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Trosman I, Ivanenko A. Classification and Epidemiology of Sleep Disorders in Children and Adolescents. Psychiatr Clin North Am 2024; 47:47-64. [PMID: 38302213 DOI: 10.1016/j.psc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Sleep disturbances are common in children and adolescents but still remain unrecognized and undertreated. Several classification systems of sleep disorders are available, which include recent attempts to develop more specific nosologic categories that reflect developmental aspects of sleep. The prevalence of sleep disorders has been studied across various samples of healthy, typically developing children and those with special medical, psychiatric, and neurodevelopmental needs. Sleep disorders are highly prevalent in children and adolescents with psychiatric disorders, making it important for mental health professionals to be aware of sleep problems and to address them in the context of psychiatric comorbidities.
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Affiliation(s)
- Irina Trosman
- Division of Pulmonary and Sleep Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue Box 43, Chicago, IL 60611-2991, USA
| | - Anna Ivanenko
- Division of Child and Adolescent Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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Shamshudinov T, Kassym L, Taukeleva S, Sadykov B, Diab H, Milkov M. Tympanoplasty and adenoidectomy in children: Comparison of simultaneous and sequential approaches. PLoS One 2022; 17:e0265133. [PMID: 35271666 PMCID: PMC8912196 DOI: 10.1371/journal.pone.0265133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background The authors sought to compare simultaneous and sequential tympanoplasty and adenoidectomy surgery in pediatric patients. Methods This retrospective single-center study included 65 children (36 males, 29 females; mean age 9.16 ± 3.82 years; range 3–17 years) requiring both tympanoplasty and adenoidectomy. Simultaneous surgeries were performed on the same day, during single general anesthesia, whereas sequential surgeries were separated at least 12 weeks. The groups were compared with regard to restoration of hearing, tympanic membrane status, and utilization of medical resources. All study participants had a 12-months follow-up period after surgery. Results No statistically significant differences were observed between the groups regarding pre- and post-operative ABG values and average hearing gains. However, the post-operative ABG was significantly lower than the pre-operative ABG in both groups (p<0.001). There were no significant differences between simultaneous and sequential groups with respect to complete healing rates and complications (all p>0.355). Simultaneous tympanoplasty and adenoidectomy surgery management is associated with a significantly decreased cumulative hospital stay, cumulative operating room time, and cumulative pure surgical time (all p≤0.016). Conclusions The results of first comparative study of simultaneous versus sequential tympanoplasty and adenoidectomy surgery managements demonstrate no advantages for the sequential approach. The same-day surgery can show the clinical outcomes comparable to those in the sequential group. The simultaneous surgery approach appears to be associated with reduced medical resources consumption. Therefore, simultaneous surgery management is an effective and safe option for children with chronic otitis media and adenoid hypertrophy.
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Affiliation(s)
- Timur Shamshudinov
- Center of Pediatric Otorhinolaryngology, General Hospital #5, Almaty, Republic of Kazakhstan
| | - Laura Kassym
- School of Medicine, Nazarbayev University, Nur-Sultan, Republic of Kazakhstan
- * E-mail:
| | - Saule Taukeleva
- Kazakh-Russian Medical University, Almaty, Republic of Kazakhstan
| | - Bolat Sadykov
- Center of Pediatric Otorhinolaryngology, General Hospital #5, Almaty, Republic of Kazakhstan
| | - Hassan Diab
- The National Medical Research Center for Otorhinolaringology, Federal Medico-Biological Agency, Moscow, Russian Federation
| | - Mario Milkov
- Medical University of Varna, Faculty of Dental Medicine, Varna, Bulgaria
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Xu S, Turakhia S, Miller M, Johnston D, Maddalozzo J, Thompson D, Trosman I, Grandner M, Sheldon SH, Ahluwalia V, Bhushan B. Association of obstructive sleep apnea and total sleep time with health-related quality of life in children undergoing a routine polysomnography: a PROMIS approach. J Clin Sleep Med 2022; 18:801-808. [PMID: 34669574 PMCID: PMC8883074 DOI: 10.5664/jcsm.9726] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) negatively impacts health-related quality of life (HR-QoL) in adults, but few pediatric studies have explored this relationship or the relationships between HR-QoL domains. METHODS Patients aged 8-17 years visiting the sleep laboratory from July 2019 to January 2020 for overnight polysomnography participated in the study. Controls seen for problems other than sleep disturbance were recruited from Department of Pediatrics outpatient clinics. HR-QoL was assessed by Patient-Reported Outcome Measure Information System (PROMIS) profile questionnaires, version 2.0. Statistical analysis was conducted using R 3.6.0 (R Foundation for Statistical Computing, Vienna, Austria). RESULTS One hundred twenty-two patients were included in the final analysis. Sixty-four patients were males (52.4%). Twenty-nine (23.8%) had mild OSA, 8 (6.6%) had moderate OSA, 17 (13.9%) had severe OSA, 46 (37.7%) were without OSA, and 22 (18.0%) were controls. Patients referred for polysomnography had lower physical function mobility compared with controls (P = .03). Increased OSA severity was linearly associated with a decrease in physical function mobility (P = .008). Correlation analysis revealed that physical function mobility was positively associated with total sleep time (P = .02) and negatively associated with apnea-hypopnea index (P = .01). Age was positively associated with fatigue (P = .02) and negatively associated with deep sleep (P < .001). Regression analysis revealed that physical function mobility was positively associated with total sleep time (P = .02) and negatively associated with apnea-hypopnea index (P = .04) after controlling for age, sex, and number of arousals. CONCLUSIONS OSA and total sleep time were associated with problems with physical function mobility after adjusting for age, sex, and number of arousals. CITATION Xu S, Turakhia S, Miller M, et al. Association of obstructive sleep apnea and total sleep time with health-related quality of life in children undergoing a routine polysomnography: a PROMIS approach. J Clin Sleep Med. 2022;18(3):801-808.
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Affiliation(s)
- Sarah Xu
- Otolaryngology Head and Neck Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | | | - Michael Miller
- Stanley Manne Research Institute, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Douglas Johnston
- Otolaryngology Head and Neck Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John Maddalozzo
- Otolaryngology Head and Neck Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dana Thompson
- Otolaryngology Head and Neck Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Irina Trosman
- Pulmonary and Sleep Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Michael Grandner
- Department of Psychiatry, The University of Arizona College of Medicine, Tucson, Arizona
| | - Stephen H. Sheldon
- Pulmonary and Sleep Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Vikas Ahluwalia
- Otolaryngology Head and Neck Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Bharat Bhushan
- Otolaryngology Head and Neck Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Address correspondence to: Bharat Bhushan, PhD, CCSH, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Northwestern University, 225 East Chicago Avenue, Box #25, Chicago, IL 60611-2605; Tel: (312) 227-6793; Fax: (312) 227-9414;
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The Effect of Adenotonsillectomy on Children's Behavior and Cognitive Performance with Obstructive Sleep Apnea Syndrome: State of the Art. CHILDREN-BASEL 2021; 8:children8100921. [PMID: 34682186 PMCID: PMC8535044 DOI: 10.3390/children8100921] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/23/2021] [Accepted: 10/12/2021] [Indexed: 12/16/2022]
Abstract
(1) Background: This systematic review was designed to analyze adenotonsillectomy’s role in treating behavioural disorders and sleep-related quality of life in pediatric OSAS. (2) Methods: Papers that report pre-operative and post-operative outcomes by using the Epworth sleepiness scale, OSA-18, NEPSY, Conners’ rating scale, BRIEF, PSQ-SRBD, PedsQL and CBCL. We performed a comprehensive review of English papers published during the last 20 years regarding behavioural disorders in OSAS patients and adenotonsillectomy. (3) Results: We included 11 studies reporting behavioral outcomes and sleep related quality of life after surgery. We investigated changes in behavior and cognitive outcomes after AT, and we found significant improvements of the scores post-AT in almost all studies. After comparing the AT group and control group, only one study had no difference that reached significance at one year post-AT. In another study, it did not show any significant improvement in terms of all behavioural and cognitive outcomes. The questionnaires on sleep-related quality of life after AT (PSQ-SRBD or ESS or OSA-18 or KOSA) may improve with positive changes in sleep parameters (AHI, ODI and SpO2). Furthermore, there is a significantly higher decrease in OSAS symptoms than the pre-AT baseline score. (4) Conclusion: Future studies should pay more attention to characterizing patient populations as well as rapid surgical treatments through existing criteria.
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Adenotonsillectomy for the Treatment of Obstructive Sleep Apnoea in Extreme Paediatric Obesity. The Journal of Laryngology & Otology 2021; 136:1071-1076. [PMID: 34593058 DOI: 10.1017/s0022215121002693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Trosman I, Ivanenko A. Classification and Epidemiology of Sleep Disorders in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2021; 30:47-64. [PMID: 33223068 DOI: 10.1016/j.chc.2020.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sleep disturbances are common in children and adolescents but still remain unrecognized and undertreated. Several classification systems of sleep disorders are available, which include recent attempts to develop more specific nosologic categories that reflect developmental aspects of sleep. The prevalence of sleep disorders has been studied across various samples of healthy, typically developing children and those with special medical, psychiatric, and neurodevelopmental needs. Sleep disorders are highly prevalent in children and adolescents with psychiatric disorders, making it important for mental health professionals to be aware of sleep problems and to address them in the context of psychiatric comorbidities.
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Affiliation(s)
- Irina Trosman
- Division of Pulmonary and Sleep Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue Box 43, Chicago, IL 60611-2991, USA
| | - Anna Ivanenko
- Division of Child and Adolescent Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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Lookabaugh S, McKenna M, Karelsky S, Davis M, Didas A, Allen P, Faria J. Drug-induced sleep endoscopy findings in surgically-naïve obese vs non-obese children. Int J Pediatr Otorhinolaryngol 2020; 138:110289. [PMID: 32814210 DOI: 10.1016/j.ijporl.2020.110289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine if drug-induced sleep endoscopy (DISE) findings are different in obese versus non-obese pediatric patients with obstructive sleep apnea (OSA) or sleep-disordered breathing (SDB). METHODS Prospective, observational cohort study from June 2017 to June 2018 at a tertiary academic pediatric medical center that included surgically-naïve children ages 2-12 with diagnoses of OSA or sleep-disordered breathing. Subjects with a known diagnosis of craniofacial syndromes, genetic disorders, prior adenoidectomy or tonsillectomy, or chronic tonsillitis as the indication for surgery were excluded. Two groups were assessed for patterns of obstruction based on DISE videos at each anatomic airway level using a previously published DISE scoring system. The groups included obese subjects (BMI ≥ 95th percentile) and non-obese controls (BMI <85th percentile). Each video was graded by two blinded, fellowship-trained Pediatric Otolaryngologists. RESULTS Fifty-one patients were included, 26 non-obese and 25 obese. Based on anatomic airway level, there was no statistically significant difference in airway obstruction at the velum (p = 0.134), adenoid (p = 0.592), lateral pharyngeal walls (p = 0.867), tongue base (p = 0.977), or supraglottis (p = 0.428) between obese and non-obese children. CONCLUSION Our prospective study did not associate severity of obstruction with obesity status based on anatomic airway levels. Further studies are needed to elucidate the etiology of the high rate of persistent obstructive sleep apnea in obese children.
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Affiliation(s)
- Sarah Lookabaugh
- Department of Otolaryngology Head and Neck Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA.
| | - Margo McKenna
- Department of Otolaryngology Head and Neck Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Sveta Karelsky
- Department of Otolaryngology Head and Neck Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael Davis
- Department of Anesthesiology, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Amanda Didas
- Department of Otolaryngology Head and Neck Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Paul Allen
- Department of Otolaryngology Head and Neck Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - John Faria
- Department of Otolaryngology Head and Neck Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
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Levi E, Alvo A, Anderson BJ, Mahadevan M. Postoperative admission to paediatric intensive care after tonsillectomy. SAGE Open Med 2020; 8:2050312120922027. [PMID: 32547746 PMCID: PMC7249556 DOI: 10.1177/2050312120922027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/03/2020] [Indexed: 12/13/2022] Open
Abstract
Objectives: To review interventions required by children admitted for intensive care management following tonsillectomy or adenotonsillectomy either as elective or unplanned admission in a tertiary children’s hospital. Methods: A retrospective chart review over a 10-year period between April 2007 and March 2017 was performed. Charts were interrogated for treatments that were administered in the paediatric intensive care unit. Respiratory support therapies such as supplemental oxygen administration, high-flow nasal oxygen, positive pressure ventilation, continuous positive airway pressure, airway interventions and tracheal intubation were reviewed. Results: There were 103 children admitted to the paediatric intensive care unit following tonsillectomy or adenotonsillectomy. The average age was 6.2 years (range 7 months–17 years). The main indications for the procedure were sleep disordered breathing or obstructive sleep apnoea syndrome. In all, 53 children had syndromes with medical comorbidities, 31 were current continuous positive airway pressure users and 5 had a tracheostomy in situ. Forty children admitted to paediatric intensive care unit did not require any high-level care. Ten children who had an unplanned admission had their respiratory interventions started in the theatre or in the post-anaesthetic care unit, before paediatric intensive care unit admission, and did not require escalation of care. Conclusion: Children may not require admission for intensive care after tonsillectomy if they have had an incident-free period in the post-anaesthetic care unit. Some of those who required high-flow nasal oxygen could have been managed on the ward provided with adequate training and monitoring facilities. The level of care they require in post-anaesthetic care unit reflected the level of care for the immediate postoperative period in the paediatric intensive care unit.
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Affiliation(s)
- Eric Levi
- Department of Paediatric Otolaryngology, Starship Children's Hospital, Auckland, New Zealand
| | - Andrés Alvo
- Department of Paediatric Otolaryngology, Starship Children's Hospital, Auckland, New Zealand
| | - Brian J Anderson
- Department of Paediatric Intensive Care, Starship Children's Hospital, Auckland, New Zealand
| | - Murali Mahadevan
- Department of Paediatric Otolaryngology, Starship Children's Hospital, Auckland, New Zealand.,Department of Surgery, The University of Auckland, Auckland, New Zealand
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Blackshaw H, Springford LR, Zhang LY, Wang B, Venekamp RP, Schilder AG. Tonsillectomy versus tonsillotomy for obstructive sleep-disordered breathing in children. Cochrane Database Syst Rev 2020; 4:CD011365. [PMID: 32347984 PMCID: PMC7193676 DOI: 10.1002/14651858.cd011365.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Obstructive sleep-disordered breathing (oSDB) is a condition encompassing breathing problems when asleep due to upper airway obstruction. In children, hypertrophy of the tonsils and/or adenoids is thought to be the commonest cause. As such, (adeno)tonsillectomy has long been the treatment of choice. A rise in partial removal of the tonsils over the last decade is due to the hypothesis that tonsillotomy is associated with lower postoperative morbidity and fewer complications. OBJECTIVES To assess whether partial removal of the tonsils (intracapsular tonsillotomy) is as effective as total removal of the tonsils (extracapsular tonsillectomy) in relieving signs and symptoms of oSDB in children, and has lower postoperative morbidity and fewer complications. SEARCH METHODS We searched the Cochrane ENT Trials Register; Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The search date was 22 July 2019. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the effectiveness of (adeno)tonsillectomy with (adeno)tonsillotomy in children aged 2 to 16 years with oSDB. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods and assessed the certainty of the evidence for our pre-defined outcomes using GRADE. Our primary outcomes were disease-specific quality of life, peri-operative blood loss and the proportion of children requiring postoperative medical intervention (with or without hospitalisation). Secondary outcomes included postoperative pain, return to normal activity, recurrence of oSDB symptoms as a result of tonsil regrowth and reoperation rates. MAIN RESULTS We included 22 studies (1984 children), with predominantly unclear or high risk of bias. Three studies used polysomnography as part of their inclusion criteria. Follow-up duration ranged from six days to six years. Although 19 studies reported on some of our outcomes, we could only pool the results from a few due both to the variety of outcomes and the measurement instruments used, and an absence of combinable data. Disease-specific quality of life Four studies (540 children; 484 (90%) analysed) reported this outcome; data could not be pooled due to the different outcome measurement instruments used. It is very uncertain whether there is any difference in disease-specific quality of life between the two surgical procedures in the short (0 to 6 months; 3 studies, 410 children), medium (7 to 13 months; 2 studies, 117 children) and long term (13 to 24 months; 1 study, 67 children) (very low-certainty evidence). Peri-operative blood loss We are uncertain whether tonsillotomy reduces peri-operative blood loss by a clinically meaningful amount (mean difference (MD) 14.06 mL, 95% CI 1.91 to 26.21 mL; 8 studies, 610 children; very low-certainty evidence). In sensitivity analysis (restricted to three studies with low risk of bias) there was no evidence of a difference between the groups. Postoperative complications requiring medical intervention (with or without hospitalisation) The risk of postoperative complications in the first week after surgery was probably lower in children who underwent tonsillotomy (4.9% versus 2.6%, risk ratio (RR) 1.75, 95% CI 1.06 to 2.91; 16 studies, 1416 children; moderate-certainty evidence). Postoperative pain Eleven studies (1017 children) reported this outcome. Pain was measured using various scales and scored by either children, parents, clinicians or study personnel. When considering postoperative pain there was little or no difference between tonsillectomy and tonsillotomy at 24 hours (10-point scale) (MD 1.09, 95% CI 0.88 to 1.29; 4 studies, 368 children); at two to three days (MD 0.93, 95% CI -0.14 to 2.00; 3 studies, 301 children); or at four to seven days (MD 1.07, 95% CI -0.40 to 2.53; 4 studies, 370 children) (all very low-certainty evidence). In sensitivity analysis (restricted to studies with low risk of bias), we found no evidence of a difference in mean pain scores between groups. Return to normal activity Tonsillotomy probably results in a faster return to normal activity. Children who underwent tonsillotomy were able to return to normal activity four days earlier (MD 3.84 days, 95% CI 0.23 to 7.44; 3 studies, 248 children; moderate-certainty evidence). Recurrence of oSDB and reoperation rates We are uncertain whether there is a difference between the groups in the short (RR 0.26, 95% CI 0.03 to 2.22; 3 studies, 186 children), medium (RR 0.35, 95% CI 0.04 to 3.23; 4 studies, 206 children) or long term (RR 0.21 95% CI 0.01 to 4.13; 1 study, 65 children) (all very low-certainty evidence). AUTHORS' CONCLUSIONS For children with oSDB selected for tonsil surgery, tonsillotomy probably results in a faster return to normal activity (four days) and in a slight reduction in postoperative complications requiring medical intervention in the first week after surgery. This should be balanced against the clinical effectiveness of one operation over the other. However, this is not possible to determine in this review as data on the long-term effects of the two operations on oSDB symptoms, quality of life, oSDB recurrence and need for reoperation are limited and the evidence is of very low quality leading to a high degree of uncertainty about the results. More robust data from high-quality cohort studies, which may be more appropriate for detecting differences in less common events in the long term, are required to inform guidance on which tonsil surgery technique is best for children with oSDB requiring surgery.
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Affiliation(s)
- Helen Blackshaw
- evidENT, Ear Institute, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Laurie R Springford
- evidENT, Ear Institute, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Lai-Ying Zhang
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Betty Wang
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Anne Gm Schilder
- evidENT, Ear Institute, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
- Julius Center for Health Sciences and Primary Care & Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Gehrke T, Hackenberg S, Steinhübel B, Hagen R, Scherzad A. Laryngeal mask versus intubation for adenoidectomies in children: Analysis of 1,500 operations. Laryngoscope 2019; 129:E383-E388. [DOI: 10.1002/lary.27794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Thomas Gehrke
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Hospital Würzburg Würzburg Germany
| | - Stephan Hackenberg
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Hospital Würzburg Würzburg Germany
| | - Bernhard Steinhübel
- Department of Anesthesiology and Intensive Care MedicineUniversity Hospital Würzburg Würzburg Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Hospital Würzburg Würzburg Germany
| | - Agmal Scherzad
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Hospital Würzburg Würzburg Germany
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11
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Li X, Tai J, Xu Z, Ma J, Peng X, Pan Y, Yan X, Wang G, Wu Y, Zheng L, Du J, Ge W, Zhang J, Zhang Y, Ni X. Systematic investigation of childhood sleep-disordered breathing (SDB) in Beijing: validation of survey methodology. BMJ Open 2018; 8:e021097. [PMID: 30158222 PMCID: PMC6119448 DOI: 10.1136/bmjopen-2017-021097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To systematically investigate and validate the survey methodology for the epidemiological study of childhood sleep-disordered breathing (SDB) in mainland China using the Mandarin version of the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder (PSQ-SRBD). DESIGN A cross-sectional study using randomised, stratified, multistage, cluster sampling method. SETTING A total of 11 kindergartens, 7 primary schools and 8 middle schools from 7 districts of Beijing, China. PARTICIPANTS A total of 9198 children with valid questionnaires (4736 boys and 4462 girls; age range 3.0-14.4 years) were included. PRIMARY AND SECONDARY OUTCOME MEASURES Data on sociodemographic characteristics and PSQ-SRBD were collected. The score on PSQ-SRBD and the included factors were calculated with the effective data after data cleaning. Logistic regression and factor analysis with the principal components method were used to evaluate the validity of the questionnaire; reliability was assessed by retesting 5% of the respondents after 2±4 weeks of the initial test, and the intraclass correlation coefficient was calculated. RESULTS The effective response rate of80.54% matched the sociodemographic characteristics of the respondents with respect to age group ratio and sex ratio in Beijing. With regard to construct validity of the PSQ-SRBD, the item score, except that of 'delayed growth', was highly correlated to the SRBD score as assessed by the logistic regression model. The exploratory factor analysis displayed a credible construct validity, with majority of the items grouped as the original dimensions. The test-retest reliability coefficient of each dimension's score ranged from 0.758 to 0.901, with an SRBD score of 0.730 indicating significant retest reliability. CONCLUSIONS This study conducted and validated a successful survey methodology for investigation of childhood SDB in Beijing, China. The questionnaire demonstrated credible construct validity and retest reliability, thereby supporting the applicability and generalisability of the PSQ-SRBD in a large epidemiological survey of childhood SDB in China.
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Affiliation(s)
- Xiaodan Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Jun Tai
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Zhifei Xu
- Respiratory Department, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Jun Ma
- Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Yongping Pan
- Health Care Center of Primary and Middle School of Dongcheng District, Beijing, China
| | - Xiaoyan Yan
- Clinical Institute of Peking University, Beijing, China
| | - Guixiang Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Yunxiao Wu
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Li Zheng
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | | | - Wentong Ge
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Jie Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Yamei Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, Beijing, China
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Thang C, Whitley M, Izadpanah N, DeUgarte D, Slusser W. Retrospective Review of Comorbid Conditions in a Multidisciplinary Pediatric Weight Management Clinic. Clin Pediatr (Phila) 2018; 57:815-820. [PMID: 28990428 DOI: 10.1177/0009922817734205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A retrospective medical chart review was conducted of patients enrolled in the Fit for Healthy Weight Clinic (Fit Clinic). At initial evaluation, comorbidities were identified by the patient and pediatrician. The number of comorbidities increased with age among patients. In reviewing the differences among the number of identified comorbidities among grade school age and adolescent patients, increases of 30% were observed in gastrointestinal-associated, 23% in psychiatric, 18% in endocrine, 16% in cardiovascular, and 14% in respiratory comorbidities. Fit Clinic patients already manifest many known obesity-related comorbidities as evidenced in identified conditions and abnormal laboratory values. The elevated blood pressures, blood glucose, and cholesterol levels raise concern for the future development of coronary artery disease and type 2 diabetes mellitus. With an average of five obesity-related comorbidities, Fit Clinic patients already have more comorbidities than what is evidenced in large US population-based studies, demonstrating that solely addressing body mass index is not sufficient.
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Affiliation(s)
- Christine Thang
- 1 Mattel Children's Hospital University of California Los Angeles, CA, USA
| | - Margaret Whitley
- 2 RAND Corporation, Santa Monica, CA, USA.,3 University of California, Irvine, CA, USA
| | | | - Daniel DeUgarte
- 1 Mattel Children's Hospital University of California Los Angeles, CA, USA
| | - Wendy Slusser
- 1 Mattel Children's Hospital University of California Los Angeles, CA, USA.,5 University of California Los Angeles Fielding School of Public Health, CA, USA
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13
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Katz SL, MacLean JE, Barrowman N, Hoey L, Horwood L, Bendiak GN, Kirk VG, Hadjiyannakis S, Legault L, Foster BJ, Constantin E. Long-Term Impact of Sleep-Disordered Breathing on Quality of Life in Children With Obesity. J Clin Sleep Med 2018; 14:451-458. [PMID: 29458697 DOI: 10.5664/jcsm.6998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/18/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES (1) To determine baseline quality of life (QOL) among children with obesity and newly diagnosed moderate-severe sleep-disordered breathing (SDB) and to compare it to the reported QOL of children with obesity or SDB alone and healthy children. (2) To evaluate QOL change after 1 year. METHODS A prospective multicenter cohort study was conducted in children (8-16 years) with obesity, prescribed positive airway pressure (PAP) therapy for moderate-severe SDB. Outcomes included parent-proxy and self-report total and subscale scores on the PedsQL questionnaire (baseline and 1-year). RESULTS Total PedsQL scores were indicative of impaired QOL in 69% of cases based on parent-report and in 62% on self-report. Parents reported significantly lower QOL in our cohort than that reported in other studies for children with obesity or SDB alone or healthy children, on total PedsQL score and on social and psychosocial subscales. PedsQL total scores for participants were significantly higher (mean difference 7.3 ± 15.3, P = .03) than those reported by parents. Parents reported significant improvements in total PedsQL (mean change 7.29 ± 13.73, P = .04) and social functioning (mean change 17.65 ± 24.69, P = .04) scores after 1 year. No significant differences were found by children's self-report or by PAP adherence. CONCLUSIONS QOL of children with obesity and SDB is lower than in children with obesity or SDB alone or healthy children. One year later, children reported no significant changes in QOL; parents reported significant improvements in total PedsQL and social functioning scores. PAP adherence did not significantly affect QOL change in this population. COMMENTARY A commentary on this article appears in this issue on page 307.
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Affiliation(s)
- Sherri L Katz
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Joanna E MacLean
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Lynda Hoey
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Linda Horwood
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Glenda N Bendiak
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Valerie G Kirk
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Stasia Hadjiyannakis
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Laurent Legault
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bethany J Foster
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Evelyn Constantin
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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14
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Powell J, Powell S. Obstructive Sleep Apnea in the Very Young. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0184-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Lewis KC, Schroeder JW, Ayub B, Bhushan B. Clinical symptoms that predict the presence of Obstructive Sleep Apnea. Int J Pediatr Otorhinolaryngol 2017; 95:139-144. [PMID: 28576523 DOI: 10.1016/j.ijporl.2017.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine if a set of clinical symptoms can help in determining the presence and severity of OSA. SETTING Tertiary urban pediatric hospital. METHODS Parents of children undergoing an overnight PSG answered a 56 item questionnaire based on their child's symptoms. The responses to the questionnaire were compared between patients with different severities of OSA (s determined by PSG) and those without OSA. Responses to questionnaire were also analyzed between obese and non-obese patients. RESULTS 235 children were included (140 male and 95 female) with a mean age of 5.76 ± 2.78 years. The mean Apnea Hypopnea Index (AHI) was 7.78 ± 14.50 events/hour (range 0-110 events/h). 74 (31.5%) children had mild-OSA (AHI between 1 and 4.99 events/h), 31 (13.19%) had moderate-OSA (AHI between 5 and 9.99 events/h), 58 (24.7%) had severe-OSA (AHI≥10events/h) and the remaining 72 (30.64%) had No-OSA (AHI≤1event/h). 87 (37%) patients were obese. Eight clinical symptoms in non-obese and six clinical symptoms in obese patients predicted the mild to severe OSA. Sixteen symptoms in non-obese patients and nine symptoms in obese patients predicted the presence of severe OSA in these patients. CONCLUSION Clinical symptoms reported in this study are useful to predict the presence of and the severity of OSA in children. Clinical symptoms can also predict the presence and severity of OSA in children who are obese, however, the symptoms required to make the prediction are different in obese children.
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Affiliation(s)
- Kevin C Lewis
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - James W Schroeder
- Division of Otolaryngology Head and Neck Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States; Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Bushra Ayub
- Division of Otolaryngology Head and Neck Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Bharat Bhushan
- Division of Otolaryngology Head and Neck Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States; Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
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16
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Wang B, Liang J. The Effect of Montelukast on Mild Persistent OSA after Adenotonsillectomy in Children: A Preliminary Study. Otolaryngol Head Neck Surg 2017; 156:952-954. [PMID: 28319673 DOI: 10.1177/0194599817696501] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study sought to evaluate the treatment effect of montelukast in children with obstructive sleep apnea (OSA) after tonsillectomy and/or adenoidectomy (T&A). Fifty-eight children with persistent OSA after T&A were included and randomly divided into 2 groups: one group was administered montelukast for 12 weeks, and the other received no treatment. Clinical information, such as the apnea-hypopnea index (AHI) and nadir oxyhemoglobin saturation (nadir SpO2), was recorded. Symptoms of OSA were evaluated using the validated Pediatric Sleep Questionnaire (PSQ). After surgery, there was no difference in terms of AHI, nadir SpO2, and PSQ scores between 2 groups. After the 12-week course of montelukast administration, the treatment group had significant improvement in the AHI, nadir SpO2, and PSQ scores ( P < .001), while the no-treatment group had no change over time ( P > .05). In summary, montelukast as a complementary therapy can improve sleep disturbances in children with OSA after T&A.
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Affiliation(s)
- Bing Wang
- 1 Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Pediatric Research Institute of Chongqing Medical University, National Key Disciplinary Areas of Pediatrics, Ministry of Education, Yuzhong District of Chongqing, China
| | - Jia Liang
- 1 Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Pediatric Research Institute of Chongqing Medical University, National Key Disciplinary Areas of Pediatrics, Ministry of Education, Yuzhong District of Chongqing, China
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Woo JM, Choi JY. Tonsillectomy as prevention and treatment of sleep-disordered breathing: a report of 23 cases. Maxillofac Plast Reconstr Surg 2016; 38:47. [PMID: 27995120 PMCID: PMC5122598 DOI: 10.1186/s40902-016-0092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The paradigm of tonsillectomy has shifted from a treatment of recurrent throat infection to one of multi-discipline management modalities of sleep-disordered breathing (SDB). While tonsillectomy as a treatment for throat problems has been performed almost exclusively by otorhinolaryngologists, tonsillectomy as a part of the armamentarium for the multifactorial, multidisciplinary therapy of sleep-disordered breathing needs a new introduction to those involved in treating SDB patients. This study has its purpose in sharing a series of tonsillectomies performed at the Seoul National University Dental Hospital for the treatment and prevention of SDB in adult patients. METHODS Total of 78 patients underwent tonsillectomy at the Seoul National University Dental Hospital from 1996 to 2015, and 23 of them who were operated by a single surgeon (Prof. Jin-Young Choi) were included in the study. Through retrospective chart review, the purpose of tonsillectomy, concomitant procedures, grade of tonsillar hypertrophy, surgical outcome, and complications were evaluated. RESULTS Twenty-one patients diagnosed with SDB received multiple surgical procedures (uvulopalatal flap, uvulopalatopharyngoplasty, genioglossus advancement genioplasty, tongue base reduction, etc.) along with tonsillectomy. Two patients received mandibular setback orthognathic surgery with concomitant tonsillectomy in anticipation of postoperative airway compromise. All patients showed improvement in symptoms such as snoring and apneic events during sleep. CONCLUSIONS When only throat infections were considered, tonsillectomy was a procedure rather unfamiliar to oral and maxillofacial surgeons. With a shift of primary indication from recurrent throat infections to SDB and emerging technological and procedural breakthroughs, simpler and safer tonsillectomy has become a major tool in the multidisciplinary treatment modality for SDB.
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Affiliation(s)
- Jae-Man Woo
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, 101 Daehakno, Jongno-Gu, Seoul, 110-768 Republic of Korea
| | - Jin-Young Choi
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, 101 Daehakno, Jongno-Gu, Seoul, 110-768 Republic of Korea ; Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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18
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Windfuhr JP. Indications for tonsillectomy stratified by the level of evidence. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 15:Doc09. [PMID: 28025609 PMCID: PMC5169082 DOI: 10.3205/cto000136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: One of the most significant clinical trials, demonstrating the efficacy of tonsillectomy (TE) for recurrent throat infection in severely affected children, was published in 1984. This systematic review was undertaken to compile various indications for TE as suggested in the literature after 1984 and to stratify the papers according to the current concept of evidence-based medicine. Material and methods: A systematic Medline research was performed using the key word of "tonsillectomy" in combination with different filters such as "systematic reviews", "meta-analysis", "English", "German", and "from 1984/01/01 to 2015/05/31". Further research was performed in the Cochrane Database of Systematic Reviews, National Guideline Clearinghouse, Guidelines International Network and BMJ Clinical Evidence using the same key word. Finally, data from the "Trip Database" were researched for "tonsillectomy" and "indication" and "from: 1984 to: 2015" in combination with either "systematic review" or "meta-analysis" or "metaanalysis". Results: A total of 237 papers were retrieved but only 57 matched our inclusion criteria covering the following topics: peritonsillar abscess (3), guidelines (5), otitis media with effusion (5), psoriasis (3), PFAPA syndrome (6), evidence-based indications (5), renal diseases (7), sleep-related breathing disorders (11), and tonsillitis/pharyngitis (12), respectively. Conclusions: 1) The literature suggests, that TE is not indicated to treat otitis media with effusion. 2) It has been shown, that the PFAPA syndrome is self-limiting and responds well to steroid administration, at least in a considerable amount of children. The indication for TE therefore appears to be imbalanced but further research is required to clarify the value of surgery. 3) Abscesstonsillectomy as a routine is not justified and indicated only for cases not responding to other measures of treatment, evident complications, or with a significant history of tonsillitis. In particular, interval-tonsillectomy is not justified as a routine. 4) TE, with or without adenoidectomy, is efficacious to resolve sleep-related breathing disorders resulting from (adeno)tonsillar hypertrophy in children. However, the benefit is reduced by co-morbidities, such as obesity, and further research is required to identify prognostic factors for this subgroup of patients. Further research is indicated to clarify selection criteria not only for this subpopulation that may benefit from less invasive procedures such as tonsillotomy in the long-term. 5) Further trials are also indicated to evaluate the efficacy of TE on the clinical course in children with psoriasis guttata as well as on psoriasis vulgaris in adults, not responding to first-line therapy. 6) Conflicting results were reported concerning the role of TE in the concert to treat Ig-A nephropathy, mandating further clinical research. 7) Most importantly, randomized-controlled clinical trials with an adequate long-term follow-up are desirable to clarify the benefit of TE in patients with recurrent episodes of tonsillitis, with or without pharyngitis. Factors like age, spontaneous healing rate and postoperative quality of life have to be included when comparing TE with antibiotic therapy.
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Affiliation(s)
- Jochen P. Windfuhr
- Department of Otolaryngology, Head & Neck Surgery, Allergology, Kliniken Maria Hilf, Mönchengladbach, Germany
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19
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Kandil A, Subramanyam R, Hossain MM, Ishman S, Shott S, Tewari A, Mahmoud M. Comparison of the combination of dexmedetomidine and ketamine to propofol or propofol/sevoflurane for drug-induced sleep endoscopy in children. Paediatr Anaesth 2016; 26:742-51. [PMID: 27212000 DOI: 10.1111/pan.12931] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 11/30/2022]
Abstract
AIM Examination of dynamic airway collapse in patients with obstructive sleep apnea (OSA) during drug-induced sleep endoscopy (DISE) can help identify the anatomic causes of airway obstruction. We hypothesized that a combination of dexmedetomidine and ketamine (Group DK) would result in fewer oxygen desaturations and a higher successful completion rate during DISE in children with OSA when compared to propofol (Group P) or sevoflurane/propofol (Group SP). METHODS In this retrospective study, we reviewed the records of 59 children who presented for DISE between October 2013 and March 2015. Data analyzed included demographics, OSA severity, and hemodynamics (heart rate and blood pressure). The primary outcomes were airway desaturation during DISE to <85% and successful completion of DISE; these were compared between the three groups: DK, P, and SP. RESULTS Preoperative polysomnography was available for 49 patients. There were significantly more patients with severe OSA in Group P as compared to the other two groups. The mean (±sd) bolus dose for ketamine, dexmedetomidine, and propofol were 2.0 ± 0.6 mg·kg(-1) , 1.9 ± 0.9 mcg·kg(-1) , and 1.8 ± 1.1 mg·kg(-1) , respectively. The mean (±sd) infusion rate for dexmedetomidine was 1.6 ± 0.7 mcg·kg(-1) ·h(-1) and for propofol was 248 ± 68 mcg·kg(-1) ·min(-1) in Group P and 192 ± 48 mcg·kg(-1) ·min(-1) in Group SP. Patients in Group DK had significantly fewer desaturations to <85% during DISE compared to Group P. Patients in Group DK had significantly more successful completion of DISE (100% Group DK, 92% Group P, and 79% Group SP) as compared to Group SP. CONCLUSIONS These results suggest that the described dose regimen of propofol used alone or in combination with sevoflurane appears to be associated with more oxygen desaturations and a lower rate of successful completion than a combination of dexmedetomidine and ketamine during DISE in children with OSA.
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Affiliation(s)
- Ali Kandil
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rajeev Subramanyam
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mohamed Monir Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stacey Ishman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pediatric Otolaryngology -Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sally Shott
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pediatric Otolaryngology -Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anurag Tewari
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mohamed Mahmoud
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Mitchell RB, Kelly J. Outcome of Adenotonsillectomy for Obstructive Sleep Apnea in Obese and Normal-Weight Children. Otolaryngol Head Neck Surg 2016; 137:43-8. [PMID: 17599563 DOI: 10.1016/j.otohns.2007.03.028] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Accepted: 03/15/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVES: 1) To evaluate the relative severity of obstructive sleep apnea (OSA) in obese and normal-weight children; 2) to compare changes in respiratory parameters after adenotonsillectomy in obese and normal-weight children. STUDY DESIGN AND SETTING: Prospective controlled trial that included children aged 3 to 18 years. All study participants underwent pre- and postoperative polysomnography. RESULTS: The study population included 33 obese children and 39 normal-weight controls. Preoperatively, the median obstructive apnea-hypopnea index (AHI) was 23.4 (range 3.7-135.1) for obese and 17.1 (range 3.9-36.5) for controls ( P < 0.001). Postoperatively, the AHI was 3.1 (range 0-33.1) for obese and 1.9 (range 0.1-7.0) for controls ( P < 0.01). Twenty-five obese children (76%) and 11 controls (28%) had persistent OSA. CONCLUSION AND SIGNIFICANCE: AHI scores are higher in obese than in normal-weight children with OSA. Both groups show a dramatic improvement in AHI after adenotonsillectomy, but persistent OSA is more common in obese children.
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Affiliation(s)
- Ron B Mitchell
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, MO 63104, USA.
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Zhang J, Zhao J, Chen M, Liu S, Zhang X, Zhang F, Zhang Y, Chen H, Ni X. Airway resistance and allergic sensitization in children with obstructive sleep apnea hypopnea syndrome. Pediatr Pulmonol 2016; 51:426-30. [PMID: 26284311 DOI: 10.1002/ppul.23264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 06/23/2015] [Accepted: 06/25/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the airway resistance in Chinese children with obstructive sleep apnea hypopnea syndrome (OSAHS) by impulse oscilloetry (IOS) and investigate the association of the severity of OSAHS with the airway resistance and allergic sensitization. METHOD A total of 120 children (92 boys) treated for snoring in Beijing Children's Hospital between October 2010 and March 2011 were included in this study. Ninety-three children were diagnosed with OSAHS and 27 did not show OSAHS. Total airway resistance (R5), proximal airway resistance (R20), and peripheral airway resistance (X5) were determined by IOS. Serum levels of total IgE and allergen-specific IgE (sIgE) were also determined. RESULTS R5 in the OSAHS group was significantly higher than that in the non-OSAHS group (P = 0.0025), whereas R20 and X5 were similar in the two groups. R5 was positively correlated with apnea hypopnea index and obstructive apnea index and negatively correlated with the lowest arterial oxygen saturation significantly (all P < 0.05). The percentage of children with abnormal serum levels of total IgE or abnormal allergen-specific IgEs was comparable in OSAHS and non-OSAHS groups. The proportions of abnormal R5 and of abnormal serum levels of total IgE were significantly higher in children with severe OSAHS compared with children with mild or moderate OSAHS (all P < 0.05). CONCLUSIONS Total airway resistance was significantly increased in Children with OSAHS. Allergic sensitization might contribute to the exacerbation of existing OSAHS in children. Large scale studies are required to further validate these findings.
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Affiliation(s)
- Jie Zhang
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Jing Zhao
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Min Chen
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Shilin Liu
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Xuexi Zhang
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Fengzhen Zhang
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Yamei Zhang
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Hui Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, P. R. China
| | - Xin Ni
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
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Imanguli M, Ulualp SO. Risk factors for residual obstructive sleep apnea after adenotonsillectomy in children. Laryngoscope 2016; 126:2624-2629. [PMID: 27010662 DOI: 10.1002/lary.25979] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/26/2016] [Accepted: 02/23/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the prevalence of residual obstructive sleep apnea (OSA) in children who had adenotonsillectomy (AT) and to identify the risk factors for residual OSA after AT. STUDY DESIGN Retrospective chart review. METHODS Children with OSA who had AT at a tertiary care children's hospital were reviewed. Data pertaining to demographics, past medical history, body mass index, tonsil and adenoid size, and polysomnography were obtained. Residual OSA was defined as apnea hypopnea index (AHI) greater than 2. The rate of residual OSA and risk factors for residual OSA were assessed. RESULTS One hundred sixty-nine children with OSA underwent polysomnography before and after AT. The prevalence of residual OSA was 38%. The prevalence of residual OSA in obese patients (49%) was higher than that of nonobese patients (27%) (P = .02). Patients with neurological/developmental/craniofacial abnormalities had higher prevalence of residual OSA (44%) than patients without comorbidities (33%) (P < .05). The prevalence of residual OSA in patients with severe OSA (42%) was higher than patients with moderate (29%) or mild OSA (0%) (P = .03). Teenage patients (67%) had a higher prevalence of residual OSA than toddlers (27%), preschooler (33%), and middle childhood groups (29%) (P = .03). CONCLUSIONS The majority of children had improvement in OSA after AT. The choice of AHI threshold used to define residual OSA influenced the prevalence of residual OSA. Teenagers and children with obesity, comorbidities including neurological/developmental/craniofacial abnormalities alone or in combination with asthma, or severe OSA have a high risk of residual OSA. LEVEL OF EVIDENCE 4 Laryngoscope, 126:2624-2629, 2016.
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Affiliation(s)
- Matin Imanguli
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Seckin O Ulualp
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. .,Division of Pediatric Otolaryngology, Children's Medical Center, Dallas, Texas, U.S.A..
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Kar M, Altıntoprak N, Muluk NB, Ulusoy S, Bafaqeeh SA, Cingi C. Antileukotrienes in adenotonsillar hypertrophy: a review of the literature. Eur Arch Otorhinolaryngol 2016; 273:4111-4117. [DOI: 10.1007/s00405-016-3983-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
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Venekamp RP, Hearne BJ, Chandrasekharan D, Blackshaw H, Lim J, Schilder AGM. Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children. Cochrane Database Syst Rev 2015; 2015:CD011165. [PMID: 26465274 PMCID: PMC9242010 DOI: 10.1002/14651858.cd011165.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Obstructive sleep-disordered breathing (oSDB) is a condition that encompasses breathing problems when asleep, due to an obstruction of the upper airways, ranging in severity from simple snoring to obstructive sleep apnoea syndrome (OSAS). It affects both children and adults. In children, hypertrophy of the tonsils and adenoid tissue is thought to be the commonest cause of oSDB. As such, tonsillectomy - with or without adenoidectomy - is considered an appropriate first-line treatment for most cases of paediatric oSDB. OBJECTIVES To assess the benefits and harms of tonsillectomy with or without adenoidectomy compared with non-surgical management of children with oSDB. SEARCH METHODS We searched the Cochrane Register of Studies Online, PubMed, EMBASE, CINAHL, Web of Science, Clinicaltrials.gov, ICTRP and additional sources for published and unpublished trials. The date of the search was 5 March 2015. SELECTION CRITERIA Randomised controlled trials comparing the effectiveness and safety of (adeno)tonsillectomy with non-surgical management in children with oSDB aged 2 to 16 years. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS Three trials (562 children) met our inclusion criteria. Two were at moderate to high risk of bias and one at low risk of bias. We did not pool the results because of substantial clinical heterogeneity. They evaluated three different groups of children: those diagnosed with mild to moderate OSAS by polysomnography (PSG) (453 children aged five to nine years; low risk of bias; CHAT trial), those with a clinical diagnosis of oSDB but with negative PSG recordings (29 children aged two to 14 years; moderate to high risk of bias; Goldstein) and children with Down syndrome or mucopolysaccharidosis (MPS) diagnosed with mild to moderate OSAS by PSG (80 children aged six to 12 years; moderate to high risk of bias; Sudarsan). Moreover, the trials included two different comparisons: adenotonsillectomy versus no surgery (CHAT trial and Goldstein) or versus continuous positive airway pressure (CPAP) (Sudarsan). Disease-specific quality of life and/or symptom score (using a validated instrument): first primary outcomeIn the largest trial with lowest risk of bias (CHAT trial), at seven months, mean scores for those instruments measuring disease-specific quality of life and/or symptoms were lower (that is, better quality of life or fewer symptoms) in children receiving adenotonsillectomy than in those managed by watchful waiting:- OSA-18 questionnaire (scale 18 to 126): 31.8 versus 49.5 (mean difference (MD) -17.7, 95% confidence interval (CI) -21.2 to -14.2);- PSQ-SRBD questionnaire (scale 0 to 1): 0.2 versus 0.5 (MD -0.3, 95% CI -0.31 to -0.26);- Modified Epworth Sleepiness Scale (scale 0 to 24): 5.1 versus 7.1 (MD -2.0, 95% CI -2.9 to -1.1).No data on this primary outcome were reported in the Goldstein trial.In the Sudarsan trial, the mean OSA-18 score at 12 months did not significantly differ between the adenotonsillectomy and CPAP groups. The mean modified Epworth Sleepiness Scale scores did not differ at six months, but were lower in the surgery group at 12 months: 5.5 versus 7.9 (MD -2.4, 95% CI -3.1 to -1.7). Adverse events: second primary outcomeIn the CHAT trial, 15 children experienced a serious adverse event: 6/194 (3%) in the adenotonsillectomy group and 9/203 (4%) in the control group (RD -1%, 95% CI -5% to 2%).No major complications were reported in the Goldstein trial.In the Sudarsan trial, 2/37 (5%) developed a secondary haemorrhage after adenotonsillectomy, while 1/36 (3%) developed a rash on the nasal dorsum secondary to the CPAP mask (RD -3%, 95% CI -6% to 12%). Secondary outcomesIn the CHAT trial, at seven months, mean scores for generic caregiver-rated quality of life were higher in children receiving adenotonsillectomy than in those managed by watchful waiting. No data on this outcome were reported by Sudarsan and Goldstein.In the CHAT trial, at seven months, more children in the surgery group had normalisation of respiratory events during sleep as measured by PSG than those allocated to watchful waiting: 153/194 (79%) versus 93/203 (46%) (RD 33%, 95% CI 24% to 42%). In the Goldstein trial, at six months, PSG recordings were similar between groups and in the Sudarsan trial resolution of OSAS (Apnoea/Hypopnoea Index score below 1) did not significantly differ between the adenotonsillectomy and CPAP groups.In the CHAT trial, at seven months, neurocognitive performance and attention and executive function had not improved with surgery: scores were similar in both groups. In the CHAT trial, at seven months, mean scores for caregiver-reported ratings of behaviour were lower (that is, better behaviour) in children receiving adenotonsillectomy than in those managed by watchful waiting, however, teacher-reported ratings of behaviour did not significantly differ.No data on these outcomes were reported by Goldstein and Sudarsan. AUTHORS' CONCLUSIONS In otherwise healthy children, without a syndrome, of older age (five to nine years), and diagnosed with mild to moderate OSAS by PSG, there is moderate quality evidence that adenotonsillectomy provides benefit in terms of quality of life, symptoms and behaviour as rated by caregivers and high quality evidence that this procedure is beneficial in terms of PSG parameters. At the same time, high quality evidence indicates no benefit in terms of objective measures of attention and neurocognitive performance compared with watchful waiting. Furthermore, PSG recordings of almost half of the children managed non-surgically had normalised by seven months, indicating that physicians and parents should carefully weigh the benefits and risks of adenotonsillectomy against watchful waiting in these children. This is a condition that may recover spontaneously over time.For non-syndromic children classified as having oSDB on purely clinical grounds but with negative PSG recordings, the evidence on the effects of adenotonsillectomy is of very low quality and is inconclusive.Low-quality evidence suggests that adenotonsillectomy and CPAP may be equally effective in children with Down syndrome or MPS diagnosed with mild to moderate OSAS by PSG.We are unable to present data on the benefits of adenotonsillectomy in children with oSDB aged under five, despite this being a population in whom this procedure is often performed for this purpose.
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Affiliation(s)
- Roderick P Venekamp
- University Medical Center UtrechtJulius Center for Health Sciences and Primary Care & Department of OtorhinolaryngologyHeidelberglaan 100UtrechtNetherlands3508 GA
| | - Benjamin J Hearne
- Faculty of Brain Sciences, University College LondonevidENT, Ear InstituteLondonUK
| | | | - Helen Blackshaw
- Faculty of Brain Sciences, University College LondonevidENT, Ear InstituteLondonUK
| | - Jerome Lim
- Medway Maritime HospitalEar, Nose and Throat DepartmentWindmill RoadGillinghamKentUKME7 5NY
| | - Anne GM Schilder
- Faculty of Brain Sciences, University College LondonevidENT, Ear InstituteLondonUK
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Tatlıpınar A, Kınal E. Links and risks associated with adenotonsillectomy and obesity. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2015; 6:123-127. [PMID: 29388606 PMCID: PMC5683260 DOI: 10.2147/phmt.s66730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Adenotonsillectomy (A&T) is a very common surgical procedure in children. Over the past 20 years the principal indication for A&T in children has changed from recurrent adenotonsillitis to obstructive sleep apnea. The physiopathology of obstructive sleep apnea syndrome (OSAS) is multifactorial and obesity has been shown to be one of the main factors correlated with its occurrence. On the other hand, the prevalence and severity of childhood obesity have become a veritable epidemic problem in the past 30 years. So the increasing prevalence of obesity in children and high prevalence of obstructive sleep apnea in obese children implies that an increasing number of these children will present for A&T. Due to more prevalent anatomical alterations of the oronasopharyngeal airways, it is often difficult to predict operation success in obese children. However, previous studies supports that although the risk of presence of residual symptoms of OSAS and airway-related perioperative complication in obese may be more than nonobese group, A&T is effective to reduce obstructive symptoms and improve quality of life in obese children with OSAS.
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Affiliation(s)
- Arzu Tatlıpınar
- ENT Clinic, Fatih Sultan Mehmet Research and Training Hospital, Kozyatağı, İstanbul, Turkey
| | - Emrah Kınal
- ENT Clinic, Fatih Sultan Mehmet Research and Training Hospital, Kozyatağı, İstanbul, Turkey
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Hakim F, Kheirandish-Gozal L, Gozal D. Obesity and Altered Sleep: A Pathway to Metabolic Derangements in Children? Semin Pediatr Neurol 2015; 22:77-85. [PMID: 26072337 PMCID: PMC4466552 DOI: 10.1016/j.spen.2015.04.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
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 are undoubtedly 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 an increased risk for increased orexigenic behaviors and dysfunctional satiety, hyperlipidemia, and insulin resistance that ultimately favor the emergence of metabolic syndrome. Here, we review some of the critical evidence supporting the proposed associations between sleep disruption and the metabolism-obesity complex. In addition, we describe the more recent evidence linking the potential interactive roles of OSA and obesity on metabolic phenotype.
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Affiliation(s)
- Fahed Hakim
- Pediatric Pulmonary Institute, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Leila Kheirandish-Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
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The relation between childhood obesity and adenotonsillar hypertrophy. Eur Arch Otorhinolaryngol 2015; 273:505-9. [DOI: 10.1007/s00405-015-3554-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 02/06/2015] [Indexed: 10/24/2022]
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Blackshaw H, Zhang LY, Venekamp RP, Wang B, Chandrasekharan D, Schilder AGM. Tonsillectomy versus tonsillotomy for sleep-disordered breathing in children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Helen Blackshaw
- Faculty of Brain Sciences, University College London; evidENT, Ear Institute; 330 Grays Inn Road London UK WC1X 8DA
| | - Lai-Ying Zhang
- University of Queensland; School of Medicine; Brisbane Australia
| | - Roderick P Venekamp
- University Medical Center Utrecht; Department of Otorhinolaryngology & Julius Center for Health Sciences and Primary Care; Heidelberglaan 100 Utrecht Netherlands 3508 GA
| | - Betty Wang
- University of Queensland; School of Medicine; Brisbane Australia
| | - Deepak Chandrasekharan
- Faculty of Brain Sciences, University College London; evidENT, Ear Institute; 330 Grays Inn Road London UK WC1X 8DA
| | - Anne GM Schilder
- Faculty of Brain Sciences, University College London; evidENT, Ear Institute; 330 Grays Inn Road London UK WC1X 8DA
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Venekamp RP, Hearne BJ, Chandrasekharan D, Blackshaw H, Lim J, Schilder AGM. Tonsillectomy or adenotonsillectomy versus non-surgical management for sleep-disordered breathing in children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Tan E, Healey D, Schaughency E, Dawes P, Galland B. Neurobehavioural correlates in older children and adolescents with obesity and obstructive sleep apnoea. J Paediatr Child Health 2014; 50:16-23. [PMID: 24134790 DOI: 10.1111/jpc.12390] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The relationship between obstructive sleep apnoea (OSA) and poorer neurobehavioural outcomes in school-age children is well established, but the relationship in obese children and adolescents, in whom OSA is more common, is not so well established. We aimed to investigate this relationship in 10-18-year-olds. METHODS Thirty-one participants with a mean body mass index (BMI) of 32.3 ± 4.9 enrolled. BMI-for-age cut-offs were used to define obesity. Participants underwent polysomnography and were classified into OSA (apnoea-hypopnoea index (AHI) > 2 per hour) and non-OSA (AHI ≤ 2) groups. Intelligence, memory and learning, academic achievement, behaviour and executive functioning were assessed using the Wechsler Abbreviated Scale of Intelligence, Wide Range Assessment of Memory and Learning 2, Wechsler Individual Achievement Test II (WIAT-II), Behavioural Assessment System for Children 2 and Behaviour Rating Inventory of Executive Function, respectively. RESULTS Forty-eight per cent (15/31) were classified as having OSA, and 52% (16/31) as non-OSA. The obese cohort performed below the average of normative data on several neurobehavioural measures. WIAT-II maths scores were significantly lower (P = 0.034) in the OSA group than in the non-OSA group (means 84.5 vs. 94.6, respectively), losing significance after adjustment for IQ, age and gender. Self-reported school problems were significantly worse in the OSA group before and after multivariate adjustment (P = 0.010, Cohen's d = 1.02). No other significant differences were found. CONCLUSIONS Results suggest that OSA may increase risk for some poorer educational and behavioural outcomes. The findings are reasonably consistent with and add to the evidence base of the few studies that have explored this relationship.
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Affiliation(s)
- Evan Tan
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
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Abstract
PURPOSE OF REVIEW An inconsistent link between sleep-disordered breathing (SDB) and allergic rhinitis has been reported in the literature for decades. This review attempts to highlight some of the recent epidemiological studies purporting and refuting this connection, discuss possible mechanisms for this relationship and discuss how treatment of allergic rhinitis can help ameliorate SDB. RECENT FINDINGS Recently, a large systematic review that included 18 studies and 27 000 individuals of the association between allergic rhinitis and SDB in children was published supporting a correlation between SDB and allergic rhinitis. SUMMARY Although the evidence generally supports a connection between SDB and allergic rhinitis, this connection is not definitive and the mechanism linking these two diseases remains poorly understood. In addition to epidemiological studies, several small studies have demonstrated an improvement in SDB upon treatment of allergic rhinitis; however, large studies using objective measures to quantify SDB and allergic rhinitis are needed.
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Kang KT, Chou CH, Weng WC, Lee PL, Hsu WC. Associations between adenotonsillar hypertrophy, age, and obesity in children with obstructive sleep apnea. PLoS One 2013; 8:e78666. [PMID: 24205291 PMCID: PMC3808373 DOI: 10.1371/journal.pone.0078666] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 09/14/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate the contributions of adenoid and tonsil size to childhood obstructive sleep apnea (OSA) and the interactions between adenotonsillar hypertrophy, age, and obesity in children with OSA. METHODS In total, 495 symptomatic patients were recruited. The patients were assigned to four groups according to age: toddler (age 1-3, n=42), preschool (age 3-6, n=164), school (age 6-12, n=200), and adolescence (age 12-18, n=89). All subjects had tonsil size graded by otolaryngologists, adenoid size determined on lateral radiographs (Fujioka method), and a full-night polysomnography. The apnea-hypopnea index (AHI), adenoid size, and tonsil size were compared in obese and non-obese children in the four age groups. Adjusted odds ratios (ORs) and 95% confidence interval (CI) of adenotonsillar hypertrophy and OSA risk were estimated by multi-logistic regression. RESULTS The AHI was positively related to tonsil grade (r=0.33, p <0.001) and adenoid size (r=0.24, p <0.01) in all patients. Tonsil grade was positively related to AHI in all four age groups. Adenoid size was positively related to AHI in the toddler, preschool, school groups, but not in the adolescent group (r=0.11, p=0.37). Tonsil grade and adenoid size were both positively related to AHI in obese and non-obese children. In the regression model, obesity (OR=2.89; 95% CI 1.47-5.68), tonsillar hypertrophy (OR=3.15; 95% CI 2.04-4.88), and adenoidal hypertrophy (OR=1.89; 95% CI 1.19-3.00) significantly increased OSA risk. CONCLUSIONS Adenotonsillar hypertrophy and obesity are the major determinants of OSA in children. However, the influence of adenoid size decreases in adolescence.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, R.O.C.
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan, R.O.C.
| | - Chen-Han Chou
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
| | - Wen-Chin Weng
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
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Kelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, Urbina EM, Ewing LJ, Daniels SR. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation 2013; 128:1689-712. [PMID: 24016455 DOI: 10.1161/cir.0b013e3182a5cfb3] [Citation(s) in RCA: 707] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Severe obesity afflicts between 4% and 6% of all youth in the United States, and the prevalence is increasing. Despite the serious immediate and long-term cardiovascular, metabolic, and other health consequences of severe pediatric obesity, current treatments are limited in effectiveness and lack widespread availability. Lifestyle modification/behavior-based treatment interventions in youth with severe obesity have demonstrated modest improvement in body mass index status, but participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs. The role of medical management is minimal, because only 1 medication is currently approved for the treatment of obesity in adolescents. Bariatric surgery has generally been effective in reducing body mass index and improving cardiovascular and metabolic risk factors; however, reports of long-term outcomes are few, many youth with severe obesity do not qualify for surgery, and access is limited by lack of insurance coverage. To begin to address these challenges, the purposes of this scientific statement are to (1) provide justification for and recommend a standardized definition of severe obesity in children and adolescents; (2) raise awareness of this serious and growing problem by summarizing the current literature in this area in terms of the epidemiology and trends, associated health risks (immediate and long-term), and challenges and shortcomings of currently available treatment options; and (3) highlight areas in need of future research. Innovative behavior-based treatment, minimally invasive procedures, and medications currently under development all need to be evaluated for their efficacy and safety in this group of patients with high medical and psychosocial risks.
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Wildermuth SA, Mesman GR, Ward WL. Maladaptive eating patterns in children. J Pediatr Health Care 2013; 27:109-19. [PMID: 23414976 DOI: 10.1016/j.pedhc.2011.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 07/22/2011] [Accepted: 07/26/2011] [Indexed: 11/25/2022]
Abstract
Given the increasing frequency of obesity and related maladaptive eating patterns in pediatric populations, health care professionals in a variety of settings must find ways to treat persons who are obese and have maladaptive eating patterns. The authors summarized literature related to binge eating disorder, boredom eating, emotional eating, and night eating syndrome and developed educational handouts designed for children/adolescents and their families who present with these eating problems. These educational handouts may be used by primary care physicians, psychologists, psychiatrists, nurses, and other specialists in medical settings. They are free for use in educational purposes, with permission from the authors, but are not intended to replace appropriate health care and follow-up.
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Khetani JD, Madadi P, Sommer DD, Reddy D, Sistonen J, Ross CJD, Carleton BC, Hayden MR, Koren G. Apnea and oxygen desaturations in children treated with opioids after adenotonsillectomy for obstructive sleep apnea syndrome: a prospective pilot study. Paediatr Drugs 2012; 14:411-5. [PMID: 23013460 DOI: 10.2165/11633570-000000000-00000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Recent case reports have alerted the medical community of fatality in children receiving codeine after tonsillectomy and/or adenoidectomy for obstructive sleep apnea syndrome. OBJECTIVE The objective of this study was to compare the rates of oxygen desaturation before and after adenotonsillectomy in children with obstructive sleep apnea syndrome (OSAS), and to examine the relationship between cytochrome P450 2D6 (CYP2D6) genotype and respiratory events. STUDY DESIGN This was a prospective observational study. METHODS Twenty-six children with OSAS (mean age 78 months, range 1.8-17 years) who underwent adenotonsillectomy were studied. CYP2D6 genotype was characterized in 21 of these children. The primary endpoints of the study were the change in the rate of desaturation and in the nadir oxygen saturation values before and in the first 24 hours after surgery as measured by pulse oximetry. RESULTS Twenty-two children received codeine and four were managed with hydrocodone. There was no post-operative improvement in the mean rate of desaturation (1.84 ± 1.45/hour pre-operative vs 2.97 ± 3.3/hour post-operative; p = 0.119; 95% CI -2.56, 0.313), or the post-operative nadir of oxygen saturation (85.2 ± 5.8% pre-operative vs 84.0 ± 6.8% post-operative; p = 0.632; 95% CI -3.00, 4.84) on the night after surgery. Prior to surgery, six children had an oxygen saturation nadir <80%, while post-surgery, the number increased to eight children. Ten children improved their parameters after surgery. CYP2D6 genotype by itself did not predict the changes in desaturation or nadir. CONCLUSION Post-operative use of opioids following OSAS may not be safe for all children. It is conceivable that if the child is among the significant proportion that experiences increased oxygen desaturations, the CNS depressing effects of codeine or hydrocodone and their respectively potent morphine or hydromorphone metabolites can further compromise respiratory drive. Larger studies are needed to investigate the potential contribution of CYP2D6 genotype.
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Affiliation(s)
- Justin D Khetani
- Department of Surgery, OtolaryngologyHead Neck Surgery Division, McMaster University, Hamilton, ON, Canada
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Abstract
The clinical syndrome of obstructive sleep apnea (OSAS) in children is a distinct, yet somewhat overlapping disorder with the condition that occurs in adults, such that the clinical manifestations, polysomnographic findings, diagnostic criteria and treatment approaches need to be considered in an age-specific manner. Childhood OSAS has now become widely recognized as a frequent disorder and as a major public health problem. Pediatric OSAS, particularly when obesity is concurrently present, is associated with substantial end-organ morbidities and increased healthcare utilization. Although adenotonsillectomy (T&A) remains the first line of treatment, evidence in recent years suggests that the outcomes of this surgical procedure may not be as favorable as expected, such that post-T&A polysomnographic evaluation may be needed, especially in high-risk patient groups. In addition, incorporation of nonsurgical approaches for milder forms of the disorder and for residual OSAS after T&A is now being investigated.
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Affiliation(s)
- Riva Tauman
- Sleep Disorders Center, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv 64239, Israel.
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Verse T, Hörmann K. The surgical treatment of sleep-related upper airway obstruction. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:216-21. [PMID: 21505609 DOI: 10.3238/arztebl.2010.0216] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 04/27/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a very common disorder among adults: the prevalence of mild OSA is 20%, and that of moderate or severe OSA is 6% to 7%. Simple snoring is even more common. Conservative treatments such as nocturnal ventilation therapy and oral appliances are successful as long as the patient actually uses them, but they do not eliminate the underlying obstruction of the upper airway. METHOD The relevant literature up to 2008 on the surgical treatment of OSA was selectively reviewed. RESULTS Five types of surgical treatment for OSA are available, each for its own indications: optimization of the nasal airway to support nasal ventilation therapy, (adeno-)tonsillectomy as first-line treatment for OSA in children, minimally invasive surgery for simple snoring and mild OSA, invasive surgery as first- and second-line treatment for mild OSA, and invasive multilevel surgery as second-line treatment of moderate to severe OSA that remains refractory to ventilation therapy. CONCLUSION Surgical treatment for OSA is appropriate for specific indications as a complement to the established conservative treatment methods.
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Affiliation(s)
- Thomas Verse
- Abteilung für HNO-Heilkunde, Kopf- und Halschirurgie, Asklepios Klinik Harburg, Eißendorfer Pferdeweg 52, D-21075 Hamburg
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Chang SJ, Chae KY. Obstructive sleep apnea syndrome in children: Epidemiology, pathophysiology, diagnosis and sequelae. KOREAN JOURNAL OF PEDIATRICS 2010; 53:863-71. [PMID: 21189956 PMCID: PMC3004499 DOI: 10.3345/kjp.2010.53.10.863] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 09/30/2010] [Indexed: 11/27/2022]
Abstract
The prevalence of pediatric obstructive sleep apnea syndrome (OSAS) is approximately 3% in children. Adenotonsillar hypertrophy is the most common cause of OSAS in children, and obesity, hypotonic neuromuscular diseases, and craniofacial anomalies are other major risk factors. Snoring is the most common presenting complaint in children with OSAS, but the clinical presentation varies according to age. Agitated sleep with frequent postural changes, excessive sweating, or abnormal sleep positions such as hyperextension of neck or abnormal prone position may suggest a sleep-disordered breathing. Night terror, sleepwalking, and enuresis are frequently associated, during slow-wave sleep, with sleep-disordered breathing. Excessive daytime sleepiness becomes apparent in older children, whereas hyperactivity or inattention is usually predominant in younger children. Morning headache and poor appetite may also be present. As the cortical arousal threshold is higher in children, arousals are not easily developed and their sleep architectures are usually more conserved than those of adults. Untreated OSAS in children may result in various problems such as cognitive deficits, attention deficit/hyperactivity disorder, poor academic achievement, and emotional instability. Mild pulmonary hypertension is not uncommon. Rarely, cardiovascular complications such as cor pulmonale, heart failure, and systemic hypertension may develop in untreated cases. Failure to thrive and delayed development are serious problems in younger children with OSAS. Diagnosis of pediatric OSAS should be based on snoring, relevant history of sleep disruption, findings of any narrow or collapsible portions of upper airway, and confirmed by polysomnography. Early diagnosis of pediatric OSAS is critical to prevent complications with appropriate interventions.
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Affiliation(s)
- Sun Jung Chang
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Wang JH, Chung YS, Cho YW, Kim DY, Yi JS, Bae JS, Shim MJ. Palatine tonsil size in obese, overweight, and normal-weight children with sleep-disordered breathing. Otolaryngol Head Neck Surg 2010; 142:516-9. [DOI: 10.1016/j.otohns.2010.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 01/06/2010] [Accepted: 01/11/2010] [Indexed: 10/19/2022]
Abstract
Objective: To assess palatine tonsil size relative to degree of obesity in children with sleep-disordered breathing (SDB). Study Design: Case-control study. Setting: Tertiary care rhinology clinic. Subjects and Methods: We compared the subjective and objective tonsil size, including tonsil height (TH), tonsil width (TW), tonsil thickness (TT), tonsil weight (TWt), and tonsil volume (TV), in 26 obese children and 26 age- and gender-matched control children with SDB, and in 29 overweight children and 29 matched controls with SDB. Results: Despite similar subjective tonsil size in obese and control children, the objective tonsil size, including TH, TW, TT, and TWt, was larger in obese than in control children, and the mean TV was significantly greater in obese than in control children with SDB (8.53 ± 3.30 mL vs 6.90 ± 2.05 mL; 95% confidence interval [CI] of the difference 0.03-3.25; P = 0.019). In contrast, mean TV (7.38 ± 3.43 mL vs 7.65 ± 1.97 mL; 95% CI −1.92 to 1.37; P = 0.320) as well as the other parameters of objective palatine tonsil size, including TH, TW, TT, and TWt, did not differ significantly between overweight children and controls. Conclusion: Obese children with SDB had larger palatine tonsils than did normal-weight children with SDB. This finding suggests that larger palatine tonsils may have a greater effect on upper airway obstruction in obese than in normal-weight children with SDB.
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Affiliation(s)
- Jong Hwan Wang
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoo-Sam Chung
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Wook Cho
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do-Youn Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Sook Yi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Seon Bae
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung Joo Shim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Brunetti L, Tesse R, Miniello VL, Colella I, Delvecchio M, Logrillo VP, Francavilla R, Armenio L. Sleep-disordered breathing in obese children: the southern Italy experience. Chest 2010; 137:1085-90. [PMID: 20139225 DOI: 10.1378/chest.09-1529] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The association of obesity with sleep-associated respiratory disturbances, which has traditionally been described as a problem in adults, actually originates in childhood. We sought an association between sleep-disordered breathing (SDB) and overweight and/or obesity in a large cohort of school- and preschool-aged children in Southern Italy. METHODS One thousand two hundred seven children (612 girls and 595 boys; mean age 7.3 years) were screened by self-administered questionnaires. According to answers, subjects were divided into three groups: nonsnorers (NS), occasional snorers (OS), and habitual snorers (HS). All HS, who also failed an oximetry study at home, underwent polysomnographic monitoring for the definition of SDB. BMI was calculated according to Italian growth charts. RESULTS A total of 809 subjects (67.0%) were eligible for the study. Of them, 44 subjects (5.4%) were classified as HS, 138 (17.0%) as OS, and 627 (77.5%) as NS. Fourteen subjects (1.7%) were given a diagnosis of obstructive sleep apnea syndrome (OSAS). Sixty-four subjects (7.9%) were defined as obese, 121 (14.9%) as overweight, and 624 (77.2%) as normal weight. The frequency of HS was significantly higher in obese subjects than in overweight and normal-weight subjects (12.5% vs 5.8% vs 4.6%, respectively; P = .02), whereas the frequency of OSAS was 1.6% in normal-weight, 1.6% in overweight, and 3.1% in obese subjects (P = not significant). CONCLUSIONS Our findings in a large sample of Italian children suggest that obesity is associated with snoring.
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Affiliation(s)
- Luigia Brunetti
- Clinica Pediatrica "S. Maggiore," Policlinico, University of Bari, Piazza Giulio Cesare, 11-70124 Bari, Italy.
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Mitchell RB, Boss EF. Pediatric Obstructive Sleep Apnea in Obese and Normal-Weight Children: Impact of Adenotonsillectomy on Quality-of-Life and Behavior. Dev Neuropsychol 2009; 34:650-61. [DOI: 10.1080/87565640903133657] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Friberg D, Sundquist J, Li X, Hemminki K, Sundquist K. Sibling risk of pediatric obstructive sleep apnea syndrome and adenotonsillar hypertrophy. Sleep 2009; 32:1077-83. [PMID: 19725259 PMCID: PMC2717198 DOI: 10.1093/sleep/32.8.1077] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To estimate sibling risk of hospitalization for children with sleep disordered breathing (SDB), diagnosed with (1) obstructive sleep apnea syndrome (OSAS), or (2) adenotonsillar hypertrophy in the total Swedish population. DESIGN, SETTING, AND PARTICIPANTS Using the MigMed database at the Karolinska Institute, we divided the population of Sweden aged 0-18 years into sibling groups based on a shared mother and father and presence of a primary hospital diagnosis of OSAS or adenotonsillar hypertrophy for each individual born between 1978 and 1986, during the follow-up period 1997-2004. Individuals with at least one affected sibling were identified and the incidence rates were computed, using standardized incidence ratios (SIRs) with 95% confidence intervals (CIs). Reference groups were boys and girls with unaffected siblings of 2 or more. RESULTS After accounting for socioeconomic status, age, and geographic region, boys with at least one sibling with OSAS had an increased risk of having OSAS (SIR, 33.2; 95% CI, 16.5-64.8), and in girls the SIR was 40.5 (19.4-81.4). For hypertrophy of the tonsils or hypertrophy of the adenoids and tonsils the corresponding SIRs were 4.53 (3.0-6.8) for boys and 4.94 (3.3-7.4) for girls. CONCLUSIONS The study indicate an increased sibling risk of sleep disordered breathing in children, which may be due to heritable genes and/or shared environment such as increased awareness among family members or referring doctors. Caregivers should ask parents if siblings have similar symptoms, and thus offer them early treatment.
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Affiliation(s)
- Danielle Friberg
- Department of Otorhinolaryngology, Karolinska Institutet, Stockholm, Sweden.
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Abstract
Sleep-disordered breathing (SDB) is a continuum of breathing abnormalities that affects children and adults. This disorder has been continuously evolving, particularly in children, with new insights in its pathogenesis, clinical manifestations, diagnosis, treatments, and outcomes. The purpose of this review is to provide a current framework for pediatric anesthesiologists to address the perioperative needs of these children to ensure their safe conduct through anesthesia.
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Affiliation(s)
- Jerrold Lerman
- Department of Anesthesia, Women and Children's Hospital of Buffalo, 219 Bryant St., Buffalo, NY 14222, USA.
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Changes in incidence and indications of tonsillectomy and adenotonsillectomy, 1970-2005. Otolaryngol Head Neck Surg 2009; 140:894-901. [DOI: 10.1016/j.otohns.2009.01.044] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 12/15/2008] [Accepted: 01/27/2009] [Indexed: 11/18/2022]
Abstract
Objective: To investigate 35-year epidemiological trends in tonsillectomy and adenotonsillectomy. Study Design/Subjects: Cross-sectional survey. Subjects included all patients from birth to age 29 years who had tonsillectomy or adenotonsillectomy from 1970 to 2005. Results: Study included 8106 patients (median age 8.0 years; range, 6 months to 29 years; male 3646 patients [45%]). Overall tonsillectomy incidence increased from 126 (95% confidence interval [CI], 111-140) per 100,000 person-years in 1970 through 1974 to 153 (95% CI, 139-166) in 2000 through 2005. A dominant factor, adenotonsillectomy incidence rose sharply from 243 (95% CI, 223-261) per 100,000 person-years in 1970 through 1974 to 485 (95% CI, 462-509) in 2000 through 2005. The indication of upper airway obstruction increased from 12 percent of patients in 1970 to 77 percent in 2005. Conclusions: Epidemiological trends in tonsillectomy and adenotonsillectomy have shifted substantially. Overall numbers have increased, and surgical indications have shifted from infection to upper airway obstruction.
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Costa DJ, Mitchell R. Adenotonsillectomy for obstructive sleep apnea in obese children: A meta-analysis. Otolaryngol Head Neck Surg 2009; 140:455-60. [DOI: 10.1016/j.otohns.2008.12.038] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 12/09/2008] [Accepted: 12/16/2008] [Indexed: 01/17/2023]
Abstract
Objective: The purpose of this study was to determine the effectiveness of adenotonsillectomy (T&A) for treating obstructive sleep apnea (OSA) in obese children. Data Sources: PubMed and Ovid databases. Review Methods: A meta-analysis of studies that reported sleep parameters in obese children with OSA before and after T&A. Data were analyzed using the random effects model. Statistical significance was P ≤ 0.05. Results: Data from four studies that included 110 children were analyzed. The mean sample size was 27.5 (range, 18–33). The mean body mass index z score was 2.81. The mean pre- and postoperative apnea-hypopnea index (AHI) was 29.4 (range, 22.2–34.3) and 10.3 (range, 6.0–12.2), respectively. The weighted mean difference between pre- and postoperative AHI was a significant reduction of 18.3 events per hour (95% confidence interval [CI], 11.2–25.5). The mean pre- and postoperative oxygen saturation nadir was 78.4 percent (range, 73.9%-81.1%) and 85.7 percent (range, 83.6%-89.9%), respectively. The weighted mean difference was a significant increase of the oxygen saturation nadir of 6.3 percent (95% CI, 3.9–8.7). Forty-nine percent of children had a postoperative AHI <5, 25 percent of children had a postoperative AHI <2, and 12 percent of children had a postoperative AHI <1. Conclusions: T&A improves but does not resolve OSA in the majority of obese children. The efficacy and role of additional therapeutic options require more study. The high incidence of obesity in children makes this a public health priority.
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Affiliation(s)
- Dary J. Costa
- Department of Otolaryngology, St Louis University School of Medicine, St. Louis, MO
| | - Ron Mitchell
- Department of Otolaryngology, St Louis University School of Medicine, St. Louis, MO
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Abstract
Obstructive sleep apnea (OSA) is increasingly recognized in children. There is accumulating robust evidence to support early diagnosis and treatment of this condition. The purpose of this review is to provide an update on the epidemiology, clinical features, complications, and treatment of childhood OSA. The authors have also proposed an easy-to-follow flowchart on the management of children with snoring or sleep disturbance for clinical use by busy pediatricians.
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Affiliation(s)
- Chun Ting Au
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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47
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Abstract
Several indications for surgery for obstructive sleep apnea (OSA) have been clarified within the past 3 years. In pediatric OSA, adenotonsillectomy and tonsillotomy are the most common treatments and are highly effective. In adults, nasal surgery facilitates--and sometimes enables--nasally applied continuous positive airway pressure (CPAP) treatment. Today, minimally invasive treatment options for mild OSA are established. Furthermore, several invasive surgical techniques have proven to be efficient in the treatment of mild to moderate OSA. Above an apnea-hypopnea index of 30, surgery should be done only as secondary treatment in cases of CPAP failure or noncompliance. Special forms of OSA, such as laryngeal OSA and supine OSA, must be kept in mind.
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Affiliation(s)
- T Verse
- HNO-Abteilung, Asklepios-Klinik Harburg, Eissendorfer Pferdeweg 52, 21075 Hamburg, Deutschland.
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Rudnick EF, Walsh JS, Hampton MC, Mitchell RB. Prevalence and ethnicity of sleep-disordered breathing and obesity in children. Otolaryngol Head Neck Surg 2008; 137:878-82. [PMID: 18036414 DOI: 10.1016/j.otohns.2007.08.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Revised: 05/21/2007] [Accepted: 08/03/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To compare the prevalence of obesity in children with sleep-disordered breathing (SDB) who undergo adenotonsillectomy to that in the general pediatric population. DESIGN Cross-sectional controlled study. METHODS A body-mass-index (BMI-for-age) percentile was determined for children with SDB and for matched controls from a general pediatric clinic. Children who were obese (>85th %) were analyzed. Groups were compared using a t test or chi(2) analysis. Risk factors were estimated with logistic regression. RESULTS The study population included 299 children, of whom 170 (56.9%) had SDB. Compared with controls, more children with SDB were obese (46% vs 33%, P = 0.029) or underweight (8% vs 3%, P = 0.110), and fewer children with SDB were healthy weight (46% vs 64%, P = 0.002). Among African American children, those who were obese were more likely to have SDB (OR, 2.22, P < 0.01). CONCLUSIONS Children with SDB who undergo adenotonsillectomy are more likely to be obese than children seen in a general pediatric clinic. African American children who are obese are more likely to have SDB.
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Affiliation(s)
- Emily F Rudnick
- University of Washington School of Medicine, Children's Hospital and Regional Medical Center, Seattle, WA 98105, USA.
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Cortese S, Konofal E, Dalla Bernardina B, Mouren MC, Lecendreux M. Does excessive daytime sleepiness contribute to explaining the association between obesity and ADHD symptoms? Med Hypotheses 2008; 70:12-6. [PMID: 17587509 DOI: 10.1016/j.mehy.2007.04.036] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2007] [Accepted: 04/25/2007] [Indexed: 11/28/2022]
Abstract
Recent studies suggest a significant association between obesity and attention-deficit/hyperactivity disorder (ADHD). The factors underlying this newly described comorbidity are still unclear and unexplored. In the present article, we propose that excessive daytime sleepiness (EDS) contributes to explaining the association between ADHD and obesity. The background for this hypothesis comes from studies on the association between ADHD and EDS, as well as from investigations on EDS in obese individuals. Available studies suggest that ADHD behaviours are significantly associated with EDS. Moreover, increasing evidence indicates that obesity is significantly associated with EDS independently of sleep-disordered breathing (SDB) or any other sleep disorders. Given the relationship between EDS and ADHD behaviors, we hypothesize that the higher than expected rates of EDS in obese individuals contribute to explaining the association between obesity and ADHD behaviors. We further speculate on the role of the brain derived neurotrophic factor (BDNF) and other molecules such as the proinflammatory cytokines IL-6 and TNF-alpha. Our hypothesis generates potentially relevant clinical and therapeutic implications. From a clinical standpoint, it may suggest to systematically look for ADHD symptoms (including hyperactivity and impulsivity) in obese patients described as sleepy. With regard to the therapeutic implications, we suggest that wake-promoting agents with anorexigenic effect, such as mazindol, might be particularly indicated for the treatment of ADHD symptoms in obese patients, since they might address both ADHD symptoms and weight reduction. In conclusion, considering the burden that ADHD adds to obesity, we believe that further studies on the comorbidity between obesity and ADHD are necessary. Research on the role of EDS might allow advancements in this field, suggesting a more effective management and, ultimately, a better quality of life of patients with both obesity and ADHD.
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Affiliation(s)
- Samuele Cortese
- AP-HP, Child and Adolescent Psychopathology Unit, Robert Debré Hospital, Paris VII University, Paris, France.
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Abstract
OBJECTIVES Children with obstructive sleep apnea (OSA) frequently exhibit behavioral and neurocognitive problems. There is a high prevalence of OSA among obese children. This study aims to evaluate the relationship between OSA and behavioral problems in obese children as compared with normal-weight children (controls). STUDY DESIGN Prospective, nonrandomized, controlled study of obese and normal-weight children with OSA presenting to a tertiary medical center for adenotonsillectomy. METHODS All study participants underwent preoperative polysomnography to document OSA. Obesity was defined as age- and sex-adjusted body mass index at the 95th percentile or higher. Behavior was evaluated using the Behavior Assessment System for Children (BASC). Preoperatively, the Behavioral Symptoms Index (BSI), a global measure of behavior, and BASC scores for obese and normal-weight children were compared using an unpaired t test. RESULTS The study population included 52 children, 18 (35%) of whom were obese. The mean age of obese children was 8.6 (range, 2.0-14.9) years. The mean age of normal-weight children was 6.4 (range, 2.1-12.9) years. Demographics were otherwise similar. The mean apnea-hypopnea index for obese children was 17.2 (5.0-38.0) and for normal-weight children was 15.7 (5.3-88.0). The BSI score was 55.3 (SD, 15.9) for obese and 55.9 (SD, 15.0) for normal-weight children. Seven (38.9%) obese and 12 (35.3%) normal-weight children had clinically significant or abnormal behavior. Similar results were seen for the BASC scales of atypicality, depression, hyperactivity, and somatization in both groups. CONCLUSIONS Behavioral problems are highly prevalent in children with OSA. However, these problems exist independently of whether children are obese or normal weight.
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Affiliation(s)
- Emily F Rudnick
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia 23298, USA.
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