Diagnostic techniques and surgical outcomes for persistent pediatric obstructive sleep apnea after adenotonsillectomy: A systematic review and meta-analysis

Socarras, Melissa; Landau, Barcleigh P.; Durr, Megan L.

doi:10.1016/j.ijporl.2019.02.030

Cited by 29 publications

(29 citation statements)

References 44 publications

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“…In more recent years, and particularly since 2006 when we initially described the relatively high prevalence of residual OSA after T&A [11,12], confirmation and realization that, although the severity of OSA will routinely improve after surgery, it can persist in a significant proportion of patients has definitely settled in [13][14][15][16]. Indeed, persistent OSA after T&A may occur between 13% to 29% among children defined as low-risk patients, while residual OSA may be present in up to 75% in higher-risk groups such as in obese children [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Other risk factors for persistence of OSA after surgical intervention include age >7 years, asthma, nocturnal enuresis, allergic rhinitis, and the severity of OSA prior to T&A [20,[31][32][33][34].…”

Section: Adenotonsillectomy (Tanda)mentioning

confidence: 86%

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Gozal

Tan

Kheirandish‐Gozal

2020

JCM

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Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care.

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Section: Adenotonsillectomy (Tanda)mentioning

confidence: 86%

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Gozal

Tan

Kheirandish‐Gozal

2020

JCM

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“…Combinations of dexmedetomidine and ketamine have less adverse events and higher rate of successful completion of DISE . Cine MRI images are taken while the patient is in a medication‐induced sleep to create a movie to further characterize the site and extent of airway obstruction . In a significant subset of patients, residual OSA remains after surgical treatment.…”

Section: Surgical Treatment Of Osamentioning

confidence: 99%

“…In a significant subset of patients, residual OSA remains after surgical treatment. DISE and cine MRI can be utilized to understand where the residual obstruction is and help developing an individualized surgical plan, which can lead to improvement in OSA . In addition, different medical societies offer varying recommendations as to whether PSG should be done .…”

Section: Surgical Treatment Of Osamentioning

confidence: 99%

“…The severity is determined by the obstructive apnea‐hypopnea index (OAHI) defined as the sum of obstructive apneas, obstructive hypopneas, and mixed apneas divided by total sleep time, measured with polysomnography (PSG) as follows: OAHI below 1.5 events per hour is considered normal based on population studies conducted in asymptomatic children . Some authors have proposed the following severity classification of OSA, which has not been appropriately tested based on outcomes: 1‐5 mild, 6‐10 moderate, and >10 severe OSA . OAHI is interchangeably used with AHI although the latter typically includes both obstructive and central apnea.…”

Section: Introductionmentioning

confidence: 99%

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New treatments for obstructive sleep apnea in children

Oguh

Elden

Swanson

et al. 2020

Pediatric Anesthesia

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Obstructive sleep apnea (OSA) has a prevalence of up to 5% in children and 50% in obese children. OSA is associated with various comorbidities in the general population and in the perioperative period. In this review, we will provide background of OSA and insights into the available treatment options both surgically and medically. Unlike adults, most pediatric OSA is treated with adenotonsillectomy. Continuous positive airway pressure therapy is the commonly used medical treatment. Management of pediatric OSA is multidisciplinary. We will discuss the surgical options and medical options of managing pediatric OSA.

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“…They concluded that mild pediatric OSA had approximately equal chances of worsening or improving over time without surgical intervention which is further supported by the CHAT study. Furthermore, in obese children, there is a high rate of OSA persistence after surgical intervention 60,61 but data in the nonobese and younger children are lacking. There is also a higher rate of persistence with African‐American ethnicity and male gender 62,63 …”

Section: Introductionmentioning

confidence: 99%

Pediatric obstructive sleep apnea: Preoperative and neurocognitive considerations for perioperative management

Chandrakantan

Musso

Floyd

2020

Pediatric Anesthesia

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Obstructive sleep apnea (OSA) affects up to 7.5% of the pediatric population and is associated with a variety of behavioral and neurocognitive sequelae. Prompt diagnosis and treatment is critical to halting and potentially reversing these changes. Depending on the severity of the OSA and comorbid conditions, different treatment paradigms can be pursued, each of which has its own unique risk:benefit ratio. Adenotonsillectomy is first‐line recommended surgical treatment for pediatric OSA. However, it carries its own perioperative risks and the decision regarding surgical timing is therefore made in the context of procedural risk versus patient benefit. This article presents the seminal perioperative and neurocognitive risks from pediatric OSA to aid with perioperative management.

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Diagnostic techniques and surgical outcomes for persistent pediatric obstructive sleep apnea after adenotonsillectomy: A systematic review and meta-analysis

Cited by 29 publications

References 44 publications

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

New treatments for obstructive sleep apnea in children

Pediatric obstructive sleep apnea: Preoperative and neurocognitive considerations for perioperative management

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