Searching for the happy medium in the therapeutic approach to childhood sleep disordered breathing

Abstract

@ERSpublicationsIs the optimum approach to childhood sleep disordered breathing prompt surgical intervention or watchful waiting? http://ow.ly/XypalThe natural history of a disease is the course it takes in an individual, without medical intervention, from its pathological onset until its eventual resolution or death. Knowledge of this natural history is essential for understanding the disease and designing the most effective strategies for its prevention and control.Sleep disordered breathing (SDB) is a relatively novel disease and we have little knowledge about its onset, causes and course. At present, we are limited to several risk factors that cannot fully explain the different phenotypes and features observed in specific populations such as middle-aged men, women, the elderly and children. As with other chronic disorders, it is difficult to identify the precise onset of SDB and trace its natural history. Moreover, the impairment of health status and cardiovascular risks associated with this disorder means that there are ethical implications in withholding treatment to observe its evolution over time. In this respect, children may offer a unique possibility for better tracing the onset and course of the disease, given the fewer coexisting comorbidities and chronic diseases in this population.The paper by BIXLER et al. [1] in the current issue of European Respiratory Journal sheds some light on the natural history of SDB in the transition from childhood to adolescence, by reassessing a large cohort of children 8 years after baseline evaluation. This study provides two main findings: 1) all children with severe SDB (apnoea−hypopnoea index (AHI) >5 episodes per hour) and most with moderate SDB (defined in this study as an AHI of 2−5 episodes per hour) experienced either partial or complete remission in the AHI; and 2) risk factors for SDB in adolescence were similar to those found in adulthood but were very different from those observed in childhood.Spontaneous remission of SDB may change the therapeutic approach to this disorder in children, thereby opening up the question of whether to apply active treatment or watchful waiting as the first-line treatment. Current guidelines recommend active treatment for those children with an AHI >5 episodes per hour or an AHI of 1−5 episodes per hour and the presence of cardiovascular morbidity, symptomatic disease or factors predicting SDB persistence [2]. These recommendations are based on strong evidence demonstrating that SDB may impair quality of life and increase blood pressure, hyperactivity symptoms, cognitive deficits, academic difficulties and behavioural disorders [3][4][5][6]. The preferred treatment in children is adenotonsillectomy [2], which in the study by BIXLER et al.[1] showed a trend, albeit nonsignificant, towards an increased incidence of SDB in adolescence, a finding also reported in other studies [7]. Therefore, the key question would be to choose between an early treatment, assuming the risks of surgery or even the possibility that surgery itself m...

Frequency of snoring, rather than apnea–hypopnea index, predicts both cognitive and behavioral problems in young children

“…Although a substantial proportion of childhood cases of SDB will naturally remit prior to adolescence [66], opinions differ on the appropriate approach and urgency of SDB treatment, given the potential risk for adverse medical and psychological outcomes if SDB is left untreated [67]. Indeed, as illustrated in the current analysis, various forms of behavioral and cognitive problems that may affect learning and school functioning often accompany both OSA and PS.…”

Condição miofuncional e controle motor orofacial em crianças com apneia obstrutiva do sono

“…O reconhecimento de anormalidades na infância é importante, pois solucionálas precocemente é uma das maneiras de realizar a prevenção dos DRS do adulto, bem como diminuir o risco elevado de morbidades associadas à AOS (Campos-Rodriguez;Martínez-García, 2016;Tan;Kheirandish-Gozal, 2020).…”