Rhino‐sinus involvement in children with obstructive sleep apnea syndrome

Arens, Raanan; Sin, Sanghun; Willen, Seth; Bent, John P.; Parikh, Sanjay R.; Freeman, Katherine; Wootton, David; McDonough, Joseph M.; Shifteh, Keivan

doi:10.1002/ppul.21284

Cited by 24 publications

(18 citation statements)

References 34 publications

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“…[30][31][32][33][34][35][36] Children with OSA are unable to activate airway tone to maintain airway patency. [37][38][39] The lack of sensation of nasal airflow, as by adenotonsillar hypertrophy or nasal obstruction common in the pediatric population, is associated with increased nasopharyngeal resistance and contributes to OSA, [40][41][42][43][44][45] suggesting that sensation of nasal airflow reduces airway resistance and elicits compensatory increase in pharyngeal tone. 36,46 Therefore, the delivery of heated and humidified air to the nasopharynx at higher than usual flow rates may activate, or reactivate, the protective airway reflex via nasopharyngeal mechanoreceptor or thermoreceptor stimulation, as well as reduce irritation, swelling, and congestion associated with dryness.…”

Section: Discussionmentioning

confidence: 99%

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

Hawkins

Huston

Campbell

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Continuous positive airway pressure (CPAP) is effective but challenging for children with obstructive sleep apnea (OSA). High-flow air via open nasal cannula (HFNC) as treatment in children remains controversial. We report the efficacy of HFNC in children with OSA and CPAP intolerance, a titration protocol, and a discussion of potential mechanisms. Methods: Patients aged 1 to 18 years with OSA (defined by obstructive apnea-hypopnea index [OAHI] greater than 1 event/h) and CPAP intolerance were enrolled. Routine polysomnography data obtained during 1 night wearing HFNC was compared with diagnostic data by Wilcoxon rank-sum test. Results: Ten school-age subjects (representing all patients attempting HFNC at our institution to date) with varied medical conditions, moderate to severe OSA, and CPAP intolerance wore HFNC from 10 to 50 L/min of room air with oxygen supplementation if needed (room air alone for 6 of the 10). HFNC reduced median OAHI from 11.1 events/h (interquartile range 8.7-18.8 events/h) to 2.1 events/h (1.7-2.2 events/h; P = .002); increased oxyhemoglobin saturation (SpO2) mean from 91.3% (89.6% to 93.5%) to 94.9% (92.4% to 96.0%; P < .002); increased SpO2 nadir from 76.0% (67.3% to 82.3%) to 79.5% (77.2% to 86.0%; P = .032); decreased SpO2 desaturation index from 19.2 events/h (12.7-25.8 events/h) to 6.4 events/h (4.7-10.7 events/h; P = .013); and reduced heart rate from 88 bpm (86-91 bpm) to 74 bpm (67-81 bpm; P = .004). Stratified analysis of the 6 subjects with only room air via HFNC, the OAHI, obstructive hypopnea index, and mean SpO2 still demonstrated improvements (P = .031). Conclusions: High-flow nasal cannula reduces respiratory events, improves oxygenation, reduces heart rate, and may be effective for CPAP intolerant children with moderate to severe OSA. Our data suggest HFNC warrants further study and consideration by payers as OSA therapy.

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Section: Discussionmentioning

confidence: 99%

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

Hawkins

Huston

Campbell

et al. 2017

Journal of Clinical Sleep Medicine

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“…However, this belief has recently been questioned, because in normal children the growth of adenotonsillar tissue may actually be proportionate to airway growth, suggesting that any deviation from this trajectory would be abnormal. 4 Children with enlarged tonsils and adenoids may have increased upper airway collapsibility. 5 Several studies suggest that SDB may be more frequent in children of African-American race compared with Caucasians 6,7 and that boys may be at higher risk of SDB than girls, [8][9][10] especially in studies that included teenagers, 11 where pubertal hormonal changes likely contribute to the gender differences observed in adults.…”

Section: Prevalence and Risk Factorsmentioning

confidence: 99%

Sleep-Related Breathing Disorder, Cognitive Functioning, and Behavioral-Psychiatric Syndromes in Children

O’Brien

2015

Sleep Medicine Clinics

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“…In the vast majority of cases of OSA in children, hypertrophic tonsils and adenoids in the upper airway play a major role [77], that requires however the concurrent presence of alterations in structural and anatomical characteristics, protective reflexes and neuromuscular abnormalities of the upper airway. Thus, pediatric OSA is more common in those children with a positive family history of OSA, children with allergy, children born prematurely, in African American children, and in children with chronic upper and lower respiratory tract diseases [78-82]. …”

Section: Obesity and Obstructive Sleep Apnea Syndrome: Bad Bad And mentioning

confidence: 99%

Obesity and Altered Sleep: A Pathway to Metabolic Derangements in Children?

Hakim

Kheirandish‐Gozal

Gozal

2015

Seminars in Pediatric Neurology

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Obstructive sleep apnea (OSA) is a frequent disorder in children and is primarily associated with adenotonsillar hypertrophy., The prominent increases in childhood overweight and obesity rates in the world even among youngest of children have translated into parallel increases in the prevalence of OSA, and such trends will undoubtedly be associated with deleterious global health outcomes and life expectancy. Even an obesity phenotype in childhood OSA, more close to the adult type, has been recently proposed. Reciprocal interactions between sleep in general, OSA, obesity, and disruptions of metabolic homeostasis have emerged in recent years. These associations have suggested the a priori involvement of complex sets of metabolic and inflammatory pathways all of which may underlie increased risk for increased orexigenic behaviors and dysfunctional satiety, hyperlipidemia, and insulin resistance that ultimately favor the emergence of metabolic syndrome. Here, we will review some of the critical evidence supporting the proposed associations between sleep disruption and the metabolism-obesity complex. In addition, we will describe the more recent evidence linking the potential interactive roles of OSA and obesity on metabolic phenotype.

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Rhino‐sinus involvement in children with obstructive sleep apnea syndrome

Abstract: Childhood OSAS is associated with a wide range of upper respiratory tract perturbations and is not limited to adenoid and tonsillar hypertrophy.

Cited by 24 publications

References 34 publications

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

Sleep-Related Breathing Disorder, Cognitive Functioning, and Behavioral-Psychiatric Syndromes in Children

Obesity and Altered Sleep: A Pathway to Metabolic Derangements in Children?

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