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

Abstract

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

Automated Screening of Children With Obstructive Sleep Apnea Using Nocturnal Oximetry: An Alternative to Respiratory Polygraphy in Unattended Settings

“…2 More recently published guidelines for the diagnosis and management of childhood OSA still point out the importance of conducting an objective diagnostic test in every symptomatic child, de facto highlighting that further research is still needed to effectively simplify pediatric OSA diagnosis. 11 Despite robust published evidence showing that the apneahypopnea index is inherently underestimated, 12 RP is rapidly becoming a widely implemented alternative to PSG in clinical settings. 8,9,11 Furthermore, ambulatory RP at home (HRP) has been suggested as a valid approach in low resource settings when in-laboratory PSG is not available.…”

Knowledge and attitudes about pediatric sleep apnea among parents in an orthodontic clinic

“…1 Çocuklarda uyku apnesi görülme sıklığı %1-4 arasında rapor edilmektedir. 2,3 Çocukluk döneminde görülen uyku apnesinin en yaygın etyolojik faktörü büyümüş adenoid ve/veya tonsiller ile obezitedir. 4 Maksiller ve mandibuler retrognati, artmış yüz yüksekliği, azalmış yüz genişliği ve artmış overjet gibi kraniyofasiyal anomaliler de havayolu morfolojisindeki değişiklikler ve solunum problemleri ile ilişkilidir.…”

Identificação de fatores de risco para apneia obstrutiva do sono após adenotonsilectomia: estudo piloto

“…O ronco é apontado como importante preditor clínico a suspeita da AOS em crianças 23,24 . No presente estudo, o sintoma ronco esteve presente em toda a amostra, entretanto, ressalta-se que apenas o relato da sintomatologia não é eficaz para diagnosticar a AOS e diferenciar os graus de gravidade 1,20,21,23,24 .…”

“…O ronco é apontado como importante preditor clínico a suspeita da AOS em crianças 23,24 . No presente estudo, o sintoma ronco esteve presente em toda a amostra, entretanto, ressalta-se que apenas o relato da sintomatologia não é eficaz para diagnosticar a AOS e diferenciar os graus de gravidade 1,20,21,23,24 . A grande variedade de manifestações clínicas da AOS e a subjetividade do quadro clínico relatado pelos familiares contribui para não-homogeneidade dos sintomas em cada faixa etária, mesmo quando a severidade da síndrome é semelhante 2,23,24 .…”