Diagnosis and perioperative management in pediatric sleep‐disordered breathing

Abstract

Summary Sleep‐disordered breathing has a prevalence of 12% in the pediatric population. It represents a spectrum of disorders encompassing abnormalities of the upper airway that lead to sleep disruption, including primary snoring, obstructive sleep apnea, central sleep apnea, and sleep‐related hypoventilation. Sleep‐disordered breathing is the most common indication for adenotonsillectomy, one of the most common procedures performed in children. In recent years, the American Academy of Otolaryngology‐Head and Neck Surgery, American Academy of Pediatrics, and the American Society of Anesthesiologists have crafted guidelines to help safely manage children with sleep‐disordered breathing. Each organization recommends in‐laboratory polysomnography for definitive diagnosis of obstructive sleep apnea in certain cases. However, because this test is both costly and inconvenient, there has been significant interest in alternative methods for diagnosing clinically significant sleep‐disordered breathing. Accurate diagnosis is critical because sleep‐disordered breathing confers certain perioperative risks and increased mortality in some instances. Recent studies have elucidated the danger of anesthesia and opioids in worsening obstructive sleep apnea, and recommendations for alternative analgesia are being created. In addition, determining the most appropriate level and duration of monitoring in the postoperative period is actively being evaluated. This article presents an overview of the recent literature on the perioperative care of pediatric patients with sleep‐disordered breathing. It highlights innovative modalities and limitations in diagnosing obstructive sleep apnea, the importance of a tailored anesthetic/analgesic approach to children with obstructive sleep apnea, and the need for postoperative monitoring. It also brings to focus that further studies on the perioperative care of these children are necessary.

Reduced circulating growth hormone and insulin-like growth factor-1 and delayed growth of premature rats are aggravated by longer daily duration of chronic intermittent hypoxia exposure

“…The physiological consequences of this disease include sleep fragmentation, intermittent hypoxia, increased sympathetic activation, and nocturnal arousal (1). In children, the prevalence of OSA could reach to 3%-10% (2), and this disease is associated with several comorbidities, including decreased quality of life, worsened mental health, increased cardiovascular problems, and poor growth and development (3)(4)(5)(6).…”

Association between sleep-disordered breathing and periodontal diseases: A systematic review protocol

“…As a consequence of sleep apnea, sleep fragmentation results in excessive daytime sleepiness and poor concentration (4). SDB is associated with increased incidence of cardiovascular diseases, neurocognitive deficits and metabolic syndrome (5,6). The prevalence of SDB ranges widely from 0.7 to 36.5%, depending on gender, age and ethnicity (7)(8)(9).…”

Associations of Sedentary Behaviour, Physical Activity, Cardiorespiratory Fitness and Body Composition with Risk of Sleep-Related Breathing Disorders in Children with Overweight/Obesity: A Cross-Sectional Study

“…SRBD are considered a major public health concern due to the high prevalence, closely related to obesity [4]. In childhood, SRBD are relatively common, with a prevalence of 12% [5]. More specifically, in a general population of children with 6 to 8 years, 10% were affected by SRBD [6].…”