Positional obstructive sleep apnea in children: prevalence and risk factors

Verhelst, E; Clinck, Isabel; Deboutte, Isabel; Vanderveken, Olivier M.; Verhulst, Stijn; Boudewyns, An

doi:10.1007/s11325-019-01853-z

Cited by 23 publications

(20 citation statements)

References 32 publications

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“…Furthermore, when we compared supine oAHI between obese and nonobese children, the events per hour were similar between the groups (data not shown). Our findings may contrast from those of Dayat et al 27 and Verhelst et al 31 due to our exclusion of teenagers, who tend to have a more “adult-like” disease process in which obesity may be a greater contributor to obstruction. In the present study, there was no relationship between POSA and tonsillar size or previous AT.…”

Section: Discussioncontrasting

confidence: 96%

“…[21][22][23] The relevance of positional obstruction on treatment choice and outcomes in the adult population has long been recognized, 20,[24][25][26] but few studies have examined the significance of sleep position on OSA severity in children. Previous research suggests that POSA occurs at least to some degree in the pediatric population [27][28][29][30][31] and may occur more commonly in children who also have risk factors for persistent post-AT OSA, including obesity and Down syndrome. 27,32,33 Both persistent OSA and POSA may be due to gravity-dependent obstruction at dynamic sites such as the velum and tongue base.…”

mentioning

confidence: 99%

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Drug‐Induced Sleep Endoscopy in Children With Positional Obstructive Sleep Apnea

Kirkham

Melendez

Hoi

et al. 2020

Otolaryngol.--head neck surg.

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Objective Positional obstructive sleep apnea (POSA)—defined as obstructive sleep apnea twice as severe supine than nonsupine—may offer clues to the underlying pattern of upper airway collapse in children. We compared drug-induced sleep endoscopy (DISE) findings in children with and without POSA. We hypothesized that children with POSA would have significantly higher obstruction at the gravity-dependent palate and tongue base but not at the adenoid, lateral wall, or supraglottis. Study Design Retrospective case series. Setting Tertiary pediatric hospital. Subjects and Methods We included children aged 1 to 12 years with obstructive sleep apnea diagnosed by polysomnography who underwent DISE from July 2014 to February 2019. Scores were dichotomized as ≥50% obstruction (Chan-Parikh 2 or 3) vs <50% obstruction (Chan-Parikh 0 or 1). Results Of 99 children included, 32 (32%) had POSA and 67 (68%) did not. Children with POSA did not differ from children without POSA in age, overall apnea-hypopnea index, sex, race, syndromic diagnoses, obesity, or history of adenotonsillectomy. In logistic regression models, odds of ≥50% obstruction were significantly higher at the tongue base (odds ratio, 2.77; 95% CI, 1.04-7.39) after adjustment for age, sex, obesity, previous adenotonsillectomy, and syndrome. No difference was noted at the adenoid, velum, lateral wall, or supraglottis. Conclusion POSA was associated with higher odds of obstruction on DISE at the tongue base but not at other levels.

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Section: Discussioncontrasting

confidence: 96%

mentioning

confidence: 99%

Drug‐Induced Sleep Endoscopy in Children With Positional Obstructive Sleep Apnea

Kirkham

Melendez

Hoi

et al. 2020

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

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“…43,44 As expected, we found a significant difference in supine OAHI and nonsupine OAHI among children with obesity. Similar trends were observed by Verhelst and colleagues 36 among children with and without POSA. However, the difference in supine OAHI in their study was smaller between groups, which could be attributed to the heterogeneity of their study cohort.…”

Section: Discussionsupporting

confidence: 89%

“…Additionally, because OSA tends to worsen during REM sleep, POSA may be a REM-specific phenomenon, where supine OAHI is greater during REM sleep as compared with NREM sleep. 36 In our study, between the POSA and non-POSA groups, no significant differences were found in supine and nonsupine OAHI values during REM sleep as well as the time spent sleeping in a supine and nonsupine position during REM sleep, which may suggest that POSA is not specifically related to REM sleep in children with obesity. Such findings are similar to those found in adults, where POSA does not worsen during REM sleep.…”

Section: Discussioncontrasting

confidence: 70%

“…POSA has been reported to be less prevalent among nonobese children and those with medical comorbidities such as Down syndrome, ranging from 9% to 31%. 19,35 More recently, a study by Verhelst and colleagues 36 assessed POSA among a large heterogenous cohort of otherwise healthy children and children without medical comorbidities, where 19% of the population had POSA.…”

Section: Discussionmentioning

confidence: 99%

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Positional obstructive sleep apnea in an obese pediatric population

Selvadurai

Voutsas

Massicotte

et al. 2020

Journal of Clinical Sleep Medicine

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Study Objectives: Positional obstructive sleep apnea (POSA) is a phenotype of obstructive sleep apnea (OSA) where sleep-related obstructive events occur predominantly in the supine position. Limited knowledge exists regarding the presence of POSA in children with obesity. The study objective was to determine the prevalence of POSA while identifying factors associated with POSA in children with obesity. Methods: This was a cross-sectional study of children with obesity, aged 8 to 18 years, with a diagnostic polysomnogram (PSG) between 2012 to 2019, who were referred for the evaluation of sleep-related breathing. POSA was defined as an overall obstructive apnea-hypopnea index (OAHI) ≥5 events/h and a supine OAHI to nonsupine OAHI ratio of ≥2. Patient demographics, anthropometrics, and PSG data were recorded. Results: Of the 112 children with obesity with a diagnostic PSG, 43 (38%) had OSA. Among those with OSA, 25 of 43 (58%) had POSA (mean age: 14.6 ± 2.3 years; mean body mass index: 37.7 ± 7.6 kg/m 2 ; 68% male) and 18 of 43 (42%) had non-POSA (mean age: 13.9 ± 2.8 years; mean body mass index: 37.9 ± 7.2 kg/m 2 ; 78% male). Among those with POSA, 13 of 25 (52%) had mild OSA, 7 of 25 (28%) had moderate OSA, and 5 of 25 (20%) had severe OSA. No significant differences were found in age, sex, and anthropometric measures between POSA and non-POSA groups. Time spent in supine and nonsupine sleep did not differ significantly between groups. Conclusions: In children with obesity and OSA, POSA occurs frequently. Identifying POSA allows for potential targeted positional therapy for children with obesity.

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Tonsillectomy Outcomes for Children With Severe Obesity

et al. 2021

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Objectives/Hypothesis: To determine the success of an adenotonsillectomy (T&A) in treating children with severe obesity utilizing a more accurate obesity scale.Study Design: Retrospective cohort. Methods: A retrospective cohort of children with obesity between 5 and 10 years of age who underwent a T&A at Children's Hospital of Colorado (CHCO) was used. This study also utilized publicly available data from the Childhood Adenotonsillectomy Trial (CHAT) study. The cohort was divided into three obesity classes using age-and sex-specific body mass index (BMI) expressed as a percentage of the 95th percentile (%BMIp95) and compared for operative success differences.Results: There were 132 patients included in our primary analysis, with obesity distribution as follows: Class 1 to 53 patients (40%), Class 2 to 45 patients (34%), and Class 3 to 34 patients (26%). Overall, 52 patients (35.9%) experienced a cure (obstructive apnea/hypopnea index [OAHI] <1), with 27 (52%) patients in Class 1 obesity, 18 (35%) in Class 2, and 7 (13%) in Class 3. Class 3 had a significantly lower obstructive sleep apnea cure rate compared with Class 1 patients (P = .013), but after adjusting for covariates, this difference was no longer present (P > .05). There was no significant difference in the preoperative to postoperative percent change in mean oxygen saturation (P = .82 CHCO, P = .43 CHAT), oxygen nadir (P = .20 CHCO, P = .49 CHAT), or OAHI (P = .12 CHCO, P = .26 CHAT) between the obesity classes.Conclusion: After adjusting for covariates, children with Class 3 obesity are as likely to be cured with a T&A as those with Class 1 obesity. A T&A should be considered a first line treatment for all children with obesity.

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Positional obstructive sleep apnea in children: prevalence and risk factors

Cited by 23 publications

References 32 publications

Drug‐Induced Sleep Endoscopy in Children With Positional Obstructive Sleep Apnea

Drug‐Induced Sleep Endoscopy in Children With Positional Obstructive Sleep Apnea

Positional obstructive sleep apnea in an obese pediatric population

Tonsillectomy Outcomes for Children With Severe Obesity

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