Obstructive Sleep Apnea in Children with Achondroplasia: Surgical and Anesthetic Considerations

Sisk, Elizabeth A.; Heatley, Diane G.; Borowski, Bret; Leverson, Glen; Pauli, Richard M.

doi:10.1016/s0194-5998(99)70414-6

Cited by 77 publications

(62 citation statements)

References 31 publications

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“…Children with OSAS have increased frequency of interictal epileptiform discharges (class IV) [41]. g) Class III or IV studies have demonstrated a high prevalence of OSAS and central apnoeas in children with achondroplasia (midface hypoplasia and brainstem compression) [42][43][44]. Chiari malformation is accompanied by obstructive and central apnoeas and hypoventilation with risk factors being the degree of brainstem crowding at the foramen magnum and the length of herniation (class III-IV) [45][46][47][48].…”

Section: Literature Reviewmentioning

confidence: 99%

“…b) AHI >4.7 episodes·h −1 and obesity are significant risk factors for residual OSAS post-adenotonsillectomy (class I and IV, and meta-analysis) [126,156,213]. Efficacy of adenotonsillectomy is modest in children with SDB and craniofacial abnormalities and/or neuromuscular disorders (class IV) [44,185,188,193,194,[214][215][216]. c) Quality of life improves post-adenotonsillectomy (class I and III, meta-analysis and systematic review) [111,113,126,178,211,217,218].…”

Section: Literature Reviewmentioning

confidence: 99%

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Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

et al. 2015

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This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h, those with an AHI of 1-5 episodes·h −1 and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7). @ERSpublications Management of obstructive sleep disordered breathing in childhood should follow a stepwise approach

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Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

et al. 2015

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“…While in the formers, SDB becomes clinically significant early, in achondroplasia, SDB usually develops in later years with a rate of at least 40%. Early occurrence does occur [33]. A study of 17 infants with achondroplasia and respiratory difficulties showed that in addition to the maxillary hypoplasia, "relative" adenotonsillar hypertrophy, muscular and neurological factors resulting from small foramen magnum, and hydrocephalus contributed to SDB [34].…”

Section: Craniofacial Malformationsmentioning

confidence: 99%

“…childhood [3,6,33]. A major difference between infants who are referred because of excessive night wakings and non-referred infants lies in the phenomenology of night wakings.…”

mentioning

confidence: 99%

Clinical practice

Sadeh

Sivan

2009

Eur J Pediatr

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Sleep problems are very prevalent during infancy. The most common problems are those related to night wakings and sleep-disordered breathing (SDB). Most common night waking problems do not have identified physiologic etiology. Their causes appear to be behavioral or developmental by nature, and they usually respond well to behavioral interventions. SDB may result from a variety of anatomic and neurologic factors and is associated with a variety of medical and developmental disorders. Because of the high prevalence of sleep problems during infancy, their persistence, their potential adverse developmental effects, and the positive treatment outcomes, pediatricians should serve as the primary address for screening and referral to proper assessment and treatment.

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“…Difficult airway features (Figure 1) are present due to the premature fusion of the skull base, frontal bossing, depressed nasal bridge, maxillary hypoplasia, macroglossia, abnormal teeth implantation, large mandible, short neck with fat deposition, cervical osteophytes and anomaly causing atlanto-axial instability and limited neck extension [1,3,4,5]. Foramen magnum is narrow and funnel shaped and can be compressed during laryngoscopy and cause cord ischemia leading to sudden death [4].…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic Management of an Achondroplastic Dwarf with Difficult Airway and Spine for Total Hip Replacement: A Case Report

Nisa¹,

Khanna²

2016

Gen Med

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Achondroplasia is the commonest form of dwarfism and possesses multiple anesthetic challenges ranging from securing intravenous line, monitoring and calculating drug dosage to abnormalities of the airway, spine, thoracic cage, and obesity, cardiopulmonary and neurological system. Multiple case reports describing neuraxial anaesthesia, particularly in obstetrics patients are available but there are limited literature on airway management and general anaesthesia. We came across an achondroplastic dwarf for hip replacement with spine deformity where neuraxial anaesthesia was impossible and her difficult airway and chronic lung disease imposed serious anesthetic challenges. We describe the importance of awake fiberoptic intubation (FOI) for airway management and general anaesthesia in this patient with difficult airway and spine and restrictive lung disease for total hip replacement.

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Obstructive Sleep Apnea in Children with Achondroplasia: Surgical and Anesthetic Considerations

Cited by 77 publications

References 31 publications

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Clinical practice

Anaesthetic Management of an Achondroplastic Dwarf with Difficult Airway and Spine for Total Hip Replacement: A Case Report

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