PEDIATRIC OBSTRUCTIVE SLEEP APNEA SYNDROME

Tonsillar surgery was, from the 19th century, the reference treatment for apneic patients. Adapting to the technical limitations of the time, surgeons devised ingenious procedures. The purpose of this historical note is to travel back to that time and rediscover one of the techniques favored by Chassaignac: “simultaneous enucleation” of the tonsils.

Childhood obstructive sleep apnea–hypopnea syndrome (OSAHS), the most common sleep-related breathing disorder, may lead to cognitive impairment. This study aims to investigate the association between mild or moderate childhood OSAHS and cognitive dysfunction.

A total of 59 children (4–12 years of age) diagnosed with mild or moderate OSAHS by polysomnography and 60 age-  and sex-matched healthy children were included in the study. The China-Wechsler Younger Children Scale of Intelligence and China-Wechsler Intelligence Scale for Children were used to evaluate the cognition of the participating children aged <6 years and ≥6 years, respectively.

In the <6-years-old subgroup, children with OSAHS had significantly lower scores of full-scale IQ (FIQ), verbal IQ (VIQ), comprehension test, and visual analysis than the healthy children (all p < 0.05). In the ≥6-years-old subgroup, VIQ and classification test scores were significantly lower in children with OSAHS than in the healthy controls (all p < 0.05). FIQ, VIQ, and performance IQ (PIQ) scores did not correlate with AHI, OAHI, and the lowest nocturnal SO₂. Notably, in the <6-years-old subgroup of OSAHS, the accumulated time of SO₂<90% (p = 0.046) and the percentage of the accumulated time of SO₂<90% in the total sleep time (p = 0.034) correlated with PIQ negatively and significantly.

Mild to moderate childhood OSAHS may adversely affect cognitive function, particularly in young children (<6 years of age). This study may increase the awareness of childhood OSAHS-associated cognitive dysfunction and advocate early interventions in childhood OSAHS.

The optimal surgical technique for the management of patients with Robin Sequence (RS) has not been established. One of the most commonly used surgical techniques, mandibular distraction osteogenesis (MDO), is still controversial because of its potential risks and the lack of clear evidence of its efficacy.

To assess variations in airway patency, clinical symptoms, and polysomnographic parameters in children with RS who underwent MDO.

In this prospective cohort study, 38 patients with RS were evaluated before and after MDO. Symptom severity was classified using a grading scale for RS clinical manifestations. Patients underwent flexible fiberoptic laryngoscopy, and the images were classified by a blinded examiner using two validated grading scales for airway obstruction. Patients not requiring ventilatory support underwent a polysomnography.

Patients' symptoms significantly improved after MDO, as shown by a decreased score in the grading scale for RS clinical manifestations (preoperative score of 2.20 vs. postoperative score of 0.81; P < 0.001). The two endoscopic grading scales also showed a statistically significant postoperative improvement in airway obstruction (first scale: preoperative score of 1.56 vs. postoperative score of 0.92; second scale: preoperative score of 2.19 vs. postoperative score of 1.16; P < 0.001 for both). Moreover, there was a statistically significant variation in the following polysomnographic parameters evaluated pre- and postoperatively: apnea-hypopnea index, total sleep time, oxygen desaturation nadir, and oxygen desaturation index (P < 0.05).

MDO seems to be an effective surgical option for children, as shown by postoperative improvements in clinical symptoms, endoscopic grading scales, and polysomnographic parameters.

Fractional time in REM sleep <20% (‘little REM sleep’) is indicative of more severe sleep-disordered breathing (SDB) in adults. We examined if other REM% is predictive of more severe SDB in children.

In this retrospective study of 616 pediatric SDB patients, age, sex ratio, BMI, sleep efficiency, awakening frequency, sleep latency, apnea-hypopnea index (AHI), obstructive apnea index (OAI), and lowest oxygen pulse saturation (LSpO₂) were compared among groups stratified according to REM%: REM≥20%, REM<20%, 15% ≤ REM<20%, 10% ≤ REM<15%, and REM<10%. Correlations with AHI, OAI, LSpO₂, sleep efficiency, and awakening frequency were examined in REM<20% and REM<10% groups. Associations of these parameters with REM<10% were examined by single- and multifactor regression.

Pediatric SDB patients with little REM sleep demonstrated poorer sleep quality than patients with REM≥20%, while patients with REM<10% also exhibited more severe SDB. Specifically, the REM<20% group exhibited higher number of awakenings and lower sleep efficiency than the REM≥20% group (both P ≤ 0.001), as did each REM%<20% subgroup (lower sleep efficiency: all P < 0.05; higher awakening frequency: all P < 0.001). Moreover, compared to the REM≥20% group, the REM<10% also exhibited higher AHI (P = 0.025) and lower LSpO₂ (P = 0.019). In the REM<10% group, individual REM% was negatively correlated with AHI (r = −0.216, P = 0.031) and positively with LSpO₂ (r = 0.2, P = 0.046). Multifactor logistic regression correcting for age and BMI identified AHI as an independent predictor of REM<10% (P = 0.012, OR = 1.016, 95% CI [1.004,1.029]).

REM% <10% is associated with poor sleep quality and SDB severity in children, suggesting that this threshold should define “little REM sleep” in pediatric patients.