Long-Term Improvements in Sleep and Respiratory Parameters in Preschool Children Following Treatment of Sleep Disordered Breathing

Abstract

Study Objectives: Sleep disordered breathing (SDB) in preschool-aged children is common, but long-term outcomes have not been investigated. We aimed to compare sleep and respiratory parameters in preschool children to examine the effects of treatment or non-treatment after 3 years. Methods: Children (3-5 years) diagnosed with SDB (n = 45) and non-snoring controls (n = 30) returned for repeat overnight polysomnography (39% of original cohort), 3 years following baseline polysomnography. Children with SDB were grouped according to whether they had received treatment or not. SDB resolution was defi ned as an obstructive apnea hypopnea index (OAHI) ≤ 1 event/h, no snoring detected on polysomnography and habitual snoring not indicated by parents on questionnaire. Results: Fifty-one percent (n = 23) of the children with SDB were treated. Overall, SDB resolved in 49% (n = 22), either spontaneously (n = 8) or with treatment (n = 14). SDB remained unresolved in 39% (n = 9) of those treated and 64% (n = 14) of the children who were untreated. Two of the non-snoring controls developed SDB at follow-up. The treated group had signifi cantly lower OAHI (p < 0.01), respiratory disturbance index (p < 0.001), total arousal and respiratory arousal indices (p < 0.01 for both) at follow-up compared with baseline. There were no differences between studies for the untreated group. Conclusion: Although treatment resulted in an improvement in indices related to SDB severity, 39% had SDB 3 years following diagnosis. These fi ndings highlight that parents should be made aware of the possibility that SDB may persist or recur several years after treatment. This is relevant regardless of the severity of SDB at baseline and the treatment given.

Association between slow-wave activity, cognition and behaviour in children with sleep-disordered breathing

“…The sleep, arousal and respiratory changes observed in the current sub-sample at follow-up did not differ from the full cohort [19]. In summary, both the Resolved and Unresolved groups showed a significantly higher OAHI than the Control group at baseline (χ 2 =15.6, p<0.001), but only the Unresolved group remained significantly different to Controls at follow-up (χ 2 =16.9, p<0.001).…”

“…At both baseline and follow-up, children were otherwise healthy and were not using nasal steroids, leukotriene receptor antagonists or antibiotics. Results of sleep and respiratory [19], cardiovascular [20,21], and neurocognitive and behavioural [22] changes from baseline to follow-up in the full cohort have previously been published. To be included in the current study, children had to have complete neurocognitive, behavioural and polysomnographic data at both time points.…”

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

“…In a very small cohort of 12 school-age children who underwent re-evaluation four years after T&A treatment of OSA, two-thirds appeared to have normalized their PSG findings [42]. Similarly, of the 23 pre-school children who underwent PSG evaluations three years after T&A, 61% had normal sleep studies [43]. However, considering that >600,000 T&A are performed annually in the US alone, the absence of long-term outcomes and the uncertainties related to the potentially adverse effects of T&A later in life [44][45][46], there is a clear need for improved tracking of large cohorts to gain insight as to the potential lifelong consequences of T&A.…”

Montelukast for Children with Obstructive Sleep Apnea: Results of a Double-blind Randomized Placebo-controlled Trial

“…Obstructive sleep apnea (OSA) is a highly prevalent condition in children that imposes a vast array of morbidities including neurocognitive, behavioral, cardiovascular, and metabolic (1). Adenotonsillar hypertrophy has been recognized as the major pathophysiological contributor to OSA in children, and is traditionally treated by surgical removal of enlarged adenoids and tonsils with favorable, albeit variably efficacy being reported (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). The realization that a substantial proportion of children with OSA undergoing adenotonsillectomy may develop postoperative complications (12) and have persistent disease after surgery (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11) has instigated exploration of nonsurgical therapeutic alternatives (13)(14)(15) or even prompted consideration of watchful waiting in selected cases (3,16,17).…”