant effect on adenoidal size or the severity of OSA, and adverse effects preclude the long-term use of this therapy. Intranasal corticosteroids are effective in relieving nasal obstruction in allergic rhinitis, and allergic sensitization is more prevalent among children who snore than among those who do not snore. Intranasal corticosteroids have also been demonstrated to reduce adenoidal size, independent of the individual's atopic status. There is preliminary evidence of an improvement in the severity of OSA in children treated with intranasal corticosteroids, but further studies are needed before such therapy can be routinely recommended. Prescribing clinicians should take into account the potential benefits to the patient, the age of the child, the presence of comorbidities such as allergic rhinitis, the agent used, and the dose and duration of treatment when considering such therapy.
Available from: Rocio Sanchez-Carpintero
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ABSTRACT: Summary Introduction: Sleep disorders are frequent in infancy and childhood. Although obstructive sleep apnoea (OSA) is not as prevalent as other sleep disorders in childhood, this review is focused on OSA as it has a larger impact on children's health than other sleep disturbances. Obstructive sleep apnoea: OSA is caused by a prolonged upper respiratory airway obstruction during sleep. Symptoms in children are subtle and may pass unrecognised. Subsequent changes in quality and quantity of sleep may have an impact on children's cognitive and physical growth. Diagnosis: Polysomnography is the gold standard technique for OSA diagnosis, although other methods can be used as screening tools. Treatment: Treatment may be surgical, medical or pharmacological. Surgical approach with adenotonsillectomy is the most frequently indicated, as adenotonsillar hypertrophy is the commonest cause of OSA in childhood. Prognosis: Outcome of childhood OSA in adulthood is not well known. Long term follow-up of treated patients throughout adolescence and adulthood is indicated to detect relapses. Conclusions: OSA in childhood may have an impact on physical and cognitive development. Early diagnosis and treatment and adequate follow up are important to prevent physical disturbances secondary to chronic hypoxemia and to avoid cognitive deficits associated with disrupted sleep architecture.
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ABSTRACT: As pediatric sleep facilities and resources expand, increasing numbers of children with sleep-disordered breathing requiring continuous positive airway pressure (CPAP) treatment are being identified. Despite extensive expertise in treating adults with CPAP, many centres have little experience using CPAP in the pediatric population. The successful initiation and continued effective treatment with CPAP requires a unique and specialized approach to the pediatric patient and their family. Nearly, half of children needing CPAP will be uncooperative upon initial exposure to this unusual treatment. This review aims to outline an approach to the successful initiation of CPAP treatment in children including some trouble-shooting strategies to maximize initial and ongoing compliance with prescribed therapy.
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