Assessment and Treatment of Obstructive Sleep-Disordered Breathing

Bodenner, Kaitlyn Anne; Jambhekar, Supriya; Com, Gulnur; Ward, Wendy L.

doi:10.1177/0009922814527501

Cited by 28 publications

(24 citation statements)

References 63 publications

(110 reference statements)

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“…OSA is a common condition in children that affects 1-3% of the general pediatric population [18] and is associated with numerous adverse health outcomes. The most common identified risk factor for OSA is adenotonsillar hypertrophy, and the primary treatment is adenotonsillectomy, which accounts for more than 500,000 procedures annually in the USA alone [19].…”

Section: Adenotonsillectomy Evidencementioning

confidence: 99%

Adenoidectomy in Children: What Is the Evidence and What Is its Role?

Schüpper

Nation

Pransky

2018

Curr Otorhinolaryngol Rep

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Purpose of Review Review the current state of the adenoidectomy procedure in the pediatric population with up-to-date indications for surgery, operative techniques, adverse events, non-surgical management of adenoid hypertrophy, and future directions. Recent Findings Adenoidectomy is indicated in children for the treatment of sleep-disordered breathing, nasal airway obstruction, recurrent acute otitis media, and chronic rhinosinusitis. A new recommendation was released in 2016, not supporting adenoidectomy for a primary indication of otitis media in children under 4 years old, including those with prior tympanostomy tubes, unless a distinct indication exists such as nasal obstruction or chronic adenoiditis. Although adenotonsillectomy is the mainstay of treatment for obstructive sleep apnea (OSA), recent studies have identified that non-obese patients with moderate OSA and small tonsils have comparable benefits with adenoidectomy alone with less complications. While conventional approaches such as indirect mirror-assisted curette and suction coagulation are still utilized, direct transnasal endoscopeassisted removal of the adenoids has proven to be a safe technique, with good short-and long-term outcomes. Novel nonsurgical therapies including immunotherapy have been evaluated. Summary Adenoidectomy is a safe procedure in the pediatric population and leads to excellent outcomes. Adverse events are rare, and hospitalization is uncommon. Children with sleep disturbance from nasal airway obstruction, ear disease, or chronic rhinosinusitis are the best operative candidates for this procedure.

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Section: Adenotonsillectomy Evidencementioning

confidence: 99%

Adenoidectomy in Children: What Is the Evidence and What Is its Role?

Schüpper

Nation

Pransky

2018

Curr Otorhinolaryngol Rep

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“…In the general pediatric population, obstructive sleep apnea is estimated to have a prevalence of approximately 4%. 2 Given that the observed prevalence in our study is probably an underestimate-yet is more than double the rate seen in the general population-we suggest that this condition may be a very common unrecognized source of morbidity in patients with myelomeningocele.…”

Section: Sleep-disordered Breathing In Patients With Myelomeningocelementioning

confidence: 51%

Sleep-disordered breathing in patients with myelomeningocele

Patel¹,

Rocque²,

Hopson³

et al. 2015

PED

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OBJECT A paucity of literature examines sleep apnea in patients with myelomeningocele, Chiari malformation Type II (CM-II), and related hydrocephalus. Even less is known about the effect of hydrocephalus treatment or CM-II decompression on sleep hygiene. This study is an exploratory analysis of sleep-disordered breathing in patients with myelomeningocele and the effects of neurosurgical treatments, in particular CM-II decompression and hydrocephalus management, on sleep organization. METHODS The authors performed a retrospective review of all patients seen in their multidisciplinary spina bifida clinic (approximately 435 patients with myelomeningocele) to evaluate polysomnographs obtained between March 1999 and July 2013. They analyzed symptoms prompting evaluation, results, and recommended interventions by using descriptive statistics. They also conducted a subset analysis of 9 children who had undergone polysomnography both before and after neurosurgical intervention. RESULTS Fifty-two patients had polysomnographs available for review. Sleep apnea was diagnosed in 81% of these patients. The most common presenting symptom was “breathing difficulties” (18 cases [43%]). Mild sleep apnea was present in 26 cases (50%), moderate in 10 (19%), and severe in 6 (12%). Among the 42 patients with abnormal sleep architecture, 30 had predominantly obstructive apneas and 12 had predominantly central apneas. The most common pulmonology-recommended intervention was adjustment of peripheral oxygen supplementation (24 cases [57%]), followed by initiation of peripheral oxygen (10 cases [24%]). In a subset analysis of 9 patients who had sleep studies before and after neurosurgical intervention, there was a trend toward a decrease in the mean number of respiratory events (from 34.8 to 15.9, p = 0.098), obstructive events (from 14.7 to 13.9, p = 0.85), and central events (from 20.1 to 2.25, p = 0.15) and in the apnea-hypopnea index (from 5.05 to 2.03, p = 0.038, not significant when corrected for multiple measures). CONCLUSIONS A large proportion of patients with myelomeningocele who had undergone polysomnography showed evidence of disordered sleep on an initial study. Furthermore, 31% of patients had moderate or severe obstructive sleep apnea. Myelomeningocele patients with an abnormal sleep structure who had undergone nonoperative treatment with peripheral oxygen supplementation showed improvement in the apnea-hypopnea index. Results in this study suggested that polysomnography in patients with myelomeningocele may present an opportunity to detect and classify sleep apnea, identify low-risk interventions, and prevent future implications of sleep-disordered breathing.

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“…6 Yet, in children, there's no evidence of augmented for cardiovascular mortality, but OSA diagnosis is also accompanied of cardiovascular comorbidities. 3,22 In our review, we evidence that children with OSA may also present a diminished vagal tone and higher sympathetic responsiveness, which represents a sympathetic-parasympathetic imbalance. Another metanalysis using HRV spectral analysis tried to address this question.…”

Section: Discussionmentioning

confidence: 89%

“…2 The peak of incidence occurs at 2-8 years and the most common cause of OSA in children is enlarged tonsils and adenoids. 2,3 Moreover, OSA is associated with morbidity that involves central nervous system (CNS), cardiovascular and metabolic systems. 4 The recurrent hypoxia is suggested as the main cause of altered autonomic nervous system (ANS) in those patients.…”

Section: Introductionmentioning

confidence: 99%