An Update on the Management of Pediatric Obstructive Sleep Apnea

Rubinstein, Benjamin J.; Baldassari, Cristina M.

doi:10.1007/s40746-015-0022-8

Cited by 18 publications

(20 citation statements)

References 48 publications

(36 reference statements)

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“…Sleep-disordered breathing (SDB) is defined as disturbance of sleep architecture due to recurrent periods of partial or complete obstruction of the upper airway, which may be associated with alterations in oxygen saturation. 1,2 This term encompasses diseases on a spectrum of severity, from primary snoring to obstructive sleep apnea (OSA). 3 Although various neurophysiologic factors may contribute, SDB in children is most commonly caused by hypertrophy of the tonsils and adenoids.…”

mentioning

confidence: 99%

Outcomes of Children with Mild Obstructive Sleep Apnea Treated Nonsurgically: A Retrospective Review

Kohn

Cohen

Patel

et al. 2019

Otolaryngol.--head neck surg.

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Objective Obstructive sleep apnea (OSA) is characterized by partial or complete obstruction of the upper airway and is commonly caused by adenotonsillar hypertrophy in children. Accordingly, adenotonsillectomy is considered first-line treatment. However, in cases of mild OSA, nonsurgical management has been proposed as an alternative. The purpose of this study was to determine the outcomes of pediatric patients with mild obstructive sleep apnea (OSA) treated without surgical intervention. Study Design Case series with chart review. Setting Tertiary care university medical center. Subjects and Methods The medical records of children ages 2 to 18 years with OSA at Boston Medical Center from January 2000 to April 2017 were reviewed. Children with mild OSA (apnea- hypopnea index [AHI] between 1 and 5), who were managed nonsurgically and had serial polysomnograms, were included. Serial sleep studies were compared to assess for patterns of change. Results Of the 201 patients with mild OSA who were identified, 104 (52%) opted for initial nonsurgical management. Of those, 91 had a follow-up sleep study to reassess their OSA. Forty-two (46 %) had a greater than 20% decrease in AHI and 38 (41%) had a greater than 20% increase on the second sleep study. The remaining 11 had changes less than 20% in either direction. There was not a significant difference in the proportion of patients with an increase vs decrease in AHI on follow-up sleep study (P > .05). Conclusions Mild pediatric OSA has approximately equal chances of worsening or improvement over time without surgical intervention, which is useful for counseling parents on treatment options.

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confidence: 99%

Outcomes of Children with Mild Obstructive Sleep Apnea Treated Nonsurgically: A Retrospective Review

Kohn

Cohen

Patel

et al. 2019

Otolaryngol.--head neck surg.

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“…The topic of pediatric SDB is of concern, not only because of its prevalence but also because of the negative impact it has been shown to have on a child's growth and development, including increased behavioral problems such as hyperactivity, poor school performance, decreased ability to sustain attention, and an overall reduced quality of life . The cornerstone of treatment for this disease process in children is adenotonsillectomy, as the primary cause of obstruction is most commonly at the level of the tonsils and adenoids . Recognition and accurate diagnosis of SDB is of the utmost importance to avoid the associated health risks of untreated disease while reserving surgical intervention for only those patients who are appropriate candidates.…”

Section: Introductionmentioning

confidence: 99%

“…Sleep-disordered breathing (SDB), ranging in severity from primary snoring to true obstructive sleep apnea (OSA) is a common problem in the pediatric population. [1][2][3][4] The topic of pediatric SDB is of concern, not only because of its prevalence but also because of the negative impact it has been shown to have on a child's growth and development, including increased behavioral problems such as hyperactivity, [5][6][7][8] poor school performance, decreased ability to sustain attention, 6 and an overall reduced quality of life. 9 The cornerstone of treatment for this disease process in children is adenotonsillectomy, as the primary cause of obstruction is most commonly at the level of the tonsils and adenoids.…”

Section: Introductionmentioning

confidence: 99%

“…9 The cornerstone of treatment for this disease process in children is adenotonsillectomy, as the primary cause of obstruction is most commonly at the level of the tonsils and adenoids. 2,10,11 Recognition and accurate diagnosis of SDB is of the utmost importance to avoid the associated health risks of untreated disease while reserving surgical intervention for only those patients who are appropriate candidates.…”

Section: Introductionmentioning

confidence: 99%

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Factors affecting completion of sleep studies in pediatric patients with sleep‐disordered breathing

et al. 2019

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Objectives/Hypothesis To determine demographic factors associated with failure to complete ordered polysomnograms (PSGs) in pediatric patients with sleep‐disordered breathing (SDB). Study Design Retrospective case series. Methods This study was conducted at an urban safety‐net hospital and included 829 patients with SDB, ages 0 to 18 years, for whom PSGs were ordered during a 1‐year time period. Factors including age, race, language, and insurance status were reported for each patient. The data were reviewed by univariate and multivariate analyses to determine factors associated with failure to complete the PSGs. Results Of 829 patients, 200 (24%) failed to complete the PSGs. By univariate analysis, age was the only significant factor affecting completion (P < .01), with toddlers having the highest rate of completion (81%) and teenagers the lowest (68%). Primary language and insurance type were not significantly associated with completion rate. Hispanics were more likely than non‐Hispanic whites to complete the PSGs (81% vs. 70%), but this did not achieve statistical significance. By multivariate analysis, the teenage group remained significantly less likely to complete sleep study than toddlers (P = .04). There was again no statistically significant difference for race by multivariate analysis. Conclusions Among pediatric patients with SDB, age is a significant factor affecting completion of PSGs. Racial minorities and non–English‐speaking patients were not less likely to complete PSGs. Other demographic factors do not appear to be associated with completion of PSGs. Level of Evidence 4 Laryngoscope, 130:E258–E262, 2020

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“…While pathophysiology in children is multifactorial, adenotonsillar hypertrophy is the most important risk factor. 2 Data have indicated 2 to 6 years of age as the peak window during which SDB is encountered, but SDB can also develop in children outside this range. 1 As a result, adenotonsillectomy is the primary treatment of SDB and OSA.…”

mentioning

confidence: 99%

Characteristics and Frequency of Children With Severe Obstructive Sleep Apnea Undergoing Elective Polysomnography

Bains

Abraham

Hsieh

et al. 2020

Otolaryngol.--head neck surg.

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Objective To determine the prevalence and demographics features of pediatric patients with severe obstructive sleep apnea (OSA) who would not undergo preoperative polysomnography (PSG) under current American Academy of Otolaryngology (AAO) guidelines. Study Design In this retrospective cohort study, we identified patients from the electronic medical record who underwent elective polysomnography for evaluation of sleep-disordered breathing between 2012 and 2018. Setting Urban tertiary safety net hospital. Subjects and Methods A total of 456 patients with a mean (SD) age of 5.7 (3.2) years (263 male, 193 female). Demographic factors (age, sex, race, language, insurance status) and clinical findings (symptom severity, tonsil size) were recorded. The data were analyzed by univariate analysis. Results Of 456 patients identified, 66 (14.5%) were found to have severe OSA. African American patients had 3.7 times the odds of severe OSA compared to white patients (95% CI, 1.2-10.8). Patients aged 2 to 3 years had 2.2 times the odds of severe OSA compared to patients aged 4 to 6 years (95% CI, 1.2-4.0). Sex, ethnicity, language, and insurance type were not significantly associated with severity of OSA. The presence of apneic episodes and tonsil size were not found to be statistically significant. Conclusion Up to 14.5% of healthy pediatric patients with sleep-disordered breathing may have severe OSA; young age and African American race are statistically significant predictors. Clinical findings, such as tonsil size and symptom severity, were not found to be statistically significant predictors.

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An Update on the Management of Pediatric Obstructive Sleep Apnea

Cited by 18 publications

References 48 publications

Outcomes of Children with Mild Obstructive Sleep Apnea Treated Nonsurgically: A Retrospective Review

Outcomes of Children with Mild Obstructive Sleep Apnea Treated Nonsurgically: A Retrospective Review

Factors affecting completion of sleep studies in pediatric patients with sleep‐disordered breathing

Characteristics and Frequency of Children With Severe Obstructive Sleep Apnea Undergoing Elective Polysomnography

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