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Chen C, Ioan I, Thieux M, Nicolino M, Franco P, Coutier L. Hypoventilation in patients with Prader-Willi syndrome across the pediatric age. Pediatr Pulmonol 2024. [PMID: 38179881 DOI: 10.1002/ppul.26852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/11/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Few data on alveolar hypoventilation in Prader-Willi syndrome (PWS) are available and the respiratory follow-up of these patients is not standardized. The objectives of this study were to evaluate the prevalence of alveolar hypoventilation in children with PWS and identify potential risk factors. STUDY DESIGN This retrospective study included children with PWS recorded by polysomnography (PSG) with transcutaneous carbon dioxide pressure (PtcCO2) or end-tidal CO2 (ETCO2) measurements, between 2007 and 2021, in a tertiary hospital center. The primary outcome was the presence of alveolar hypoventilation defined as partial pressure of carbon dioxide (pCO2) ≥ 50 mmHg during ≥2% of total sleep time (TST) or more than five consecutive minutes. RESULTS Among the 57 included children (38 boys, median age 4.8 years, range 0.1-15.6, 60% treated with growth hormone [GH], 37% obese), 19 (33%) had moderate-to-severe obstructive sleep apnea syndrome (defined as obstructive apnea-hypopnea index ≥5/h) and 20 (35%) had hypoventilation. The median (range) pCO2 max was 49 mmHg (38-69). Among the children with hypoventilation, 25% were asymptomatic. Median age and GH treatment were significantly higher in children with hypoventilation compared to those without. There was no significant difference in terms of sex, BMI, obstructive or central apnea-hypopnea index between both groups. CONCLUSION The frequency of alveolar hypoventilation in children and adolescents with PWS is of concern and may increase with age and GH treatment. A regular screening by oximetry-capnography appears to be indicated whatever the sex, BMI, and rate of obstructive or central apneas.
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Affiliation(s)
- Catherine Chen
- Service de pneumologie pédiatrique, Hôpital Femme Mère Enfant, Hospices, Civils de Lyon, Bron, France
- Université Claude-Bernard Lyon 1, Lyon, France
| | - Iulia Ioan
- Service d'explorations fonctionnelles pédiatriques, Hôpital d'Enfants, CHRU de Nancy; Unité DevAH, Université de Lorraine, Nancy, France
| | - Marine Thieux
- Université Claude-Bernard Lyon 1, Lyon, France
- Service Épilepsie-Sommeil-Explorations, Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de, Lyon, Bron, France
- Unité INSERM U1028 CNRS UMR 5292, Université Lyon 1, Lyon, France
| | - Marc Nicolino
- Université Claude-Bernard Lyon 1, Lyon, France
- Service d'endocrinologie pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Patricia Franco
- Université Claude-Bernard Lyon 1, Lyon, France
- Service Épilepsie-Sommeil-Explorations, Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de, Lyon, Bron, France
- Unité INSERM U1028 CNRS UMR 5292, Université Lyon 1, Lyon, France
| | - Laurianne Coutier
- Service de pneumologie pédiatrique, Hôpital Femme Mère Enfant, Hospices, Civils de Lyon, Bron, France
- Université Claude-Bernard Lyon 1, Lyon, France
- Unité INSERM U1028 CNRS UMR 5292, Université Lyon 1, Lyon, France
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2
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Aubertin G, Akkari M, Andrieux A, Colas des Francs C, Fauroux B, Franco P, Gagnadoux F, de Santerre OG, Grollemund B, Hartley S, Jaffuel D, Lafond L, Schröder CM, Schweitzer C, Charley-Monaca C. Management of obstructive sleep apnea syndrome type 1 in children and adolescents - A French consensus. Arch Pediatr 2023; 30:510-516. [PMID: 37537084 DOI: 10.1016/j.arcped.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/23/2023] [Accepted: 06/04/2023] [Indexed: 08/05/2023]
Abstract
This document is the outcome of a group of experts brought together at the request of the French Society of Sleep Research and Medicine to provide recommendations for the management of obstructive sleep apnea syndrome type 1 (OSA1) in children. The recommendations are based on shared experience and published literature. OSA1 is suspected when several nighttime respiratory symptoms related to upper airway obstruction are identified on clinical history taking. A specialist otolaryngologist examination, including nasofibroscopy, is essential during diagnosis. A sleep study for OSA1 is not mandatory when at least two nighttime symptoms (including snoring) are noted. Therapeutic management must be individualized according to the location of the obstruction. Ear, nose, and throat (ENT) surgery is often required, as hypertrophy of the lymphoid tissues is the main cause of OSA1 in children. According to clinical findings, orthodontic treatment generally associated with specialized orofacial-myofunctional therapy might also be indicated. Whatever treatment is chosen, follow-up must be continuous and multidisciplinary, in a network of trained specialists.
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Affiliation(s)
- G Aubertin
- Pediatric Pulmonology, Armand Trousseau Hospital, AP-HP Hospital, Sorbonne University, Paris, 75012, France; Centre de recherche Saint Antoine (CRSA), INSERM UMR-S 938, Paris, 75012, France; Centre de pneumologie de l'enfant, Ramsay Générale de Santé, Boulogne-Billancourt, 92100, France.
| | - M Akkari
- Ear, Nose and Throat & Head and Neck Surgery, University Hospital Gui de Chauliac, University of Montpellier, Montpellier, 34000, France
| | - A Andrieux
- Cabinet de pneumo-pédiatrie et somnologie pédiatrique, Mérignac, 33700, France; Pôle d'Exploration des Apnées du Sommeil (PEAS), Nouvelle Clinique Bel Air, Bordeaux, 33200, France; Pediatric Pulmonology Unit, University Hospital Pellegrin - Enfants, University of Bordeaux, Bordeaux, 33000, France
| | - C Colas des Francs
- Pediatric Sleep Unit, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, 69500, France; Réseau Morphée, Garches, 92380, France
| | - B Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, 75015, France; VIFASOM, University of Paris Cité, Paris, 75004, France
| | - P Franco
- Pediatric Sleep Unit, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, 69500, France; Integrative Physiology of the Brain Arousal Systems, CRNL, INSERM U1028, CNRS UMR5292 University of Lyon 1, Bron, 69675, France
| | - F Gagnadoux
- Department of Pulmonary and Sleep Medicine, University Hospital of Angers, Angers, 49000, France; INSERM 1083, UMR CNRS 6015, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, 49000, France
| | | | - B Grollemund
- Department of Dental-Facial Orthopedics, Pole of Bucco Dentaries' Medicine and Surgery, Cleft Competence Center, Strasbourg University Hospital, Strasbourg, 67000, France
| | - S Hartley
- Réseau Morphée, Garches, 92380, France; Sleep Unit, Department of Physiology, Raymond Poincaré Hospital, AP-HP, Garches, 92380, France
| | - D Jaffuel
- Department of Respiratory Diseases, University Hospital of Montpellier, Montpellier, 34000, France; PhyMedExp, CNRS, INSERM, Montpellier University, Montpellier, 34000, France
| | - L Lafond
- Oro-myofunctional Therapy Office, Bordeaux, 33000, France
| | - C M Schröder
- Department of Child and Adolescent Psychiatry, Strasbourg University and Strasbourg University Hospitals, Strasbourg, 67000, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, 67000, France; Sleep Disorders Center & CIRCSom (International Research Center for ChronoSomnology), Strasbourg University Hospitals, Strasbourg, 67000, France
| | - C Schweitzer
- Children's Medicine, Department of Pediatric Lung Function Testing, Children's Hospital, University Hospital of Nancy, Vandoeuvre les Nancy, 54501, France; EA3450 Développement Adaptation et Handicap (DevAH), University of Lorraine, Vandoeuvre les Nancy, 54505, France
| | - C Charley-Monaca
- Department of Clinical Neurophysiology-Sleep Disorders Unit, University of Lille, University Hospital of Lille, and U1172 - LilNCog - Lille Neurosciences & Cognition, Lille, 59000, France
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3
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Borrelli M, Corcione A, Cimbalo C, Annunziata A, Basilicata S, Fiorentino G, Santamaria F. Diagnosis of Paediatric Obstructive Sleep-Disordered Breathing beyond Polysomnography. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1331. [PMID: 37628330 PMCID: PMC10452996 DOI: 10.3390/children10081331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Obstructive sleep-disordered breathing (SDB) has significant impacts on health, and therefore, a timely and accurate diagnosis is crucial for effective management and intervention. This narrative review provides an overview of the current approaches utilised in the diagnosis of SDB in children. Diagnostic methods for SDB in children involve a combination of clinical assessment, medical history evaluation, questionnaires, and objective measurements. Polysomnography (PSG) is the diagnostic gold standard. It records activity of brain and tibial and submental muscles, heart rhythm, eye movements, oximetry, oronasal airflow, abdominal and chest movements, body position. Despite its accuracy, it is a time-consuming and expensive tool. Respiratory polygraphy instead monitors cardiorespiratory function without simultaneously assessing sleep and wakefulness; it is more affordable than PSG, but few paediatric studies compare these techniques and there is optional recommendation in children. Nocturnal oximetry is a simple and accessible exam that has high predictive value only for children at high risk. The daytime nap PSG, despite the advantage of shorter duration and lower costs, is not accurate for predicting SDB. Few paediatric data support the use of home testing during sleep. Finally, laboratory biomarkers and radiological findings are potentially useful hallmarks of SDB, but further investigations are needed to standardise their use in clinical practice.
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Affiliation(s)
- Melissa Borrelli
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Adele Corcione
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Chiara Cimbalo
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Anna Annunziata
- Department of Intensive Cure, Unit of Respiratory Pathophysiology, Monaldi Hospital, 80131 Naples, Italy; (A.A.); (G.F.)
| | - Simona Basilicata
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Giuseppe Fiorentino
- Department of Intensive Cure, Unit of Respiratory Pathophysiology, Monaldi Hospital, 80131 Naples, Italy; (A.A.); (G.F.)
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
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Riha RL, Celmina M, Cooper B, Hamutcu-Ersu R, Kaditis A, Morley A, Pataka A, Penzel T, Roberti L, Ruehland W, Testelmans D, van Eyck A, Grundström G, Verbraecken J, Randerath W. ERS technical standards for using type III devices (limited channel studies) in the diagnosis of sleep disordered breathing in adults and children. Eur Respir J 2023; 61:13993003.00422-2022. [PMID: 36609518 DOI: 10.1183/13993003.00422-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023]
Abstract
For more than three decades, type III devices have been used in the diagnosis of sleep disordered breathing in supervised as well as unsupervised settings. They have satisfactory positive and negative predictive values for detecting obstructive and central sleep apnoea in populations with moderately high pre-test probability of symptoms associated with these events. However, standardisation of commercially available type III devices has never been undertaken and the technical specifications can vary widely. None have been subjected to the same rigorous processes as most other diagnostic modalities in the medical field. Although type III devices do not include acquisition of electroencephalographic signals overnight, the minimum number of physical sensors required to allow for respiratory event scoring using standards outlined by the American Academy of Sleep Medicine remains debatable. This technical standard summarises data on type III studies published since 2007 from multiple perspectives in both adult and paediatric sleep practice. Most importantly, it aims to provide a framework for considering current type III device limitations in the diagnosis of sleep disordered breathing while raising research- and practice-related questions aimed at improving our use of these devices in the present and future.
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Affiliation(s)
- Renata L Riha
- Department of Sleep Medicine, The Royal Infirmary Edinburgh, Edinburgh, UK
| | - Marta Celmina
- Epilepsy and Sleep Medicine Centre, Children's Clinical University Hospital, Riga, Latvia
| | - Brendan Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, UK
| | | | - Athanasios Kaditis
- Division of Paediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | | | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Penzel
- Department of Cardiology and Angiology, Interdisciplinary Center of Sleep Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Warren Ruehland
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Dries Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Annelies van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp (Edegem), Belgium
- Department of Pediatrics, Antwerp University Hospital, Antwerp (Edegem), Belgium
| | | | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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5
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CPAP Adherence Assessment via Gaussian Mixture Modeling of Telemonitored Apnea Therapy. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Sleep disorders pose serious cardiovascular threats if not treated effectively. However, adherence to Continuous Positive Airway Pressure (CPAP), the most recommended therapy, is known to be challenging to monitor. Telemonitored CPAP equipment has improved the follow-up of CPAP adherence (hours of use per night) by producing far larger amounts of data collected daily. The analysis of such data have relied on averaging the entire therapeutic history and interpreting it without a proper reference concerning the level of adherence. By contrast, we contribute with an unsupervised machine-learning methodology that (i) translates the adherence data to a scale of discrete numbers that hold correspondence to the most usual 30-day-long patterns as observed in a real-word database; (ii) avoids the loss of information aggregation problem by creating summaries of the time series that capture the dynamic nature of the everyday-use CPAP. Our experiments have detected eight particular adherence behaviors validated with information-oriented statistical criteria; we successfully applied them to the time series of a French hospital to produce summaries that reflect the adherence of any 30 days of interest. Our method can aid physicians in more precisely evaluating the therapy adherence, as well as fostering systems to alert of problems in the treatment automatically.
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6
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[Diagnostic criteria for obstructive sleep apnea syndrome in adolescent]. Rev Mal Respir 2021; 38:829-839. [PMID: 34565640 DOI: 10.1016/j.rmr.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/13/2021] [Indexed: 11/20/2022]
Abstract
The obstructive sleep apnoea syndrome (OSAS) affects 1-4% of adolescents. It represents a transitional stage between paediatric and adult OSA and is characterized by specific symptoms. BACKGROUND: The persistence of childhood OSAS during adolescence is not frequent. Risk factors are male sex, obesity and a history of tonsillectomy or adenoidectomy. Symptoms may be misleading such as tiredness and depressive disorders. In adolescence, untreated OSAS may result in neuro-behavioural and cognitive deficits, systemic inflammation, cardiovascular and metabolic disorders. The French Society of Research and Sleep Medicine organized a meeting on OSAS in adolescents. A multidisciplinary group of specialists (pulmonologists, pediatricians, ENT and maxillo-facial surgeons, dentofacial orthopedists/orthodontists, myofunctional therapists and sleep specialists) exchanged their experience, discussed publications and drew up a consensus document on the diagnosis and polysomnographic criteria for OSAS in adolescents. They proposed a practical diagnostic guideline and follow-up for these adolescents. OUTLOOK AND CONCLUSION: A good knowledge of the particularities of this pathology by the physician will lead to an early diagnosis, propose adapted multifactorial treatments and avoid the deleterious consequences of this pathology at adult age.
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Childhood Obesity and its Influence on Sleep Disorders: Kids-Play Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217948. [PMID: 33138179 PMCID: PMC7663090 DOI: 10.3390/ijerph17217948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 12/26/2022]
Abstract
Background: Sleep disorders are associated with overweight and obese children, and could decrease life quality with limitations to normal daily activities. The purpose of the study is to describe the prevalence of sleep disorders in a cohort of overweight/obese children using respiratory polygraphy. Methods: A descriptive cross-sectional study was conducted in Granada (Spain) on a sample of 98 children with overweight or obesity. The presence of sleep disorders was determined by respiratory polygraphy. Results: Regarding apnoea–hypopnea-index (AHI) results, 44% of affected children had severe sleep apnoea–hypopnea syndrome (SAHS), and the remaining 56% had a mild form of the disorder. With respect to oxygen-desaturation index, 56% of the same group had severe SAHS, 32% had mild SAHS, and the remaining 12% did not suffer from SAHS. Among participants, average scores of 13.8 obstructive apnoea, 7.7 central apnoea, and 13.6 hypopnoea were recorded. Conclusions: Respiratory polygraphy can provide conclusive results in the diagnosis of SAHS in overweight/obese children. Interventional programmes designed and implemented to reduce overweight and obesity can improve quality of sleep and life in children.
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Remy F, Bonnaure P, Moisdon P, Burgart P, Godio-Raboutet Y, Thollon L, Guyot L. Preliminary results on the impact of simultaneous palatal expansion and mandibular advancement on the respiratory status recorded during sleep in OSAS children. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:235-240. [PMID: 32777308 DOI: 10.1016/j.jormas.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The study aimed to evaluate the evolution of the respiratory status during sleep of OSAS children treated with a custom-made device combining maxillary expansion and mandibular advancement. MATERIAL AND METHODS Sleep studies were performed before and after the treatment for 103 children presenting an initial OSAS and Class II malocclusion. Sleep questionnaires were also addressed to parents several years after the end of the treatment to evaluate its long-term effects. RESULTS After nine months of treatment, the sleep breathing quality significantly improved: the Apnea/Hypopnea Index systematically decreased ≤5. According to the sleep questionnaires results, 84% of the patients did not show any loud or troubled breathing several years after the end of the treatment. DISCUSSION Simultaneous maxillary expansion and mandibular advancement induced an increase of the oral space in the three spatial dimensions, helping in the significant improvement of the OSAS symptoms, with long-terms effects on the sleep breathing quality.
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Affiliation(s)
- F Remy
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France; YooMed, Montpellier, France.
| | | | | | | | | | - L Thollon
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
| | - L Guyot
- Department of Oral-Maxillofacial, Plastic and Reconstructive Surgery, A.P.-H.M., North University Hospital, Marseille, France; Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France
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9
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Home Respiratory Polygraphy is Useful in the Diagnosis of Childhood Obstructive Sleep Apnea Syndrome. J Clin Med 2020; 9:jcm9072067. [PMID: 32630238 PMCID: PMC7408887 DOI: 10.3390/jcm9072067] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/21/2020] [Accepted: 06/29/2020] [Indexed: 12/17/2022] Open
Abstract
The utility of home respiratory polygraphy (HRP) was assessed as an alternative to polysomnography (PSG) in the diagnosis of childhood obstructive sleep apnea syndrome (OSAS). PSG was indicated only in patients with concomitant disease or where HRP results were questionable. The follow-up period was 1 year. We recorded clinical and anthropometric data, physical examination findings, respiratory variables, severity level and choice of therapy. We assessed 121 children, 70 boys and 51 girls, with mean age 7 ± 4 years, mean body mass index (BMI) 19 ± 5 kg/m2, and mean BMI percentile 62 ± 38%. We included 104 HRP and 24 PSG recordings. Of the latter, 7 were preceded by HRP (false negatives) and 17 were indicated as the first-choice method owing to concomitant disease. Of the initial HRP recordings, 93% were technically valid. All technically valid HRPs and 96% of PSGs resulted in a diagnosis of OSAS (apnea-hypopnea index 9.5 ± 9.1/h). Thirty-three percent of cases were moderate and 22% severe. Apnea-hypopnea index showed no correlation with BMI or BMI percentile. Adenotonsillectomy was indicated in 93 patients (77%), conservative treatment in 17 (14%), and conservative treatment combined with CPAP/BiPAP in 11 (9%). There were no significant differences between children diagnosed by HRP and by PSG in terms of treatment choice. The prevalence of OSAS in our sample was 96.7%. In conclusion, when the probability of OSAS is high, HRP is usually sufficient for diagnosing the syndrome and establishing therapy in children. PSG is advisable in complex or questionable cases.
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10
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Coutier L, Franco P. [Sleep-related breathing disorders in children and teenagers: diagnosis, consequences and comorbidities]. Orthod Fr 2019; 90:273-287. [PMID: 34643515 DOI: 10.1051/orthodfr/2019034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Obstructive sleep apnoea syndrome (OSAS) is a frequent sleep-related breathing disorder in children with a prevalence of approximately 3% between the ages of 3 and 8. Its origin is multifactorial (hypertrophy of pharyngeal soft tissues, narrowing of the bone airways, damage to the neuromuscular tone). The symptoms and clinical signs to look for during the day and at night are directly related to upper airway (UA) obstruction or poor sleep quality. After a complete anamnestic and clinical evaluation, including nasofibroscopy, the ENT specialist will refer to an adeno-amygdalectomy or night recording by polysomnography or polygraph to confirm the diagnosis in the child. Among adolescents, the prevalence of OSAS is reported to be between 0.5 and 6%. The main risk factors are obesity, male sex and a history of tonsillectomy. In addition to the classic symptoms of childhood OSAS, this syndrome may, in adolescents, manifest itself as a misleading semiology of dyssomnia, excessive daytime sleepiness and/or mood disorders. Differential diagnoses with risk behaviours, phase delay or narcolepsy should be systematically discussed. It is essential to record breathing during sleep. Even if the obstructive apnea/hypopnea index is low, it must be considered. In both children and adolescents, multidisciplinary management (ENT, orthodontist, maxillofacial physiotherapist, pulmonologist) should be early in order to avoid neurocognitive, behavioural, cardiovascular and metabolic complications. Maxillofacial surgery can be discussed from the age of 15. It is important not to forget to pay attention to the rules of healthy living and sleep as well as the management of obesity.
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Affiliation(s)
- Laurianne Coutier
- Service de pneumologie, allergologie et mucoviscidose pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 59 boulevard Pinel, 69500 Lyon, France, Unité de sommeil pédiatrique, ESEFNP, HFME, Hospices Civils de Lyon & U1028, CRNL, Université Lyon 1, 59 boulevard Pinel, 69500 Lyon, France, U1028, CNRL, Université de Lyon 1, 59 boulevard Pinel, 69500 Lyon, France
| | - Patricia Franco
- Unité de sommeil pédiatrique, ESEFNP, HFME, Hospices Civils de Lyon & U1028, CRNL, Université Lyon 1, 59 boulevard Pinel, 69500 Lyon, France, U1028, CNRL, Université de Lyon 1, 59 boulevard Pinel, 69500 Lyon, France
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11
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Blanc F, Kennel T, Merklen F, Blanchet C, Mondain M, Akkari M. Contribution of drug-induced sleep endoscopy to the management of pediatric obstructive sleep apnea/hypopnea syndrome. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:447-454. [PMID: 31537488 DOI: 10.1016/j.anorl.2019.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The role of drug-induced sleep endoscopy (DISE) in the management of obstructive sleep apnea/hypopnea syndrome (OSAHS) is not precisely defined in children. The primary objective of this study was to describe DISE-induced revision of airway obstruction site location and the ensuing treatment changes in children with OSAHS. Secondary objectives were to analyze the correlation of number of obstruction sites found on DISE with apnea-hypopnea index (AHI) and with type of OSAHS. MATERIAL AND METHODS A retrospective single-center study included 31 children (mean age: 5.5±2.6years) undergoing DISE for management of OSAHS between 2015 and 2018. Revisions of airway obstruction site location and in treatment were noted. The correlation of number of obstruction sites with AHI and with type of OSAHS was analyzed. RESULTS Airway obstruction site location was reconsidered in 77% of children (n=24), modifying treatment in 45.2% (n=14). There was no significant correlation between number of obstruction sites and AHI: Spearman coefficient 0.20 (P=0.26). Patients with type-III OSAHS did not show more obstruction sites than others: respectively, 2.0 versus 1.8 (P=0.40). CONCLUSION DISE induced significant revision of the location and change in treatment of obstruction sites in children with OSAHS. Systematic implementation, especially in type-I OSAHS, would allow more precise pre-therapeutic classification and treatment adapted to actual airway obstruction.
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Affiliation(s)
- F Blanc
- Service d'ORL et Chirurgie Cervico Faciale, UAM d'ORL Pédiatrique, Hôpital Gui de-Chauliac, CHU de Montpellier, Université de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - T Kennel
- Service d'ORL et Chirurgie Cervico Faciale, UAM d'ORL Pédiatrique, Hôpital Gui de-Chauliac, CHU de Montpellier, Université de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - F Merklen
- Service d'ORL et Chirurgie Cervico Faciale, UAM d'ORL Pédiatrique, Hôpital Gui de-Chauliac, CHU de Montpellier, Université de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - C Blanchet
- Service d'ORL et Chirurgie Cervico Faciale, UAM d'ORL Pédiatrique, Hôpital Gui de-Chauliac, CHU de Montpellier, Université de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - M Mondain
- Service d'ORL et Chirurgie Cervico Faciale, UAM d'ORL Pédiatrique, Hôpital Gui de-Chauliac, CHU de Montpellier, Université de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - M Akkari
- Service d'ORL et Chirurgie Cervico Faciale, UAM d'ORL Pédiatrique, Hôpital Gui de-Chauliac, CHU de Montpellier, Université de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
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Blanc F, Merklen F, Blanchet C, Mondain M, Akkari M. Respiratory polygraphy in children: Feasibility in everyday practice in an ENT department and value of automatic detection of respiratory events. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:235-240. [DOI: 10.1016/j.anorl.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Akkari M, Marianowski R, Chalumeau F, Fayoux P, Leboulanger N, Monteyrol PJ, Mondain M. French Society of Otorhinolaryngology and Head and Neck Surgery (SFORL) guidelines concerning the role of otorhinolaryngologists in the management of paediatric obstructive sleep apnoea syndrome: Follow-up protocol for treated children. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:427-431. [PMID: 30318322 DOI: 10.1016/j.anorl.2018.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The authors present the French Society of Oto-Rhino-Laryngology and Head and Neck Surgery (SFORL) clinical practice guidelines concerning the role of otorhinolaryngologists in the management of paediatric obstructive sleep apnoea syndrome (OSAS). This chapter is devoted to the follow-up protocol for children treated for OSAS. METHODS A multidisciplinary task force was commissioned to carry out a review of the scientific literature on this topic. On the basis of the articles selected and the personal experience of each member of the task force, guidelines were drafted and graded as A, B or C or expert opinion according to a decreasing level of scientific evidence, and were then reviewed by a reading committee, independently of the task force. The final guidelines were established at a consensus meeting. RESULTS Short-term, medium-term and long-term clinical follow-up and complementary investigations are necessary in view of the risk of residual OSAS, and the risk of recurrence of OSAS related to adenoid and tonsillar regrowth following adenotonsillectomy, the treatment most commonly performed. The modalities of follow-up after surgery, continuous positive airway pressure (CPAP) ventilation, orthodontic treatment, myofascial rehabilitation, and drug therapy are described. The indications for nasal endoscopy and sleep studies as part of follow-up are specified.
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Affiliation(s)
- M Akkari
- Département d'ORL et chirurgie cervico faciale, UAM d'ORL pédiatrique, hôpital Gui de Chauliac, CHU de Montpellier, 80, avenue Augustin Fliche, 34295 Montpellier cedex 5, France.
| | - R Marianowski
- Département d'ORL et chirurgie cervico faciale, hôpital Morvan, CHU de Brest, 29000 Brest, France
| | - F Chalumeau
- Centre d'étude du sommeil, Antony, 94260 Fresnes, France
| | - P Fayoux
- Département d'ORL et chirurgie cervico faciale pédiatrique, hôpital Jeanne de Flandre, CHU de Lille, 59037 Lille, France
| | - N Leboulanger
- Département d'ORL et chirurgie cervico faciale pédiatrique, hôpital Necker-Enfants-Malades, Assistance Publique des Hôpitaux de Paris, 75015 Paris, France
| | - P J Monteyrol
- Département d'ORL et chirurgie cervico faciale, polyclinique du Tondu et clinique du sommeil, hôpital Pellegrin, 33000 Bordeaux, France
| | - M Mondain
- Département d'ORL et chirurgie cervico faciale, UAM d'ORL pédiatrique, hôpital Gui de Chauliac, CHU de Montpellier, 80, avenue Augustin Fliche, 34295 Montpellier cedex 5, France
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The watch-pat in pediatrics sleep disordered breathing: Pilot study on children with negative nocturnal pulse oximetry. Int J Pediatr Otorhinolaryngol 2017; 97:245-250. [PMID: 28483245 DOI: 10.1016/j.ijporl.2017.04.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The main purpose of this study was to determine the efficacy of Watch-PAT in Pediatric Sleep Disordered Breathing (PSDB) diagnosis in children with symptoms suggestive of PSDB, in which the nocturnal pulse oximetry was negative according to the Brouilette criteria. METHODS We enrolled 28 patients aged between 5 and 12 years (mean age: 7.75 ± 1.69), who underwent the registration with Watch-PAT, that utilizes the Peripheral Arterial Tone (PAT), AHI, RDI, body position, snoring, pulse oximetry and actigraphy. RESULTS Recording Watch-PAT was indicative of PSDB in 10/28 (35.7%) patients; when it was placed the threshold of AHI > 1 the number of positive patients for PSDB increased to 17/28 (60.7%). Exists a positive correlation between pat-RDI (rho = 0.798, p = 0.005) and the snoring > 40% of the time (rho = 0.656, p < 0.001) were correlated with the pat-AHI values. CONCLUSION The recording Watch-PAT appears to permit the defection of a certain number of SDB that might escape to the clinical evaluation and pulse oximetry only.
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