Age-Dependent Changes in the Size of Adenotonsillar Tissue in Childhood: Implications for Sleep-Disordered Breathing

Papaioannou, Georgia; Kambas, Ilias; Tsaoussoglou, Marina; Panaghiotopoulou-Gartagani, Polytimi; Chrousos, George P.; Kaditis, Athanasios G.

doi:10.1016/j.jpeds.2012.07.041

Cited by 80 publications

(71 citation statements)

References 17 publications

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“…f ) Neuromuscular disorders (cerebral palsy, Duchenne muscular dystrophy and myotonic muscular dystrophy) and uncontrolled epilepsy are related to a high risk for OSAS and nocturnal hypoventilation. Outcomes monitored after intervention (6 weeks-12 months): symptoms, PSG, quality of life, cardiovascular or central nervous system morbidity, enuresis, growth rate b) If PSG not available: polygraphy, oximetry/capnography c) PSG ≥6 weeks after adenotonsillectomy (persistent SDB symptoms or at risk of persistent OSAS preoperatively); after 12 weeks of montelukast/nasal steroid d) PSG after 12 months of rapid maxillary expansion (earlier if symptoms persist) and after 6 months with an oral appliance e) PSG for titration of CPAP, NPPV and then annually; PSG as predictor of successful decannulation with tracheostomy f) Airway re-evaluation by nasopharyngoscopy, drug-induced sleep endoscopy, MRI Literature review a) In children with snoring, the adenoid and tonsils are large early in life and remain enlarged during late childhood and adolescence (class IV) [16]. The association between tonsillar size evaluated subjectively and OSAS severity as determined by polysomnography is weak at best.…”

Section: Literature Reviewmentioning

confidence: 99%

“…c) Cephalometry is a standardised lateral radiographic view of the head incorporating skeletal and soft-tissue structures (systematic review and meta-analysis) [29]. MRI of the upper airway has been applied in studies of children with OSAS and adenotonsillar hypertrophy and/or obesity (class III-IV) [16,[63][64][65]. CT scanning has been applied in complex patients (e.g.…”

Section: Literature Reviewmentioning

confidence: 99%

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Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

et al. 2015

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This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h, those with an AHI of 1-5 episodes·h −1 and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7). @ERSpublications Management of obstructive sleep disordered breathing in childhood should follow a stepwise approach

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Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

et al. 2015

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“…[3][4][5][6] Early diagnosis of SDB, or potential associations of SDB, is essential to encourage normal facial development. 7,8 Reduced pharyngeal dimensions established early in life could potentially predispose to later development of SDB or even obstructive sleep apnoea, 9 as soft-tissue changes related to ageing, obesity or genetic background further reduce oropharyngeal patency. of standard records for orthodontic treatment planning.…”

Section: Introductionmentioning

confidence: 99%

Proposal of new upper airway margins in children assessed by CBCT

Anandarajah¹,

Abdalla²,

Dudhia³

et al. 2015

Dentomaxillofacial Radiology

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Objectives: Recently, studies have performed three-dimensional analyses of upper airways in children. However, there was a lack of airway delineation according to anatomical boundaries and/or easily mobile soft-tissue landmarks were used. The aim of the present study was to define new upper airway margins in children on CBCT according to anatomical bony landmarks and to validate the method. Methods: 25 scans were randomly selected from a larger database containing CBCT scans of children prior to orthodontic treatment (14 girls and 11 boys; mean age, 10.9 ± 2.5 years). Scans were evaluated by two observers. Specific head positioning and virtual orientation protocols were adopted and greyscale thresholding was established for each patient. Volume and minimum cross-sectional area of the oropharynx were calculated. Intra-and interobserver reliability were assessed by reassessment of the CBCTs 2 weeks later. Results: The new airway margins were defined superiorly by a line passing through the palatal plane (anterior nasal spine to posterior nasal spine) extending to the posterior wall of the pharynx, inferiorly by a line passing from the anterosuperior edge of C4 to menton, anteriorly by a line passing from the soft palate to menton, posteriorly and laterally by the respective pharyngeal walls. Method error for airway volume and minimal cross-sectional area was #2.00%, and intra-and interobserver reliability ranged from 0.99 to 1.00. Conclusions: The proposed protocol utilizes easily identifiable bony landmarks to delineate the upper airway on cone beam scans of children and was found to be reliable and reproducible.

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“…Contrary to the traditional clinical belief, adenotonsillar tissue hypertrophy does not resolve with increasing age and adenotonsillectomy is necessary to treat OSAS in cases of upper airway obstruction caused by pharyngeal lymphoid tissue hypertrophy [22].…”

Section: Obese Children With Osas Frequently Have Unfavourable Responmentioning

confidence: 87%

Focus on prevention and treatment of obstructive sleep disordered breathing in childhood

Kaditis

Lévy

2015

Eur Respir J

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Age-Dependent Changes in the Size of Adenotonsillar Tissue in Childhood: Implications for Sleep-Disordered Breathing

Cited by 80 publications

References 17 publications

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Proposal of new upper airway margins in children assessed by CBCT

Focus on prevention and treatment of obstructive sleep disordered breathing in childhood

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