PEDIATRIC OBSTRUCTIVE SLEEP APNEA SYNDROME
Section snippets
PREVALENCE
The prevalence of childhood OSAS is estimated to be around 2%. This estimate translates into a figure of more than 500,000 children with OSAS in the United States.4, 58 The peak age of OSAS is reported to be between 2 and 5 years, the developmental peak of adenotonsillar hyperplasia.39 There is a second peak of OSAS in middle to late adolescence, although these patients usually present with adult type symptomatology (i.e., nighttime arousals and daytime somnolence). Gender distribution is equal
PRESENTATION
Family practitioners, pediatricians, otolaryngologists, neurologists, pulmonologists, allergists, psychiatrists, psychologists, and neurobehavioral specialists are likely to see children with OSAS. Specialty referral often is guided by the presenting complaint of the parents and initial physical examination. A snoring child with adenotonsillar hypertrophy most likely is referred to an otolaryngologist, and a child with failure-to-thrive to a pediatrician. Sleepy children are sent to
DIAGNOSTIC CRITERIA AND EVALUATION
A complete physical examination should be performed in children with suspected OSAS. Assessment of overall growth and development should be included. Examination of the cardiovascular system and the lungs for possible consequences of OSAS is necessary. A comprehensive head and neck examination should include documenting tonsil size (0 to 4+) and airway, uvula, tonsil pillars, tongue base, and oropharyngeal and palatal shape and size. The tongue should be depressed to visualize the inferior
TREATMENT
Many treatment options are available for OSA, including observation alone for mild cases, and a variety of medical, mechanical, and surgical interventions. The decision on type of intervention must be made based on the severity of OSA, the source/site of obstruction, comorbidities, and patient and family desires. A stepwise approach to surgical management is acceptable in complex cases.6 Very mild OSA in children with minimal symptoms and no risk factors does not require as aggressive an
SPECIAL CASES
Children with Down syndrome have a high probability of developing OSA. Even asymptomatic patients may have OSA if evaluated by PSG. Children with Down syndrome are at increased risk for obstructive sleep apnea because of their relatively small midface and cranium, narrow nasopharynx, large tongue, muscular hypotonia, obesity, increased susceptibility to upper respiratory infections, and small larynx. Up to 50% of children with Down syndrome may have congenital heart disease which potentially
FOLLOW-UP
Most children with OSA have complete relief of symptoms with T&A. Residual symptoms of snoring or apnea occur in some patients. Postoperative PSG is indicated in children with residual symptoms of OSA after surgical management. Waiting up to 3 months postoperatively allows for resolution of surgical edema and maximal surgical improvement. PSG should be obtained routinely postoperatively in patients with severe OSA preoperatively (AHI>20),91 and in patients with increased risk of surgical
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2018, Sleep MedicineCitation Excerpt :Whether therapies for OSAHS can treat OSAHS-associated cognitive dysfunction effectively remains controversial. Currently, the most common therapy for childhood OSAHS is adenoid and/or tonsillectomies and continuous positive airway pressure (CPAP) [23]. Zhu and colleagues have shown that CPAP or adenoid and/or tonsillectomies improved the cognition in children with OSAHS-associated cognitive dysfunction [24].
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2018, Journal of Cranio-Maxillofacial SurgeryCitation Excerpt :The term “glossoptosis” refers to a posterior displacement of the base of the tongue causing varying degrees of airway obstruction. Flexible fiberoptic laryngoscopy (FFL) is an examination procedure that assesses airway anatomy and can diagnose this obstruction (de Sousa et al., 2003; Yellon, 2006; Manica et al., 2016), while polysomnography (PSG) is a test used to quantify the degree of obstruction during sleep (Bower and Gungor, 2000; Bravo et al., 2005; Bangiyev et al., 2016). French stomatologist Pierre Robin described the association between micrognathia and glossoptosis in 1923 (Robin, 1923).
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Address reprint requests to Charles M. Bower, MD, Arkansas Children's Hospital, 800 Marshall Street, Little Rock, AR 72202
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Department of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock, Arkansas