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Lam DJ, Hildebrand A, Nguyen T, Quintanilla-Dieck L, Tan GX, Hargunani CA, Macarthur CJ, Milczuk HA. Drug-Induced Sleep Endoscopy Predicts Subjective Outcomes of Adenotonsillectomy. Laryngoscope 2024. [PMID: 39166775 DOI: 10.1002/lary.31704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/19/2024] [Accepted: 07/31/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVES Persistent obstructive sleep apnea (OSA) after adenotonsillectomy (AT) has been reported in 20%-30% of children. The aim of this study was to determine the predictive value of drug-induced sleep endoscopy (DISE) at the time of AT on subjective AT outcomes. METHODS This was a prospective cohort study of children aged 2-18 years being treated with AT for sleep disordered breathing (SDB) with one or more risk factors for AT failure: age >7 years, obesity, severe baseline OSA, Black race. All underwent DISE at the time of AT. Potential predictors of subjective AT outcome included age, sex, obesity, and DISE patterns. Multivariable linear regression was used to model predictors of post-AT Pediatric Sleep Questionnaire (PSQ) and OSA-18 outcomes. RESULTS Pre- and post-AT PSQ/OSA-18 responses were available from 194 children. Mean age was 9.3 ± 3.5 years, with 59% obese, 50% female, and 67% White. After AT, mean PSQ score decreased from 0.60 ± 0.19 to 0.28 ± 0.22, p < 0.001 and mean OSA-18 score decreased from 66 ± 21 to 37 ± 18, p < 0.001. The most frequent sites of obstruction were the tonsils (92%), nasal airway (77%), adenoids (64%), and velopharynx (65%). Multivariable regression modeling demonstrated worse outcomes with obesity, male gender, and multilevel obstruction that included the nasal airway and tongue base in addition to adenotonsillar obstruction. CONCLUSIONS Persistent OSA and symptom burden after AT was common in this population. Obesity, male gender, and multilevel obstruction during DISE were all associated with worse subjective outcomes. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Derek J Lam
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Andrea Hildebrand
- Biostatistics and Design Program, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Thuan Nguyen
- Biostatistics and Design Program, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Lourdes Quintanilla-Dieck
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Grace X Tan
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Chris A Hargunani
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Carol J Macarthur
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Henry A Milczuk
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
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Gentin N, Howarth TP, Crossland G, Patel H, Jonas C, Blecher G, Widger J, Whybourne A, Heraganahally SS. Establishing a telehealth model addressing paediatric sleep health in remote and rural Northern Territory Australia: Overcoming the distance barrier. J Paediatr Child Health 2024; 60:212-221. [PMID: 38726707 DOI: 10.1111/jpc.16549] [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] [Received: 06/15/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 07/07/2024]
Abstract
AIM This study examined the outcomes of a telehealth model for sleep health assessment among Indigenous and non-Indigenous children residing in remote and regional communities at the Top End Northern Territory (NT) of Australia. METHODS Video telehealth consultation, that included clinical history and relevant physical findings assessed virtually with an interstate paediatric sleep physician was conducted remotely. Polysomnography (PSG) and therapeutic interventions were carried out locally at Darwin, NT. The study participants were children referred between 2015 and 2020. RESULTS Of the total 812 children referred for sleep assessment, 699 underwent a diagnostic PSG. The majority of patients were female (63%), non-Indigenous (81%) and resided in outer regional areas (88%). Indigenous children were significantly older and resided in remote or very remote locations (22% vs. 10%). Referral patterns differed according to locality and Indigenous status - (non-Indigenous via private (53%), Indigenous via public system (35%)). Receipt of referrals to initial consultation was a median of 16 days and 4 weeks from consult to PSG. Remote children had slightly longer time delay between the referral and initial consult (32 vs. 15 days). Fifty one percent were diagnosed to have OSA, 27% underwent adenotonsillectomy and 2% were prescribed with CPAP therapy. CONCLUSIONS This study has demonstrated that a telehealth model can be an effective way in overcoming logistical barriers and in providing sleep health services to children in remote and regional Australia. Further innovative efforts are needed to improve the service model and expand the reach for vulnerable children in very remote communities.
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Affiliation(s)
- Natalie Gentin
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
- Sydney Children's Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Timothy P Howarth
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
- Department of Applied Physics, University of Eastern Finland, Kuopio, Northern Savonia, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Northern Savonia, Finland
| | - Graeme Crossland
- Department of ENT, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Hemi Patel
- Department of ENT, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Catherine Jonas
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
- Paediatric Sleep Service, Northern Beaches Hospital, Frenchs Forest, New South Wales, Australia
| | - Gregory Blecher
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
- Sydney Children's Hospital, Sydney, New South Wales, Australia
- Liverpool Paediatric Care, Liverpool, New South Wales, Australia
| | - John Widger
- Division of Paediatric Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Annie Whybourne
- Women Children and Youth Division, NT Health, Darwin, Northern Territory, Australia
| | - Subash S Heraganahally
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
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Kang KT, Hsu WC. Efficacy of adenotonsillectomy on pediatric obstructive sleep apnea and related outcomes: A narrative review of current evidence. J Formos Med Assoc 2024; 123:540-550. [PMID: 37718211 DOI: 10.1016/j.jfma.2023.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/18/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023] Open
Abstract
This review summarizes the current evidence in systematic reviews, meta-analysis and randomized controlled trials regarding adenotonsillectomy outcomes in pediatric obstructive sleep apnea (OSA). Adenotonsillectomy is effective in treating OSA in children without co-morbidities, despite postoperative residual OSA remained in roughly half of these children. For children with comorbidities such as Down syndrome, Prader-Willi syndrome, sickle cell disease, or cerebral palsy, adenotonsillectomy is less effective and associated with more postoperative complications than that in children without comorbidities. For other OSA-related outcomes, evidence from meta-analyses and randomized controlled trials confirm adenotonsillectomy results in improvement of subjective OSA-related outcomes (e.g. symptoms, behaviors, and quality of life), but the results in objective OSA-related outcomes (e.g. cardiometabolic parameters or neurocognitive functions) are inconsistent. Future studies should focus on randomized controlled trials comparing objective OSA-related outcomes and the long-term effects of adenotonsillectomy in children with OSA.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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4
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Chabuz CA, Lackey TG, Pickett KL, Friedman NR. Accuracy of parental perception of nighttime breathing in children with Down syndrome after adenotonsillectomy. J Clin Sleep Med 2024; 20:237-243. [PMID: 37858282 PMCID: PMC10835771 DOI: 10.5664/jcsm.10850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/21/2023]
Abstract
STUDY OBJECTIVES Clinical practice guidelines recommend screening all children with Down syndrome for obstructive sleep apnea with polysomnography by age 4 years. Because persistent obstructive sleep apnea (obstructive apnea-hypopnea index > 1 event/h) following adenotonsillectomy (T&A) is common in children with Down syndrome, it is important to know whether clinicians can rely on parental assessment postoperatively. The primary objective is to identify accuracy of parental perception of nighttime breathing following T&A compared with preoperative assessment. METHODS Patients with Down syndrome who underwent T&A along with polysomnography prior to and after the surgical procedure were included. Parents completed a 3-question pre- and postsurgery survey regarding nighttime symptoms. The responses were categorized into 3 groups: infrequent (< 3 nights/wk), sometimes (> 3 nights/wk but < 6 nights/wk), or frequent (≥ 6 nights/wk) on at least 1 question. The primary end point was identifying the accuracy of parental perception of nighttime breathing in children with Down syndrome following T&A. RESULTS A total of 256 children met inclusion criteria, of which 117 (46%) were included. A total of 71 (68%) children had an obstructive apnea-hypopnea index > 5 events/h preoperatively compared with 55 (47%) postoperatively. There was no association between parents' perception of symptoms and obstructive sleep apnea categorization postoperatively (P > .05) or of parents' perception of symptoms improving and obstructive sleep apnea categorization improving postoperatively (P > .05). CONCLUSIONS Despite previous experience, parents are unable to predict nighttime breathing patterns following a T&A. We recommend obtaining a polysomnogram rather than relying on parental assessment to determine whether a T&A has been successful. CITATION Chabuz CA, Lackey TG, Pickett KL, Friedman NR. Accuracy of parental perception of nighttime breathing in children with Down syndrome after adenotonsillectomy. J Clin Sleep Med. 2024;20(2):237-243.
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Affiliation(s)
- Carolyn A. Chabuz
- Department of Otolaryngology – Head & Neck Surgery, University of Colorado, Aurora, Colorado
| | - Taylor G. Lackey
- Department of Otolaryngology – Head & Neck Surgery, University of Colorado, Aurora, Colorado
| | - Kaci L. Pickett
- Department of Pediatric Otolaryngology, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Norman R. Friedman
- Department of Pediatric Otolaryngology, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
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Averill SH, Forno E. Management of the pediatric patient with asthma and obesity. Ann Allergy Asthma Immunol 2024; 132:30-39. [PMID: 37827386 PMCID: PMC10760917 DOI: 10.1016/j.anai.2023.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023]
Abstract
Asthma and obesity are 2 of the most significant chronic diseases of childhood. Both are major public health problems that have been increasing in prevalence. Obesity increases the risk of developing asthma in children, and in children with asthma, obesity increases asthma severity and morbidity. The nature of this relationship is complex and not fully understood, but some pediatric patients with "obesity-related asthma" may represent a phenotype that differs from the more classical, atopic pediatric asthma. In this review, we investigate and discuss some of the currently available literature regarding treatment for asthma complicated by obesity in the pediatric population. We cover the importance of healthy lifestyle modifications, management of obesity-related comorbidities, and the potential role of nutritional supplementation or modification. We then review recent literature, mostly in adults, investigating the potential role of obesity or diabetes medications in the management of patients with asthma who have obesity. Finally, we discuss some of the necessary next steps before these potential new treatments can be considered as part of the standard clinical management of asthma.
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Affiliation(s)
- Samantha H Averill
- Division of Pulmonary, Allergy, and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Erick Forno
- Division of Pulmonary, Allergy, and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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Locci C, Cenere C, Sotgiu G, Puci MV, Saderi L, Rizzo D, Bussu F, Antonucci R. Adenotonsillectomy in Children with Obstructive Sleep Apnea Syndrome: Clinical and Functional Outcomes. J Clin Med 2023; 12:5826. [PMID: 37762766 PMCID: PMC10531828 DOI: 10.3390/jcm12185826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/27/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Adenotonsillectomy (AT) is the first-line treatment for pediatric obstructive sleep apnea syndrome (OSAS). Relatively few studies have evaluated the clinical and functional outcomes of AT in children with OSAS, but these studies show that surgery improves behavior and quality of life (QOL). However, residual OSAS after AT is reported in severe cases. This study aimed to retrospectively evaluate the clinical and functional outcomes of AT in a cohort of children with OSAS. We consecutively enrolled children with OSAS who underwent AT and were admitted to our clinic from 1 July 2020 to 31 December 2022. For each participant, medical history and physical examinations were performed. Before and after surgery, all patients underwent a standard polygraphic evaluation, and caregivers completed the OSA-18 questionnaire. A total of 65 children with OSAS, aged 2-9 years, were included. After AT, 64 (98.4%) children showed a reduction in AHI, with median (IQR) values decreasing from 13.4/h (8.3-18.5/h) to 2.4/h (1.8-3.1/h) (p-value < 0.0001). Conversely, median (IQR) SpO2 nadir increased after surgery from 89% (84-92%) to 94% (93-95%) (p-value < 0.0001). Moreover, 27 children (18%) showed residual OSAS. The OSA-18 score decreased after AT from median (IQR) values of 84 (76-91) to values of 33 (26-44) (p-value < 0.0001). A positive significant correlation was found between OSA-18 post-operative scores and AHI post-operative scores (rho 0.31; p-value = 0.01). Our findings indicate that, in children with OSAS, AT is associated with significant improvements in behavior, QOL, and polygraphic parameters. However, long-term post-surgical follow-up to monitor for residual OSAS is highly recommended, especially in more severe cases.
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Affiliation(s)
- Cristian Locci
- Pediatric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Caterina Cenere
- Pediatric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Mariangela Valentina Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Davide Rizzo
- Otorhinolaryngology Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Francesco Bussu
- Otorhinolaryngology Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Roberto Antonucci
- Pediatric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
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Herzig MX, Hildebrand AD, Nguyen T, Lam DJ. Drug-Induced Sleep Endoscopy Differences by Age in Surgically Naive Children With Sleep-Disordered Breathing. JAMA Otolaryngol Head Neck Surg 2023; 149:327-333. [PMID: 36821100 PMCID: PMC9951097 DOI: 10.1001/jamaoto.2022.5187] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/29/2022] [Indexed: 02/24/2023]
Abstract
Importance Drug-induced sleep endoscopy (DISE) is increasingly used to guide treatment decisions in children with sleep-disordered breathing (SDB). Previous reports of DISE findings in children have typically included a broad age range, but it is unclear how these patterns of obstruction vary with age. Objective To compare patterns of airway obstruction observed during DISE in 3 age groups of surgically naive children with SDB. Design, Setting, and Participants This cross-sectional analysis of a prospective cohort of surgically naive nonsyndromic children with SDB or obstructive sleep apnea [OSA] at risk for residual disease after adenotonsillectomy (defined as having at least 1 of these criteria: severe OSA, older than 7 years, obesity, or Black race) who were recruited between May 1, 2015, and February 28, 2020, was conducted at a tertiary children's hospital. Data analysis was conducted from September 2021 to February 2022. Exposures DISE. Main Outcomes and Measures DISE findings were rated at 6 anatomic sites using the Sleep Endoscopy Rating Scale (SERS). The association between age and severity of obstruction at each anatomic site and overall were compared using correlation (Kendall τ) and ordinal logistic regression analysis. Results Data from 288 children (144 girls [50%]; 20 American Indian/Alaska Native [7%], 4 Asian [1%], 19 Black [7%], 93 Hispanic [33%], 2 Middle Eastern [1%], 6 Native Hawaiian/Pacific Islander [2%], and 203 White [70%] individuals; median [IQR] age, 9.2 [7.0-11.7] years) were stratified by participant age into preschool (age 2-5 years; 27 [9%]), younger school-aged (age 5-10 years; 146 [51%]), and older school-aged (age 10-18 years; 115 [40%]). Among these subgroups, the prevalence of multilevel obstruction was 59%, 51%, and 30%, respectively. Increasing age was inversely correlated with obstruction of the nasal airway (τb, -0.19; 95% CI, -0.29 to -0.09), nasopharynx (τb, -0.20; 95% CI, -0.31 to -0.10), velopharynx (τb, -0.16; 95% CI, -0.26 to -0.06), and overall obstruction (SERS total score: τb, -0.24; 95% CI, -0.33 to -0.14). An adjusted analysis demonstrated an inverse association between age and nasopharyngeal obstruction (odds ratio [OR], 0.84; 95% CI, 0.76 to 0.92), SERS total score (OR, 0.83; 95% CI, 0.76 to 0.90), and the number of sites of complete obstruction (OR, 0.87; 95% CI, 0.87 to 0.95). Conclusions and Relevance This cross-sectional analysis of data from a prospective cohort study of surgically naive children with SDB found that preschool-aged children had more frequent multilevel obstruction, more severe overall obstruction, and nasopharyngeal obstruction compared with older children. Understanding the most common sites of obstruction and expected changes with age could inform personalized treatment for children with SDB.
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Affiliation(s)
- Maya X. Herzig
- Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Andrea D. Hildebrand
- Biostatistics and Design Program, Oregon Health and Science University, Portland
| | - Thuan Nguyen
- Biostatistics and Design Program, Oregon Health and Science University, Portland
| | - Derek J. Lam
- Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland
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Burns DW, Chan VWS, Trivedi A, Englesakis M, Munshey F, Singh M. Ready to scan? A systematic review of point of care ultrasound (PoCUS) for screening of obstructive sleep apnea (OSA) in the pediatric population. J Clin Anesth 2022; 83:110973. [PMID: 36152603 DOI: 10.1016/j.jclinane.2022.110973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/30/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
STUDY OBJECTIVE Diagnosis of obstructive sleep apnea (OSA) in pediatric practice is challenging, as screening questionnaires are inadequate and sleep studies are resource limited and time-consuming. A recent systematic review and meta-analysis of perioperative point-of-care ultrasound (PoCUS) in adults identified several parameters which correlate with OSA diagnosis and are the subject of an ongoing prospective study. The objective of this systematic review was to evaluate the usefulness of surface airway ultrasound as a PoCUS tool for OSA screening in the pediatric population. DESIGN Databases were searched for observational cohort studies and randomized controlled trials of patients under 18 years of age undergoing quantitative surface US measurement of extra-thoracic airway structures where correlation or association was examined either directly to OSA diagnosis or indirectly to an alternative reference measure. Diagnostic properties and correlation between US parameters (index test) and reference measures were evaluated where possible. MAIN RESULTS Of the initial 8499 screened articles, 12 articles (8 airway, 4 non-airway) evaluating 1237 patients were included. Six of these studies were conducted in the sleep/obesity clinic and six in in the perioperative population. Ten studies were prospective and two were cross sectional studies. Airway parameters which correlated with moderate-severe OSA were lateral pharyngeal wall thickness and total neck thickness at the retropharyngeal level. Tonsil volume was not correlated with OSA diagnosis or severity. In tonsillectomy patients, tonsil volume on preoperative ultrasound correlated well with volume of surgical specimens. Adenoid thickness correlated strongly with radiological and endoscopic measures of size and occlusion. CONCLUSION Ultrasound measurement in children indicates several parameters which correlate with OSA diagnosis or with other reference measurements. This has not yet been validated as a diagnostic tool, however the recent emergence of research in this area is encouraging and the findings from this review will inform future studies.
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Affiliation(s)
- Donogh W Burns
- Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Vincent W S Chan
- Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Aditya Trivedi
- Department of eHealth, McMaster University, Hamilton, Ontario, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, Toronto, Canada
| | - Farrukh Munshey
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mandeep Singh
- Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Toronto Sleep and Pulmonary Centre, Toronto, Canada; Department of Anesthesiology and Pain Management, Women's College Hospital, Toronto, Ontario, Canada.
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9
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Kirkham EM. Pediatric Drug-Induced Sleep Endoscopy. Otolaryngol Clin North Am 2022; 55:1165-1180. [DOI: 10.1016/j.otc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kukkala S, Vazifedan T, Baldassari CM. Association of Apnea vs Hypopnea Predominance With Pediatric Sleep Apnea Outcomes: A Secondary Analysis of the Childhood Adenotonsillectomy Trial. JAMA Otolaryngol Head Neck Surg 2022; 148:1038-1043. [PMID: 36201186 PMCID: PMC9539728 DOI: 10.1001/jamaoto.2022.3031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/20/2022] [Indexed: 12/13/2022]
Abstract
Importance Children with apnea-predominant obstructive sleep apnea (OSA) are hypothesized to have a more severe form of the disease. However, research is lacking as to whether there is a significant difference in outcomes between children with apnea-predominant vs hypopnea-predominant OSA. Objective To assess the association between baseline apnea-predominant or hypopnea-predominant OSA on polysomnography and quality of life (QOL) outcomes in children with obstructive sleep apnea managed by watchful waiting with supportive care (WWSC) or adenotonsillectomy (AT). Design, Setting, and Participants This case-control study is a secondary analysis of a randomized clinical trial, the Childhood Adenotonsillectomy Trial, which was conducted at multiple tertiary children's hospitals from October 2007 to June 2012. Children aged 5.0 to 9.9 years with OSA were randomized to WWSC or AT and underwent polysomnography and completed validated QOL and symptom assessments at baseline and 7 months. The current data analysis was performed from October 2020 to February 2022. Main Outcomes and Measures Apnea-predominant OSA was defined as an apnea hypopnea index (AHI) greater than 2 with more than 50% of the obstructive events being apneas. Patients were considered to have hypopnea-predominant OSA if they had an AHI greater than 2 and more than 50% of the obstructive events were hypopneas. Results A total of 386 children (185 boys [48%]; mean [SD] age, 6.56 [1.4] years) were analyzed. The mean (SD) obstructive AHI for patients was 6.98 (5.62), with 198 patients (51%) having mild disease. Thirty-seven children (10%) had apnea-predominant OSA at baseline. Black children were at increased risk for apnea-predominant OSA vs White children (odds ratio [OR], 13.40; 95% CI, 5.70-33.90). Children with apnea predominance were more likely to have severe OSA (AHI >10) compared with children with hypopnea predominance (OR, 2.30; 95% CI, 1.03-5.03); baseline Pediatric Sleep Questionnaire and OSA-18 QOL scores were similar between the 2 groups. Among children undergoing AT, those with baseline apnea predominance were more likely to have a Pediatric Sleep Questionnaire score greater than 0.33 at follow-up (OR, 3.30; 95% CI, 1.01-10.80). Rates of OSA resolution and improvements in QOL scores following AT or WWSC were similar between the apnea-predominant and hypopnea-predominant groups. Conclusions and Relevance In children with OSA, apnea-predominant disease is uncommon. Apnea predominance was not associated with symptom resolution and cure rates in children undergoing AT or WWSC for OSA. Further research is needed to assess how apnea predominance affects AT outcomes in children with more severe disease.
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Affiliation(s)
| | - Turaj Vazifedan
- Department of Pediatrics, Children’s Hospital of the King’s Daughters, Norfolk, Virginia
| | - Cristina M. Baldassari
- Department of Otolaryngology Head and Neck Surgery, Eastern Virginia Medical School, Norfolk
- Division of Sleep Medicine, Children’s Hospital of the King’s Daughters, Norfolk, Virginia
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11
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Benyo S, Moroco AE, Saadi RA, Patel VA, King TS, Wilson MN. Postoperative Outcomes in Pediatric Septoplasty. Ann Otol Rhinol Laryngol 2022:34894221129677. [PMID: 36226335 DOI: 10.1177/00034894221129677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Identify risk factors and perioperative morbidity for pediatric patients undergoing septoplasty. METHODS The American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) database was retrospectively queried to identify patients who underwent septoplasty (CPT 30520) for a diagnosis of deviated nasal septum (ICD J34.2) from 2018 to 2019. Outcomes analyzed include patient demographics, medical comorbidities, surgical setting, operative characteristics, length of stay, and postoperative outcomes. RESULTS A total of 729 children were identified. Median age at time of surgery was 15.8 years, with most patients (82.8%) >12 years of age; no significant association was identified between age at time of surgery and adverse surgical outcomes. Overall, postoperative complications were uncommon (0.6%), including readmission (0.4%), septic shock (0.1%), and surgical site infection (0.1%). A history of asthma was found to be a significant risk factor for postoperative complications (P = .035) as well as BMI (P = .028). CONCLUSION The 30-day postoperative complications following pediatric septoplasty in children reported in the NSQIP-P database are infrequent. Special considerations regarding young age, complex sinonasal anatomy, and surgical technique remain important features in considering corrective surgery for the pediatric nose and certainly warrant further investigation in subsequent studies.
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Affiliation(s)
- Sarah Benyo
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Annie E Moroco
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Robert A Saadi
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Vijay A Patel
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of California San Diego, La Jolla, CA, USA.,Division of Pediatric Otolaryngology, Rady Children's Hospital - San Diego, San Diego, CA, USA
| | - Tonya S King
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Meghan N Wilson
- Department of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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12
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Sharma AV, Padhya T, Nallu S. Management of Pediatric Obstructive Sleep Apnea After Failed Tonsillectomy and Adenoidectomy. Adv Pediatr 2022; 69:95-105. [PMID: 35985719 DOI: 10.1016/j.yapd.2022.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pediatric obstructive sleep apnea (OSA) represents a different entity from its adult counterpart and therefore requires a different therapeutic approach. Adenotonsillectomy (AT) is the primary treatment of pediatric OSA, and evidence shows it is very effective. However, there is a growing understanding that residual OSA is common, and next steps for patients who fail primary AT are less certain. This article reviews current methods of evaluating and treating these complex patients.
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Affiliation(s)
- Abhay Varun Sharma
- Department of Otolaryngology Head and Neck Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Boulevard, MDC 73 Tampa, FL 33612, USA.
| | - Tapan Padhya
- Department of Otolaryngology Head and Neck Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Boulevard, MDC 73 Tampa, FL 33612, USA
| | - Sagarika Nallu
- USF Health Department of Pediatrics, Division of Neurology, 13101 Bruce B Downs Boulevard, Tampa, FL 33612, USA
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13
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Liu CN, Kang KT, Yao CCJ, Chen YJ, Lee PL, Weng WC, Hsu WC. Changes in Cone-Beam Computed Tomography Pediatric Airway Measurements After Adenotonsillectomy in Patients With OSA. JAMA Otolaryngol Head Neck Surg 2022; 148:621-629. [PMID: 35616957 DOI: 10.1001/jamaoto.2022.0925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Early intervention using cone-beam computed tomography (CBCT) and adenotonsillectomy for children with obstructive sleep apnea (OSA) may prevent impaired growth, adverse cardiovascular consequences, learning deficits, and poor quality of life. Objective To assess changes in CBCT airway measurements and polysomnography (PSG) parameters that occur after adenotonsillectomy in children with OSA and to determine whether CBCT changes are correlated with apnea-hypopnea index (AHI) reduction. Design, Setting, and Participants This prospective cohort study was conducted at a tertiary medical center from 2013 to 2016. Children aged 7 to 13 years with PSG-confirmed OSA (ie, AHI ≥1) were recruited. Data analysis was performed from March to July 2021. Exposures All participants underwent CBCT and PSG before and after adenotonsillectomy. Main Outcomes and Measures Changes in PSG and CBCT parameters after adenotonsillectomy were analyzed. Results A total of 49 children (mean [SD] age, 9.5 [1.8] years; 34 boys [69.4%]) were recruited. Eighteen participants (36.7%) had obesity. After adenotonsillectomy, AHI significantly decreased from 11.4 to 1.2 events per hour (mean difference, -10.24 events per hour; 95% CI, -13.84 to -6.64 events per hour). The following CBCT parameters significantly increased: total airway volume (from 11 265 to 15 161 mm3; mean difference, 3896.6 mm3; 95% CI, 2788.0 to 5005.2 mm3), nasopharyngeal volume (from 2366 to 3826 mm3; mean difference, 1459.7 mm3; 95% CI, 1122.9 to 1796.5 mm3), minimal nasopharyngeal airway area (from 128 to 191 mm2; mean difference, 63.1 mm2; 95% CI, 47.4 to 78.8 mm2), mean nasopharyngeal airway area (from 144 to 231 mm2; mean difference, 86.8 mm2; 95% CI, 67.0 to 106.5 mm2), oropharyngeal volume (from 8898 to 11 335 mm3; mean difference, 2436.9 mm3; 95% CI, 1477.0 to 3396.8 mm3), minimal oropharyngeal airway area (from 82 to 158 mm2; mean difference, 76.2 mm2; 95% CI, 57.0 to 95.4 mm2), and mean oropharyngeal airway area (from 182 to 234 mm2; mean difference, 52.5 mm2; 95% CI, 33.6 to 71.4 mm2). Among all parameters, only body mass index percentile showed large effect size between the group with residual OSA (postoperative AHI ≥1) and the group with resolved disease, with the residual OSA group having a higher body mass index percentile (87.8 vs 61.4; mean difference, 26.33; 95% CI, 10.00 to 42.66). A quantile regression model revealed that total airway volume and minimal oropharyngeal airway area were significantly correlated with reductions in AHI. Conclusions and Relevance These findings suggest that in children undergoing adenotonsillectomy, improvements in total airway volume and oropharyngeal minimal airway area were correlated with reduction of AHI. Future studies are needed to assess whether CBCT has a role in the evaluation of children with OSA who are being considered for adenotonsillectomy.
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Affiliation(s)
- Chin-Nung Liu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yunn-Jy Chen
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan
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14
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Abstract
Pediatric obstructive sleep apnea (OSA) is a common entity that can cause both daytime and nighttime issues. Children with symptoms should be screened for OSA. If possible, polysomnography should be performed to evaluate symptomatic children. Depending on the severity, first-line options for treatment of pediatric OSA may include observation, weight loss, medication, or surgery. Even after adenotonsillectomy, about 20% of children will have persistent OSA. Sleep endoscopy and cine MRI are tools that may be used to identify sites of obstruction, which in turn can help in the selection of site-specific treatment.
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Affiliation(s)
- Pakkay Ngai
- Division of Pediatric Pulmonology, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Children's Health, 30 Prospect Avenue, WFAN 3rd Floor, Hackensack, NJ 07601, USA
| | - Michael Chee
- Division of Pediatric Otolaryngology, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Children's Health, 30 Prospect Avenue, WFAN PC-311, Hackensack, NJ 07601, USA.
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15
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Huang CC, Wu PW, Chiu CH, Lee TJ, Chen CL. Assessment of sleep-disordered breathing in pediatric otitis media with effusion. Pediatr Neonatol 2022; 63:25-32. [PMID: 34391662 DOI: 10.1016/j.pedneo.2021.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Given the role of adenoid in the pathogenesis of otitis media with effusion (OME) and sleep-disordered breathing (SDB), the present study aimed to investigate the sleep quality and the impact of adenoidectomy on improvement of sleep symptoms in children with OME. METHODS Children with SDB or OME, aged 3-12 years, were prospectively enrolled before undergoing adenoidectomy in a tertiary medical center. The symptom severity of obstructive sleep apnea syndrome (OSAS) was evaluated by OSA-18 questionnaire on the day before and 6 months after surgery. RESULTS In total, 79 pediatric patients including 50 children with SDB and 29 children with OME were enrolled. The mean total OSA-18 score was 56.5 ± 15.1 and ten (34.5%) children experienced moderate to severe symptoms of OSAS as indicated by OSA-18 score ≥ 60 in OME group. After surgery, patients in both SDB and OME groups experienced improvement (both p < 0.001) and presented no difference in the scores of OSA-18. The proportional change in OSA-18 scores after surgery was related to pre-operative OSA-18 scores and BMI in OME patients (rs = 0.400 and 0.542, p = 0.047 and 0.008), and to pre-operative OSA-18 scores in patients with SDB (rs = 0.393, p = 0.008). CONCLUSION Children with OME experienced significant symptoms of OSAS and associated impairment of quality of life. Adenoidectomy is effective in the improvement of sleep symptoms in these patients. Comprehensive assessment of sleep breathing as planning surgery for OME children is suggested.
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Affiliation(s)
- Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Pei-Wen Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
| | - Cheng-Hsun Chiu
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ta-Jen Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chyi-Liang Chen
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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16
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Cielo CM, Keenan BT, Wiemken A, Tapia IE, Kelly A, Schwab RJ. Neck fat and obstructive sleep apnea in obese adolescents. Sleep 2021; 44:zsab158. [PMID: 34165571 PMCID: PMC8598172 DOI: 10.1093/sleep/zsab158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Increased neck circumference, a surrogate for the neck fat that can narrow the upper airway in obese individuals, is a risk factor for obstructive sleep apnea syndrome (OSAS) in adults, but the association between neck fat and OSAS in adolescent males and females is unknown. We hypothesized that obese adolescents with OSAS have more neck fat than controls, females more neck fat than males, and that neck fat correlates with obesity and OSAS severity. METHODS Obese adolescents with OSAS and obese and normal-weight controls underwent upper airway magnetic resonance imaging, polysomnography, and anthropometrics, including neck circumference measurement. Intra-neck and subcutaneous neck fat measurements were manually segmented and compared among the three groups using ANOVA and between males and females using t-tests. The relationship between polysomnographic parameters and neck fat measurements was assessed in adolescents with OSAS using Pearson correlations. RESULTS One-hundred nineteen adolescents (38 females) were studied: 39 obese with OSAS, 34 obese controls, and 46 normal-weight controls. Neck fat was not greater in adolescents with OSAS compared to obese controls (p=0.35), and neck fat volume was not related to OSAS severity (p = 0.36). However, obese adolescents had more neck fat than normal-weight controls (p < 0.001), and neck fat volume correlated with neck circumference (r = 0.53, p < 0.001). Females had significantly greater cross-sectional neck fat than males (p < 0.001). CONCLUSIONS While neck fat is associated with obesity and neck circumference in adolescents and is greater in females versus males, it does not appear to correlate with presence and severity of OSAS.
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Affiliation(s)
- Christopher M Cielo
- Division of Pulmonary & Sleep Medicine, Children’s Hospital of Philadelphia
- University of Pennsylvania, Philadelphia, PA
| | - Brendan T Keenan
- University of Pennsylvania, Philadelphia, PA
- Division of Sleep Medicine, Department of Medicine
| | - Andrew Wiemken
- University of Pennsylvania, Philadelphia, PA
- Division of Sleep Medicine, Department of Medicine
| | - Ignacio E Tapia
- Division of Pulmonary & Sleep Medicine, Children’s Hospital of Philadelphia
- University of Pennsylvania, Philadelphia, PA
| | - Andrea Kelly
- University of Pennsylvania, Philadelphia, PA
- Division of Pediatric Endocrinology and Diabetes, Children’s Hospital of Philadelphia
| | - Richard J Schwab
- University of Pennsylvania, Philadelphia, PA
- Division of Sleep Medicine, Department of Medicine
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17
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Mylavarapu G, Gutmark E, Shott S, Fleck R, Mahmoud M, McConnell K, Szczesniak R, Hossain MM, Huang G, Tadesse DG, Schuler CL, Khosla S, Amin R. Predicting critical closing pressure in children with obstructive sleep apnea using fluid-structure interaction. J Appl Physiol (1985) 2021; 131:1629-1639. [PMID: 34528458 PMCID: PMC8616603 DOI: 10.1152/japplphysiol.00694.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 08/04/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022] Open
Abstract
Surgical treatment of obstructive sleep apnea (OSA) in children requires knowledge of upper airway dynamics, including the closing pressure (Pcrit), a measure of airway collapsibility. We applied a flow-structure interaction (FSI) computational model to estimate Pcrit in patient-specific upper airway models obtained from magnetic resonance imaging (MRI) scans. We sought to examine the agreement between measured and estimated Pcrit from FSI models in children with Down syndrome. We hypothesized that the estimated Pcrit would accurately reflect measured Pcrit during sleep and therefore reflect the severity of OSA as measured by the obstructive apnea-hypopnea index (AHI). All participants (n = 41) underwent polysomnography and sedated sleep MRI scans. We used Bland-Altman plots to examine the agreement between measured and estimated Pcrit. We determined associations between estimated Pcrit and OSA severity, as measured by AHI, using regression models. The agreement between passive and estimated Pcrit showed a fixed bias of -1.31 [confidence interval (CI) = -2.78, 0.15] and a nonsignificant proportional bias. A weaker agreement with active Pcrit was observed. A model including AHI, gender, an interaction term for AHI, and gender and neck circumference explained the largest variation (R2 = 0.61) in the relationship between AHI and estimated Pcrit (P < 0.0001). Overlap between the areas of the airway with the lowest stiffness, and areas of collapse on dynamic MRI, was 77.4 ± 30% for the nasopharyngeal region and 78.6 ± 33% for the retroglossal region. The agreement between measured and estimated Pcrit and the significant association with AHI supports the validity of Pcrit estimates from the FSI model.NEW & NOTEWORTHY We present a noninvasive method for estimating critical closing pressure (Pcrit) using fluid-structure interaction (FSI) simulations and magnetic resonance imaging (MRI) scans in patients with obstructive sleep apnea (OSA). We used patient-specific stiffness measures in our FSI model to account for any individual variability in the elasticity of soft tissues surrounding the upper airway. We validated this model by measuring the degree of agreement between measured and estimated Pcrit.
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Affiliation(s)
- Goutham Mylavarapu
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ephraim Gutmark
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, Ohio
- Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio
| | - Sally Shott
- Division of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert Fleck
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mohamed Mahmoud
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Keith McConnell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rhonda Szczesniak
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Md Monir Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Guixia Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Dawit G Tadesse
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christine L Schuler
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sid Khosla
- Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio
| | - Raouf Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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18
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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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19
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Williamson A, Coutras SW, Carr MM. Sleep Endoscopy Findings in Children With Obstructive Sleep Apnea and Small Tonsils. Ann Otol Rhinol Laryngol 2021; 131:851-858. [PMID: 34528454 DOI: 10.1177/00034894211045645] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Obstructive Sleep Apnea (OSA) in children is treated primarily with adenotonsillectomy (AT). When clinical exam demonstrates small tonsils, the success of AT in resolving OSA is uncertain. The purpose of this study is to determine the utility of Drug induced Sleep Endoscopy (DISE) for children with OSA and small tonsils (Brodsky scale 1+) and to identify what obstructive trends exist in this subset of patients and to determine the utility of DISE-directed surgical intervention in patients with small tonsils. METHODS A retrospective chart review was performed for patients who underwent DISE at a tertiary care center over a 2-year period. Inclusion criteria were 1+ tonsils and a positive sleep study. Data collected included DISE findings, BMI, comorbid conditions, and pre-op PSG data. RESULTS Forty children were included with a mean age of 5.0 years (range 8 months-16 years). Mean preoperative AHI was 5.46 and mean oxygen saturation nadir was 87.1%. The most common contributor to airway obstruction was the adenoid (29 patients, 72.5%), followed by the tongue base or lingual tonsil (21 patients, 52.5%). The palatine tonsils (10 patients, 25.0%), epiglottis (10.0%), or obstruction intrinsic to the larynx (10.0%) were significantly less frequently identified as contributors to OSA when compared to the adenoid (P < .001). The majority of patients had multilevel obstruction (25 patients, 62.5%). Adenoidectomy (27 patients, 67.5%) was the most commonly performed procedure, followed by tonsillectomy (10 patients, 25.0%, P < .001) and tongue base surgery (9 patient 22.5%, P < .001). CONCLUSION In this group, small palatine tonsils were infrequently identified as a contributor to airway obstruction and tonsillectomy was avoided in most cases. This study illustrates the utility of DISE as a tool to personalize the surgical management of pediatric patients with OSA and small tonsils on physical exam.
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Affiliation(s)
- Adrian Williamson
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Steven W Coutras
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Michele M Carr
- Department of Otolaryngology-Head Neck Surgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
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20
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Abulhamail A, AlShebli A, Merdad L, Wali S, Jastaniah W, Abaalkhail B. Prevalence of and risk factors for obstructive sleep apnea in children with sickle cell: a multicentric cross sectional study. Ann Hematol 2021; 101:43-57. [PMID: 34505943 DOI: 10.1007/s00277-021-04646-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Abstract
The prevalence of obstructive sleep apnea syndrome (OSAS) is elevated in some high-risk populations. Children with sickle cell disease (SCD) are known to have many comorbidities, including OSAS. The objectives of this study were to assess the prevalence of and risk factors for OSAS among children with SCD in two major tertiary health care facilities in Jeddah, Saudi Arabia. This multicenter cross-sectional study took place in two major tertiary health care facilities-King Abdulaziz University Hospital and King Khalid National Guard Hospital, Jeddah, Saudi Arabia. Children with SCD who were admitted between January 2010 and December 2017 were enrolled. The Pediatric Sleep Questionnaire (PSQ) was used to screen for OSAS. Data were collected from 150 children with SCD aged between 2 and 18 years. Eighty-five percent of the children had sickle cell anemia (SCA) with HbSS, and the rest had sickle beta-thalassemia (HbS/ß-thalassemia). Based on the PSQ, 33 of the 150 (22%) children had OSAS (score ≥ 7). The average score on the PSQ was 3.8/22 (± 3.8). A history of adenotonsillar hypertrophy was found to be a significant risk factor in bivariate and multivariate analyses [aOR 5.5; 95% CI 1.84-16.35 (P < 0.001)]. The odds of having OSAS were ninefold higher in children who had periodic limb movements than in those who did not after adjustment [95% CI 1.75-48.03 (P < 0.001)]. OSAS is a highly prevalent disease among children with SCD. Many factors were associated with OSAS in the bivariate analysis, including nationality, education level, a history of adenotonsillar hypertrophy, and a history of periodic limb movements.
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Affiliation(s)
- Albraa Abulhamail
- College of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Ahmad AlShebli
- College of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Leeena Merdad
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Siraj Wali
- College of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wasil Jastaniah
- Pediatric and Pediatric Hematology/Oncology, BMT College of Medicine, Jeddah, Saudi Arabia
| | - Bahaa Abaalkhail
- Department of Family & Community Medicine, Faculty of Medicine, King Abdul-Aziz University, Jeddah, Saudi Arabia
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21
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Herrmann BW, Campbell K, Meier M, Haemer M, Crowder R, Tholen K, Hoefner-Notz R, Nguyen T, Friedman NR. Parental Perception of Weight Status for Adenotonsillectomy Patients. Laryngoscope 2021; 131:2121-2125. [PMID: 33569790 PMCID: PMC8355242 DOI: 10.1002/lary.29445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Weight status can affect outcomes in pediatric adenotonsillectomy performed for obstructive sleep disordered breathing. Parents frequently underestimate their child's weight and are unaware weight status may affect adenotonsillectomy success. Accurate understanding of a child's weight status is important for shared decision making with the family and perioperative care. The purpose of this study is to analyze the accuracy of the parent's perception of their child's weight status. METHODS A retrospective analysis was performed of prospective data collected from families of children undergoing adenotonsillectomy from June 2018 through June 2019. RESULTS A total of 522 children met the inclusion criteria. Two hundred and thirty-two children were either overweight (n = 46, 9%) or obese (n = 186, 36%). Among parents of this cohort whose children were overweight or obese, 74 (32%) erroneously reported that their child was normal weight. For the 290 nonoverweight children, 99% of parents accurately reported weight status. After adjusting for ethnicity, race, BMI%, and sex, for every 1-year increase in age of the child, the odds of the parent correctly identifying their child as overweight increased by a factor of 1.18 (95% CI: 1.09, 1.27). CONCLUSION One-third of families with children who were overweight or obese undergoing adenotonsillectomy for obstructive sleep disordered breathing underestimated their child's weight. This study highlights the need to facilitate family understanding of weight status' potential impact on both obstructive sleep disordered breathing severity and adenotonsillectomy success, especially for younger children. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2121-2125, 2021.
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Affiliation(s)
- Brian W Herrmann
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO
- Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, CO
| | | | - Maxene Meier
- The Center for Research in Outcomes for Children’s Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Matthew Haemer
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO
| | - Renee Crowder
- University of Colorado School of Medicine, Aurora, CO
| | - Kaitlyn Tholen
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO
- Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, CO
| | - Regina Hoefner-Notz
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO
| | - Thanh Nguyen
- University of Colorado School of Medicine, Aurora, CO
- Division of Pediatric Anesthesia, Children’s Hospital Colorado, Aurora, CO
| | - Norman R Friedman
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO
- Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, CO
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22
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Arganbright JM, Lee JC, Weatherly RA. Pediatric drug-induced sleep endoscopy: An updated review of the literature. World J Otorhinolaryngol Head Neck Surg 2021; 7:221-227. [PMID: 34430829 PMCID: PMC8356111 DOI: 10.1016/j.wjorl.2021.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The field of drug-induced sleep endoscopy (DISE) has grown considerably over the last 10∼15 years, to now include its use in pediatric patients. In this review article, we outline our approach to the use of this technology in Children with Airway Obstruction, most specifically in the management of children with airway obstruction and known or suspected adenotonsillar enlargement.
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Affiliation(s)
- Jill M Arganbright
- Children's Mercy Kansas City, Division of Otolaryngology, Kansas City, MO, USA.,University of Missouri, Kansas City School of Medicine, Kansas City, MO, USA
| | - Jason C Lee
- University of Kansas Medical Center, Department of Otolaryngology, Kansas City, KS, USA
| | - Robert A Weatherly
- Children's Mercy Kansas City, Division of Otolaryngology, Kansas City, MO, USA.,University of Missouri, Kansas City School of Medicine, Kansas City, MO, USA
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23
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Liu X, Pamula Y, Immanuel S, Kennedy D, Martin J, Baumert M. Utilisation of machine learning to predict surgical candidates for the treatment of childhood upper airway obstruction. Sleep Breath 2021; 26:649-661. [PMID: 34273052 DOI: 10.1007/s11325-021-02425-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/24/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the effect of adenotonsillectomy on OSAS symptoms based on a data-driven approach and thereby identify criteria that may help avoid unnecessary surgery in children with OSAS. METHODS In 323 children enrolled in the Childhood Adenotonsillectomy Trial, randomised to undergo either early adenotonsillectomy (eAT; N = 165) or a strategy of watchful waiting with supportive care (WWSC; N = 158), the apnea-hypopnea index, heart period pattern dynamics, and thoraco-abdominal asynchrony measurements from overnight polysomnography (PSG) were measured. Using machine learning, all children were classified into one of two different clusters based on those features. The cluster transitions between follow-up and baseline PSG were investigated for each to predict those children who recovered spontaneously, following surgery and those who did not benefit from surgery. RESULTS The two clusters showed significant differences in OSAS symptoms, where children assigned in cluster A had fewer physiological and neurophysiological symptoms than cluster B. Whilst the majority of children were assigned to cluster A, those children who underwent surgery were more likely to stay in cluster A after seven months. Those children who were in cluster B at baseline PSG were more likely to have their symptoms reversed via surgery. Children who were assigned to cluster B at both baseline and 7 months after surgery had significantly higher end-tidal carbon dioxide at baseline. Children who spontaneously changed from cluster B to A presented highly problematic ratings in behaviour and emotional regulation at baseline. CONCLUSIONS Data-driven analysis demonstrated that AT helps to reverse and to prevent the worsening of the pathophysiological symptoms in children with OSAS. Multiple pathophysiological markers used with machine learning can capture more comprehensive information on childhood OSAS. Children with mild physiological and neurophysiological symptoms could avoid AT, and children who have UAO symptoms post AT may have sleep-related hypoventilation disease which requires further investigation. Furthermore, the findings may help surgeons more accurately predict children on whom they should perform AT.
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Affiliation(s)
- Xiao Liu
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, 5005, Australia.
| | - Yvonne Pamula
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, Australia
| | - Sarah Immanuel
- Centre for Artificial Intelligence Research and Optimisation, Torrens University, Adelaide, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Declan Kennedy
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, Australia.,Children's Research Centre, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia
| | - James Martin
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, Australia
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, 5005, Australia.
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Hines S, Pickett K, Tholen K, Handley E, Friedman NR. Tonsillectomy Outcomes for Children With Severe Obesity. Laryngoscope 2021; 132:461-469. [PMID: 34191279 DOI: 10.1002/lary.29712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the success of an adenotonsillectomy (T&A) in treating children with severe obesity utilizing a more accurate obesity scale. STUDY DESIGN Retrospective cohort. METHODS A retrospective cohort of children with obesity between 5 and 10 years of age who underwent a T&A at Children's Hospital of Colorado (CHCO) was used. This study also utilized publicly available data from the Childhood Adenotonsillectomy Trial (CHAT) study. The cohort was divided into three obesity classes using age- and sex-specific body mass index (BMI) expressed as a percentage of the 95th percentile (%BMIp95) and compared for operative success differences. RESULTS There were 132 patients included in our primary analysis, with obesity distribution as follows: Class 1 to 53 patients (40%), Class 2 to 45 patients (34%), and Class 3 to 34 patients (26%). Overall, 52 patients (35.9%) experienced a cure (obstructive apnea/hypopnea index [OAHI] <1), with 27 (52%) patients in Class 1 obesity, 18 (35%) in Class 2, and 7 (13%) in Class 3. Class 3 had a significantly lower obstructive sleep apnea cure rate compared with Class 1 patients (P = .013), but after adjusting for covariates, this difference was no longer present (P > .05). There was no significant difference in the preoperative to postoperative percent change in mean oxygen saturation (P = .82 CHCO, P = .43 CHAT), oxygen nadir (P = .20 CHCO, P = .49 CHAT), or OAHI (P = .12 CHCO, P = .26 CHAT) between the obesity classes. CONCLUSION After adjusting for covariates, children with Class 3 obesity are as likely to be cured with a T&A as those with Class 1 obesity. A T&A should be considered a first line treatment for all children with obesity. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Susan Hines
- Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, U.S.A.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Kaci Pickett
- Center for Research in Outcomes for Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Kaitlyn Tholen
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School, Aurora, Colorado, U.S.A.,University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Elyse Handley
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School, Aurora, Colorado, U.S.A.,University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Norman R Friedman
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School, Aurora, Colorado, U.S.A.,University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, U.S.A
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25
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Tholen K, Meier M, Kloor J, Friedman N. Persistent OSA in obese children: does body position matter? J Clin Sleep Med 2021; 17:227-232. [PMID: 33094724 DOI: 10.5664/jcsm.8902] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
STUDY OBJECTIVES The objective of this study was to determine if positional therapy is a viable treatment alternative for obese children with persistent obstructive sleep apnea (OSA). METHODS A retrospective review was performed of children who underwent an adenotonsillectomy for OSA from 2014 to 2017. Children were included if they had a body mass index ≥ 95th percentile and underwent a postoperative polysomnogram. Subjects fell into one of three categories: mixed sleep (the presence of ≥ 30 minutes of both nonsupine and supine sleep), nonsupine sleep, and supine sleep. Cure was defined as an OSA/apnea-hypopnea index of < 1 events/h. Paired t tests were used to assess the differences, and a linear model adjusting for obesity class, age at procedure, and sex was performed to assess the differences between nonsupine and supine sleep. RESULTS There were 154 children who met the inclusion criteria. Using a paired t test, supine sleep position had a significantly higher average OSA/apnea-hypopnea index (7.9 events) compared with nonsupine (OSA/apnea-hypopnea index of 4.1); P value was < .01 for the 60 children with mixed sleep. Forty-three children had predominantly nonsupine sleep and 33 predominantly supine sleep, and a McNemar's test comparing these children showed that those sleeping in the nonsupine position were significantly more likely to be cured than those in the supine position (P < .001). CONCLUSIONS Sleep physicians and otolaryngologists should be cognizant of positional treatment when consulting with families and note that the postoperative polysomnography may be inaccurate if it does not include supine sleep. Positional therapy as a potential treatment option for obese children with persistent OSA after adenotonsillectomy warrants further investigation.
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Affiliation(s)
- Kaitlyn Tholen
- Department of Pediatric Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado
| | - Maxene Meier
- Center for Research Outcomes in Children's Surgery, Center for Children's Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Jackson Kloor
- University of Colorado School of Medicine, Aurora, Colorado
| | - Norman Friedman
- Department of Pediatric Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado
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26
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Choy KR, Sin S, Tong Y, Udupa JK, Luchtenburg DM, Wagshul ME, Arens R, Wootton DM. Upper airway effective compliance during wakefulness and sleep in obese adolescents studied via two-dimensional dynamic MRI and semiautomated image segmentation. J Appl Physiol (1985) 2021; 131:532-543. [PMID: 34080921 DOI: 10.1152/japplphysiol.00839.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Novel biomarkers of upper airway biomechanics may improve diagnosis of obstructive sleep apnea syndrome (OSAS). Upper airway effective compliance (EC), the slope of cross-sectional area versus pressure estimated using computational fluid dynamics (CFD), correlates with apnea-hypopnea index (AHI) and critical closing pressure (Pcrit). The study objectives are to develop a fast, simplified method for estimating EC using dynamic MRI and physiological measurements and to explore the hypothesis that OSAS severity correlates with mechanical compliance during wakefulness and sleep. Five obese children with OSAS and five control subjects with obesity aged 12-17 yr underwent anterior rhinomanometry, polysomnography, and dynamic MRI with synchronized airflow measurement during wakefulness and sleep. Airway cross section in retropalatal and retroglossal section images was segmented using a novel semiautomated method that uses optimized singular value decomposition (SVD) image filtering and k-means clustering combined with morphological operations. Pressure was estimated using rhinomanometry Rohrer's coefficients and flow rate, and EC was calculated from the area-pressure slope during five normal breaths. Correlations between apnea-hypopnea index (AHI), EC, and cross-sectional area (CSA) change were calculated using Spearman's rank correlation. The semiautomated method efficiently segmented the airway with average Dice Coefficient above 89% compared with expert manual segmentation. AHI correlated positively with EC at the retroglossal site during sleep (rs = 0.74, P = 0.014) and with change of EC from wake to sleep at the retroglossal site (rs = 0.77, P = 0.01). CSA change alone did not correlate significantly with AHI. EC, a mechanical biomarker which includes both CSA change and pressure variation, is a potential diagnostic biomarker for studying and managing OSAS.NEW & NOTEWORTHY This study investigated the dynamics of the upper airway at retropalatal and retroglossal sites during wakefulness and sleep by evaluating the effective compliance (EC) of each site and its correlation with apnea-hypopnea index (AHI) using novel semiautomated image processing. AHI correlated significantly with retroglossal EC during sleep and change of retroglossal EC from wake to sleep. The results suggest EC as a promising noninvasive diagnostic marker for estimating the mechanical properties of various upper airway regions in patients with OSAS.
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Affiliation(s)
- Kok Ren Choy
- The Cooper Union for the Advancement of Science and Art, New York, New York
| | - Sanghun Sin
- Division of Respiratory and Sleep Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Yubing Tong
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jayaram K Udupa
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dirk M Luchtenburg
- The Cooper Union for the Advancement of Science and Art, New York, New York
| | - Mark E Wagshul
- Department of Radiology, Gruss MRRC, Albert Einstein College of Medicine, Bronx, New York
| | - Raanan Arens
- Division of Respiratory and Sleep Medicine, Children's Hospital at Montefiore, Bronx, New York.,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - David M Wootton
- The Cooper Union for the Advancement of Science and Art, New York, New York
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27
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Cheung JL, Dreyer C, Ranjitkar S. Opening up on airways: the purported effect of nasorespiratory obstruction on dentofacial growth. Aust Dent J 2021; 66:358-370. [PMID: 34031885 DOI: 10.1111/adj.12858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/26/2022]
Abstract
Nasorespiratory obstruction has been purported to influence dentofacial growth adversely. This has sparked considerable debate for decades with a resurgence in interest in 'airway friendly orthodontics' among both general and specialist dental practitioners. This critical review aims to evaluate the current literature relating to two questions: does nasorespiratory obstruction alter dentofacial growth, and does early intervention targeted at alleviating nasorespiratory obstruction improve dentofacial growth? The strength of association between nasorespiratory obstruction, mouth breathing and a long face is weak. The common methodological flaws in research include unblinded and cross-sectional study designs, a lack of adequate controls, inadequate follow-up, subjective assessments and inadequate statistical power. Vertical dentofacial growth has a strong genetic influence, which implies a relatively minor contribution of environmental factors including airway obstruction. The current evidence does not support recommending procedures, such as adenotonsillectomy and maxillary expansion, with the singular aim of negating a hyperdivergent (vertical) dentofacial growth pattern. In light of low-quality evidence, both the World Health Organization guidelines and ethical principles dictate that greater emphasis is placed on avoiding harm and wastage of resources over alternative options. These findings call for quality improvement in undergraduate and postgraduate curricula and continuing professional development for health professionals.
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Affiliation(s)
- J-Ls Cheung
- Private Practice, Melbourne, Victoria, Australia
| | - C Dreyer
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - S Ranjitkar
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia.,Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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Filipek N, Kirkham E, Chen M, Ma CC, Horn DL, Johnson KE, Parikh SR. Drug-induced sleep endoscopy directed surgery improves polysomnography measures in overweight and obese children with obstructive sleep apnea. Acta Otolaryngol 2021; 141:397-402. [PMID: 33372808 DOI: 10.1080/00016489.2020.1863465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Obstructive sleep apnea affects approximately 1-4% of all children, with increased prevalence amongst overweight and obese children. OBJECTIVE To assess the effects of drug-induced sleep endoscopy (DISE)-directed surgery on polysomnography parameters in obese and overweight children. MATERIAL/METHODS A retrospective case-series was performed on obese and overweight pediatric patients who underwent clinically indicated DISE-directed surgery. Forty children met the inclusion criteria, including: body mass index ≥85%, DISE-study, and pre- and post-DISE polysomnography. Patients were divided into surgically naïve (n = 23) and prior adenotonsillectomy (n = 17) groups. Demographic and clinical characteristics were examined with chi-square and Wilcoxon rank-sum test. Polysomnography parameters were compared with Wilcoxon signed rank test. RESULTS Of 40 children with mean BMI 94% and mean age 8 ± 6 years old, 17 (43%) underwent a previous adenotonsillectomy. Overall, significant improvements were observed in the apnea-hypopnea index (AHI; 25.0 to 9.9 events/hour, p < .01) and oxygen nadir (82.7% to 88.5%, p < .01). A similar pattern was observed among the surgically naïve (AHI: 35.9 to 12.7 events/hour, p = .04; oxygen nadir: 79.7% to 86.4%, p = .2) and post-adenotonsillectomy groups (AHI: 10.4 to 6.2 events/hour, p = .02; oxygen nadir: 86.7% to 91.2%, p < .01). CONCLUSIONS/SIGNIFICANCE Polysomnography parameters significantly improved following DISE-directed interventions in obese and overweight children with obstructive sleep apnea.
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Affiliation(s)
- Natalia Filipek
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA
| | - Erin Kirkham
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA
| | - Maida Chen
- Division of Pulmonary and Sleep Medicine, Seattle Children’s Hospital, Seattle, WA, USA
| | - Cheng Cheng Ma
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA
| | - David L. Horn
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA
| | - Kaalan E. Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA
| | - Sanjay R. Parikh
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA
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29
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Øverland B, Berdal H, Akre H. Surgery for obstructive sleep apnea in young children: Outcome evaluated by polysomnograhy and quality of life. Int J Pediatr Otorhinolaryngol 2021; 142:110609. [PMID: 33418205 DOI: 10.1016/j.ijporl.2021.110609] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/09/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Hypertrophy of adenoid and tonsils is the most common risk factor for OSA in children, and adenotonsillectomy is considered the first-line treatment. The effect of surgery for OSA in children varies considerably between studies, and few studies have focused on the effect in young children under 5 years of age. Thus, the aim of this study was to: 1) evaluate the effect of surgery for OSA in young children using objective data from polysomnography and parent-reported symptoms using questionnaires, and 2) identify predictors of residual OSA following surgery. METHODS This is a prospective cohort study of children aged 2-4 years who were referred for surgery to treat OSA. Measures collected before and after surgery included polysomnography (PSG), Pediatric Sleep Questionnaire (PSQ), OSA-18 and clinical data. RESULTS 56 children completed a preoperative and postoperative PSG. Their median age was 3.1 (IQR 2.6-3.1) years. After surgery, 63% had an obstructive apnea hypopnea index (OAHI) < 1, 82% had an OAHI < 2 and 95% had an OAHI < 5. Parent-reported OSA-18 and PSQ scores improved significantly after surgery. In logistic regression analyses, higher preoperative OAHI was the only significant clinical predictor of residual OSA after surgery. CONCLUSION There was a high resolution rate after surgery for OSA in this group of young children, with significant improvements in both the OAHI measured with PSG and parent-reported symptoms. The only clinical predictor of residual OSA after surgery was higher preoperative OAHI.
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Affiliation(s)
- Britt Øverland
- Pediatric and Adult Sleep Disorder Clinic, Lovisenberg Diaconal Hospital, Oslo, Norway.
| | - Hanne Berdal
- Pediatric and Adult Sleep Disorder Clinic, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Harriet Akre
- Department of Otorhinolaryngology/Head and Neck Surgery, Oslo University Hospital, Oslo, Norway; University of Oslo, Institute of Clinical Medicine, Oslo, Norway
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30
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Effect of body weight on upper airway findings and treatment outcome in children with obstructive sleep apnea. Sleep Med 2020; 79:19-28. [PMID: 33465738 DOI: 10.1016/j.sleep.2020.12.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE/BACKGROUND Surgical interventions for obstructive sleep apnea (OSA) are less effective in obese than in normal-weight children. However, the mechanisms that underpin this relationship are not fully understood. Therefore, this study aimed to explore how body weight influences upper airway collapse and treatment outcome in children with OSA. METHODS We conducted a retrospective analysis of prospectively collected data on polysomnography, drug-induced sleep endoscopy (DISE), and treatment outcome in otherwise healthy children with OSA. Associations between body mass index (BMI) z-score and upper airway collapse during DISE were assessed using logistic regression modelling. Treatment success was defined as obstructive apnea-hypopnea index (oAHI) < 5 events/hour and cure as oAHI < 2 events/hour with obstructive apnea index < 1 event/hour. RESULTS A total of 139 children were included [median (Q1─Q3); age 4.5 (3.1─8.4) years; BMI z-score 0.3 (-0.8 to 1.4); oAHI 10.8 (6.8─18.0) events/hour]. Twenty-five of them were overweight and 21 were obese. After adjusting for age and history of upper airway surgery, BMI z-score was significantly correlated with circumferential upper airway collapse during DISE (odds ratio 1.67; 95% confidence interval 1.12─2.65; P = 0.011). Outcome of DISE-directed treatment was similar in normal-weight (success: 91.4%; cure: 78.5%), overweight (success: 88.0%; cure: 80.0%), and obese (success: 90.5%; cure: 76.5%) children. Children with circumferential collapse responded better to continuous positive airway pressure than to (adeno)tonsillectomy. CONCLUSION Increasing body weight is associated with circumferential upper airway collapse during DISE and, accordingly, may require treatment strategies other than (adeno)tonsillectomy.
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Raposo D, Menezes M, Rito J, Trindade-Soares M, Adónis C, Loureiro HC, Freire F. Predictors of OSA following adenotonsillectomy in children with trisomy 21. Clin Otolaryngol 2020; 46:256-262. [PMID: 33058475 DOI: 10.1111/coa.13657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/24/2020] [Accepted: 09/20/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Given that 30%-50% of children with trisomy 21 have persistent obstructive sleep apnoea (OSA) after adenotonsillectomy, we evaluated whether demographic, clinical and polysomnographic factors predicted persistent OSA and OSA severity after adenotonsillectomy. DESIGN Retrospective study. SETTING Secondary care hospital. PARTICIPANTS Retrospective review of 32 children with the diagnosis of trisomy 21 and OSA by polysomnography who underwent adenotonsillectomy, from January 2010 to December 2018. MAIN OUTCOME AND MEASURE Non-parametric analysis was used to compare pre- and postoperative factors, and regression was used to model persistent OSA and OSA severity. RESULTS Thirty-two children were included (17 males, median age 10.00 ± 8.00 years, median body mass index z-score 0.89 ± 1.25). Overall, adenotonsillectomy resulted in a significant improvement in median obstructive apnoea-hypopnoea index (oAHI) from 7.5 ± 8.95 to 4.40 ± 4.38 events per hour (P < .001) and in median OSA-18 score from 85.00 ± 12.00 to 61.00 ± 37.75 (P < .001). Persistent OSA was found in 56.25% of the children. Univariate regression suggests that postoperative OSA-18 score was associated with persistent OSA after adenotonsillectomy. Preoperative oAHI, preoperative oxygen desaturation index, pre- and postoperative OSA-18 scores correlated with OSA severity after adenotonsillectomy. However, in a multivariate model only the postoperative OSA-18 score correlated with OSA severity after adenotonsillectomy. CONCLUSIONS Although adenotonsillectomy results in a significant improvement of OSA in children with trisomy 21, more than half of the children had persistent OSA. The postoperative OSA-18 score was associated both with persistent OSA and OSA severity after adenotonsillectomy.
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Affiliation(s)
- Diogo Raposo
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Marco Menezes
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - João Rito
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Mafalda Trindade-Soares
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Cristina Adónis
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | | | - Filipe Freire
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
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32
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Ali NES, Alyono JC, Kumar AR, Cheng H, Koltai PJ. Sleep surgery in syndromic and neurologically impaired children. Am J Otolaryngol 2020; 41:102566. [PMID: 32504854 DOI: 10.1016/j.amjoto.2020.102566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/03/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To examine surgery performed for obstructive sleep apnea (OSA) in children with syndromic or neurologic comorbidities. MATERIAL AND METHODS Medical records of 375 children with OSA were retrospectively reviewed, including 142 patients with trisomy 21, 105 with cerebral palsy, 53 with muscular dystrophy, 32 with spinal muscular atrophy, 18 with mucopolysaccharidoses, 14 with achondroplasia, and 11 with Prader-Willi. OUTCOME MEASURES Apnea-hypopnea index (AHI), complications, length of postoperative stay, and endoscopic findings. RESULTS 228 patients received 297 surgical interventions, with the remainder undergoing observation or positive pressure ventilation. Adenoidectomy was the most common procedure performed (92.1% of patients), followed by tonsillectomy (91.6%). Average AHI decreased following tonsillectomy, from 12.4 to 5.7 (p = 0.002). The most common DISE finding was the tongue base causing epiglottic retroflexion. Lingual tonsillectomy also resulted in an insignificant decrease in the AHI. CONCLUSIONS Adenotonsillectomy, when there is hypertrophy, remains the mainstay of management of syndromic and neurologically-impaired children with OSA. However, additional interventions are often required, due to incomplete resolution of the OSA. DISE is valuable in identifying remaining sites of obstruction and guiding future management.
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33
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Challenges of pediatric obesity in perioperative care. Int Anesthesiol Clin 2020; 58:9-13. [PMID: 32282576 DOI: 10.1097/aia.0000000000000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Savini S, Ciorba A, Bianchini C, Stomeo F, Corazzi V, Vicini C, Pelucchi S. Assessment of obstructive sleep apnoea (OSA) in children: an update. ACTA ACUST UNITED AC 2020; 39:289-297. [PMID: 31708576 PMCID: PMC6843580 DOI: 10.14639/0392-100x-n0262] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/11/2019] [Indexed: 02/04/2023]
Abstract
OSA is a condition characterised by episodes of complete or partial obstruction of the upper airway, associated with blood-gas changes and atypical sleep patterns. Early diagnosis of OSA may reduce the occurrence of systemic complications over time, although the diagnosis of OSA is, unfortunately, often late. The aim of the work is to review the current concepts in evaluation of paediatric obstructive sleep apnoea (OSA), with an updated revision of the literature considering risk factors, clinical manifestations, and basic and advanced assessment in the paediatric population. For this narrative review, PubMed, Embase and Cinahl databases were searched for the last 10 years, according to PRISMA criteria/guidelines. Assessment of paediatric OSA remains challenging and paediatric patients should always be carefully evaluated; polysomnography is the gold standard for diagnosis of paediatric OSA.
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Affiliation(s)
- S Savini
- ENT Department, University Hospital of Ferrara, Italy
| | - A Ciorba
- ENT Department, University Hospital of Ferrara, Italy
| | - C Bianchini
- ENT Department, University Hospital of Ferrara, Italy
| | - F Stomeo
- ENT Department, University Hospital of Ferrara, Italy
| | - V Corazzi
- ENT Department, University Hospital of Ferrara, Italy
| | - C Vicini
- Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - S Pelucchi
- ENT Department, University Hospital of Ferrara, Italy
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Are obstructive sleep apnea and sleep improved in response to multidisciplinary weight loss interventions in youth with obesity? A systematic review and meta-analysis. Int J Obes (Lond) 2020; 44:753-770. [PMID: 31911659 DOI: 10.1038/s41366-019-0497-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/23/2019] [Accepted: 11/06/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pediatric obesity is closely associated with obstructive sleep apnea (OSA) and short sleep duration. While multidisciplinary weight loss interventions are recommended for pediatric obesity management, the evidence for their effects on OSA severity and overall sleep in youth have not been systematically examined. OBJECTIVES To conduct a systematic review and meta-analysis investigating the effects of multidisciplinary weight loss interventions on OSA severity and prevalence, and on overall sleep health in youth with obesity. METHODS A systematic search of interventional studies (participants age range: 10-19 yrs) was performed using PubMed, CENTRAL and Embase, from inception to May 2019. The quality of the evidence was assessed using the Cochrane risk of bias tool. RESULTS Ten studies were included by the end of the screening process. Ninety percent of the included studies reported a decrease in OSA prevalence post-intervention, and OSA was normalized for 46.2-79.7% of the youth. The meta-analysis comprising seven longitudinal studies revealed significant reductions in apnea-hypopnea index (effect size: -0.51, 95%CI -0.94 to -0.08, p = 0.019), and oxygen desaturation index (effect size: -0.28, 95%CI = -0.50 to -0.05, p = 0.016). Seventy-five percent of the studies reported improved sleep duration in youth with OSA. CONCLUSIONS Evidence suggests that multidisciplinary weight loss interventions result in improvements in OSA severity and sleep duration in youth with obesity. Future randomized controlled trials are warranted to better assess and understand the independent implications of weight loss, fat mass decrease and chronic exercise on OSA and sleep health in this population.
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Verhulst S. Long Term Continuous Positive Airway Pressure and Non-invasive Ventilation in Obstructive Sleep Apnea in Children With Obesity and Down Syndrome. Front Pediatr 2020; 8:534. [PMID: 32984228 PMCID: PMC7484653 DOI: 10.3389/fped.2020.00534] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/27/2020] [Indexed: 12/29/2022] Open
Abstract
This review will focus on non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP) therapy in children with obstructive sleep apnea (OSA) due to obesity and underlying syndromes. These children have a high prevalence of OSA and residual OSA after adenotonsillectomy. Therefore, a high proportion of these children are treated with CPAP or NIV. This review will focus on treatment selection tools and will subsequently cover specific issues on CPAP treatment in obese and syndromic children with a major focus on Down syndrome.
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Affiliation(s)
- Stijn Verhulst
- Lab of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.,Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
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Fehrm J, Nerfeldt P, Sundman J, Friberg D. Adenopharyngoplasty vs Adenotonsillectomy in Children With Severe Obstructive Sleep Apnea: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2019; 144:580-586. [PMID: 29852045 DOI: 10.1001/jamaoto.2018.0487] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Adenotonsillectomy (ATE) is the primary surgical method for treating obstructive sleep apnea (OSA) in children. However, children with severe OSA have an increased risk for residual OSA after ATE. Previous studies indicate that adenopharyngoplasty (APP), a modified ATE with closure of the tonsillar pillars, might improve the surgical outcome, but the overall evidence is weak. Objective To determine whether APP is more effective than ATE for treating severe OSA in otherwise healthy children. Design, Setting, and Participants A blinded randomized clinical trial was conducted at the otorhinolaryngology department at Karolinska University Hospital, Stockholm, Sweden. Eighty-three children, aged 2 to 4 years, with an obstructive apnea-hypopnea index (OAHI) score of 10 or higher, were randomized to APP (n = 36) or ATE (n = 47). Participants were recruited from December 1, 2014, through November 31, 2016. Interventions Adenotonsillectomy was performed in all 83 patients in both groups by the cold steel technique. The APP group also underwent closure of the tonsillar pillars with 2 inverted sutures on each side. Main Outcomes and Measures The primary outcome was the difference between the groups in OAHI score change before and after surgery. A higher score indicates worse problems and a score of 10 or higher is defined as severe OSA. The outcome was evaluated per protocol and with intention-to-treat analysis. Secondary outcomes were other polysomnography variables and the Obstructive Sleep Apnea-18 (OSA-18) questionnaire (possible total symptom score range, 18-126; higher scores indicate worse quality of life). Polysomnography was performed and the OSA-18 questionnaire was completed preoperatively and 6 months postoperatively. Results A total of 83 children (49 [59%] boys; mean [SD] age, 36.6 [9.2] months) were included in the study. Of these, 74 (89%) (APP, n = 30; ATE, n = 44) completed the study. The mean (SD) preoperative OAHI score was 23.8 (11.8) for APP and 23.8 (11.5) for ATE. Both the APP and ATE groups had a significant decrease in mean OAHI score after surgery (-21.7; 95% CI, -26.3 to -17.2; and -21.1; 95% CI, -24.5 to -17.7, respectively), but there was no significant difference between the groups (0.7; 95% CI, -4.8 to 6.1). Furthermore, no significant differences between the groups were seen regarding other polysomnography variables (eg, respiratory distress index: mean, 0.6; 95% CI, -5.0 to 6.3) or the OSA-18 questionnaire (eg, total symptom score: -0.5; 95% CI, -13 to 12). One patient from each group was readmitted owing to postoperative bleeding, but no other complications were seen. Conclusions and Relevance This trial did not show that APP was more effective than ATE alone to treat otherwise healthy children with severe OSA. This finding suggests that ATE should continue to be the primary treatment for OSA in children. Trial Registration ClinicalTrials.gov Identifier: NCT02315911.
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Affiliation(s)
- Johan Fehrm
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Pia Nerfeldt
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Joar Sundman
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Danielle Friberg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Otorhinolaryngology, Institute of Surgical Science, Uppsala University, Uppsala, Sweden
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Liu X, Immanuel S, Kennedy D, Martin J, Pamula Y, Baumert M. Effect of adenotonsillectomy for childhood obstructive sleep apnea on nocturnal heart rate patterns. Sleep 2019; 41:5079141. [PMID: 30165465 DOI: 10.1093/sleep/zsy171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Indexed: 11/14/2022] Open
Abstract
Study Objectives To assess the effect of adenotonsillectomy for relieving obstructive sleep apnea syndrome (OSAS) symptoms in children on cardiac autonomic modulation. Methods In 354 children enrolled in the Childhood Adenotonsillectomy Trial, randomized to undergo either early adenotonsillectomy (eAT; N = 181) or a strategy of watchful waiting with supportive care (WWSC; N = 173), nocturnal heart rate control was analyzed during quiet, event-free sleep at baseline and at 7 months using overnight polysomnography (PSG). The relative frequency of patterns indicating monotonous changes in heart rate was quantified. Results Children who underwent eAT demonstrated a significantly greater reduction in heart rate patterns postsurgery than the WWSC group. On assessing those heart rate patterns regarding normalization of clinical PSG, heart patterns were reduced to a similar level in both groups. In children whose AHI normalized spontaneously, heart rate patterns were already significantly less frequent at baseline, suggesting that upper airway obstruction was milder in this group at the outset. Conclusions Adenotonsillectomy reduces monotonous heart rate patterns throughout quiet event-free sleep, reflecting a reduction in cardiac autonomic modulation. Heart rate pattern analysis may help quantifying the effect of OSAS on autonomic nervous system activity in children. Clinical Trial Registration: The study was registered at Clinicaltrials.gov (#NCT00560859).
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Affiliation(s)
- Xiao Liu
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, Australia
| | - Sarah Immanuel
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, Australia
| | - Declan Kennedy
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, Australia.,Children's Research Centre, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia
| | - James Martin
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, Australia
| | - Yvonne Pamula
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, Australia
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, Australia
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Prévost AS, Hylands M, Gervais M, Praud JP, Battista MC, Déziel-Malouin S, Lachance M, Lamontagne F. Drug-induced sleep endoscopy compared with systematic adenotonsillectomy in the management of obstructive sleep apnoea in children: a systematic review and meta-analysis protocol. BMJ Open 2019; 9:e028242. [PMID: 31511282 PMCID: PMC6738734 DOI: 10.1136/bmjopen-2018-028242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 08/16/2019] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnoea affects up to 6% of children worldwide. Although current guidelines recommend systematic tonsillectomy and adenoidectomy, many children do not benefit from these interventions. Drug-induced sleep endoscopy (DISE) allows the dynamic evaluation of patients' airways to identify the specific anatomic sites of obstruction. This intervention can potentially guide subsequent invasive procedures to optimise outcomes and minimise the number of children exposed to unnecessary operations. METHODS AND ANALYSIS We will identify randomised controlled trials and controlled observational studies comparing DISE-directed interventions to systematic tonsillectomy and adenoidectomy in paediatric populations. We will search MEDLINE, EMBASE, CINAHL, CENTRAL as well as clinical trial registries and conference proceedings (initial electronic search date 9 October 2018). Screening, data extraction and risk of bias assessments will be performed in duplicate by independent reviewers. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to assess the overall quality of evidence and present our results. ETHICS AND DISSEMINATION Ethics approval is not required for this systematic review of published data. This review will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will present our findings at otorhinolaryngology conferences and publish a report in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018085370.
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Affiliation(s)
- Anne-Sophie Prévost
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mathieu Hylands
- Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mireille Gervais
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jean-Paul Praud
- Division of Pediatric Pulmonology-Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Claude Battista
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Monia Lachance
- Department of Anesthesia, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Francois Lamontagne
- Department of Internal Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Lam DJ, Krane NA, Mitchell RB. Relationship between Drug-Induced Sleep Endoscopy Findings, Tonsil Size, and Polysomnographic Outcomes of Adenotonsillectomy in Children. Otolaryngol Head Neck Surg 2019; 161:507-513. [PMID: 31331227 DOI: 10.1177/0194599819860777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE (1) Determine the correlation of awake tonsil scores and preadenotonsillectomy (pre-AT) sleep endoscopy findings. (2) Assess the relationship between polysomnographic AT outcomes with awake tonsil scores and sleep endoscopy ratings of tonsil and adenoid obstruction. STUDY DESIGN Retrospective case series with chart review. SETTING Tertiary care children's hospital. SUBJECTS AND METHODS Children aged 1 to 18 years who underwent sleep endoscopy and AT from January 1, 2013, to August 30, 2016, were included. Pre-AT sleep endoscopy findings were scored with the Sleep Endoscopy Rating Scale. Awake tonsil scores and sleep endoscopy ratings were compared with Spearman correlation. Associations between changes in pre- and post-AT polysomnography parameters and (1) awake tonsil scoring and (2) sleep endoscopy scoring were assessed with 1-way analysis of variance and linear regression. RESULTS Participants included 36 children (mean ± SD age, 6.8 ± 4.3 years; 68% male, 44% obese). Awake tonsil scores and sleep endoscopy ratings were strongly correlated (R = 0.58, P = .003). Awake tonsil scores were not associated with changes in any polysomnography parameters after AT (all P > .05), while sleep endoscopy ratings of adenotonsillar obstruction were significantly associated (all P < .05, R2 = 0.16-0.35). Patients with minimal adenotonsillar obstruction during sleep endoscopy had less improvement than those with partial or complete obstruction (mean obstructive apnea-hypopnea index change: -8.2 ± 11.5 vs -15.9 ± 14.3, and -46.8 ± 31.3, respectively; P < .001). CONCLUSIONS In children at risk for AT failure, assessment of dynamic collapse with sleep endoscopy may better predict the outcome of AT than awake tonsil size assessment, thus helping to inform surgical expectations.
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Affiliation(s)
- Derek J Lam
- 1 Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Natalie A Krane
- 1 Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Ron B Mitchell
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Texas-Southwestern, Dallas, Texas, USA
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Lynch MK, Elliott LC, Avis KT, Schwebel DC, Goodin BR. Quality of Life in Youth With Obstructive Sleep Apnea Syndrome (OSAS) Treated With Continuous Positive Airway Pressure (CPAP) Therapy. Behav Sleep Med 2019; 17:238-245. [PMID: 28557581 PMCID: PMC7032644 DOI: 10.1080/15402002.2017.1326918] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE/BACKGROUND Improvement is sought for youth with obstructive sleep apnea syndrome (OSAS) who have poor quality of life (QoL), which resolves somewhat following treatment. One mitigating factor in improved QoL following treatment may be adherence to the CPAP protocol, which presents a barrier to most youth. This study explored relations between CPAP adherence and QoL in youth with OSAS. PARTICIPANTS We recruited 42 youth-caregiver dyads in which youth between the ages of 8 and 16 years were diagnosed with OSAS and required CPAP use as part of their treatment plan. METHODS Following diagnosis of OSAS requiring treatment with CPAP therapy, caregivers completed baseline measures of OSAS-specific QoL. The OSAS-specific QoL domains assessed included sleep disturbance, physical symptoms, emotional distress, daytime function, and caregiver concern. Families received routine CPAP care for three months, after which caregivers again completed measures of OSAS-specific QoL. Adherence data were collected from smartcards within the CPAP machine after three months of treatment. RESULTS Fifteen youth were adherent to CPAP therapy and 10 were not adherent. CPAP-adherent youth demonstrated significant changes in two domains of OSAS-specific QoL when compared to nonadherent youth: decreased sleep disturbance and decreased caregiver concern. CONCLUSIONS CPAP adherence appears to be associated with positive changes in OSAS-specific QoL domains. It will be important for future research and clinical work to examine strategies for improving CPAP adherence in youth with OSAS.
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Affiliation(s)
- Mary K. Lynch
- University of Alabama at Birmingham, Department of Psychology
| | | | - Kristin T. Avis
- University of Alabama at Birmingham, Department of Pediatrics
| | | | - Burel R. Goodin
- University of Alabama at Birmingham, Department of Psychology
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42
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Outcome of drug-induced sleep endoscopy-directed surgery for persistent obstructive sleep apnea after adenotonsillar surgery. Int J Pediatr Otorhinolaryngol 2019; 120:118-122. [PMID: 30776569 DOI: 10.1016/j.ijporl.2019.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Drug-induced sleep endoscopy (DISE) is suitable for evaluating persistent obstructive sleep apnea syndrome (OSAS) after adenotonsillar surgery as a means to guide surgical intervention, yet few studies demonstrate its usefulness in resolving the syndrome. We describe our experience of DISE-directed surgery in children with persistent OSAS by analysing objective and subjective outcomes of this treatment. METHODS Prospective study of 20 otherwise healthy 2-12 year-old children with OSAS persisting after adenotonsillar surgery. All patients underwent DISE-directed surgery and were followed up clinically and with a polysomnogram at 12 ± 3 months. RESULTS All 20 children had an apnea-hypopnea index (AHI) score ≥1 (mean: 6.1 ± 4.9) and 75% had AHI>3 before surgery. We performed a total of 14 total tonsillectomies (70%), 7 with associated pharyngoplasties; 5 radiofrequency turbinate reductions (25%); 7 radiofrequency lingual tonsil reductions (35%); and 10 revision adenoidectomies (50%). No surgery-related complications were observed. AHI scores at follow-up were significantly lower than AHI scores before surgery (1.895 ± 1.11 vs 6.143 ± 4.88; p < 0.05) and, in 85% (n = 17) of patients, AHI was below 3. There was a significant reduction in the number of children with AHI>3 in follow-up at 12 ± 3 months (15%; n = 3) compared to before surgery (75%; n = 15) (p < 0.005). CONCLUSION DISE-directed surgery for otherwise healthy children with persistent OSAS is a useful and safe technique to decide a therapeutic strategy and to obtain good objective and subjective results regarding resolution of the syndrome.
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Scheffler P, Wolter NE, Narang I, Amin R, Holler T, Ishman SL, Propst EJ. Surgery for Obstructive Sleep Apnea in Obese Children: Literature Review and Meta-analysis. Otolaryngol Head Neck Surg 2019; 160:985-992. [PMID: 30776977 DOI: 10.1177/0194599819829415] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Surgical intervention for obstructive sleep apnea (OSA) in overweight and obese children may not be as effective as it is in normal-weight children. The purpose of this study was to systematically review the effects of various surgical interventions for OSA in obese children and to meta-analyze the current data. DATA SOURCES PubMed, OVID, and Cochrane databases. REVIEW METHODS Databases were searched for studies examining adenotonsillectomy, uvulopalatopharyngoplasty, supraglottoplasty, or tongue base surgeries and combinations in obese children with OSA. Adenotonsillectomy was the only procedure with enough data for meta-analysis; polysomnographic data were extracted and analyzed using a random-effects model. RESULTS For adenotonsillectomy, 11 studies were included in the meta-analysis. Despite significant improvement in the apnea-hypopnea index (22.9 to 8.1 events/h, P < .001), respiratory disturbance index (24.8 to 10.4 events/h, P < .001), and oxygen saturation nadir (78.4% to 87.0%, P < .001), rates of persistent OSA ranged from 51% to 66%, depending on the outcome criterion used. There was evidence of limited effectiveness for surgical interventions to treat OSA in obese children using uvulopalatoplasty (12.5%) and tongue base surgery (74%-88%). CONCLUSIONS Surgical interventions for OSA in overweight and obese children are effective at reducing OSA but with higher rates of persistent OSA than reported for normal-weight children. However, the amount of reduction appears to vary by surgical procedure. More attention should be paid toward preoperative weight loss and patient selection, and parents should be provided with realistic postoperative expectations in this difficult-to-treat population.
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Affiliation(s)
- Patrick Scheffler
- 1 Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- 1 Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Indra Narang
- 2 Division of Respiratory Medicine and Sleep Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Reshma Amin
- 2 Division of Respiratory Medicine and Sleep Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Theresa Holler
- 1 Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Stacey L Ishman
- 3 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,4 Divisions of Otolaryngology-Head and Neck Surgery and Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Evan J Propst
- 1 Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Frye S, Fernandez-Mendoza J, Calhoun SL, Gaines J, Vgontzas AN, Liao D, Bixler EO. Childhood obesity, weight loss and developmental trajectories predict the persistence and remission of childhood sleep-disordered breathing. Pediatr Obes 2019; 14:10.1111/ijpo.12461. [PMID: 30256539 PMCID: PMC6424126 DOI: 10.1111/ijpo.12461] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/21/2018] [Accepted: 07/02/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Obesity has been recognized as a risk factor for childhood sleep-disordered breathing (SDB), yet it remains unclear how obesity and weight change predict the course of childhood SDB. OBJECTIVE The objective of the study is to investigate the role of body weight, upper airway abnormalities and developmental trajectories on the persistence and remission of childhood SDB in the transition to adolescence. METHODS The Penn State Child Cohort is a representative population sample of 700 children (5-12 years), of whom 421 were followed up as adolescents (12-23 years). Participants underwent a clinical history, physical examination and polysomnography at both time points. RESULTS Obesity and enlarged tonsils were cross-sectionally associated with childhood SDB. Longitudinally, baseline obesity predicted the persistence of childhood SDB (OR = 3.75, 95% CI = 2.00-7.05), while weight loss predicted its remission (OR = 1.67, 95% CI = 1.11-2.50). Children with enlarged tonsils who remitted from SDB had not experienced significant weight loss and only 4.4% had undergone adeno/tonsillectomy. Body fat distribution/composition at follow-up was similar in those who had remitted from childhood SDB as compared with those who had never experienced SDB, while those who persisted with childhood SDB showed significant android distribution and visceral adiposity at follow-up. CONCLUSIONS Our data support a causal role for obesity and weight loss in the chronicity and remission, respectively, of childhood SDB in the transition to adolescence and suggest that remission of SDB is related to developmental trajectories of the upper airway in a significant proportion of children. Thus, targeting childhood obesity and weight gain should be a priority in the prevention and treatment of SDB during this critical developmental period.
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Affiliation(s)
- S.S. Frye
- Sleep Research & Treatment Center, Penn State Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - J. Fernandez-Mendoza
- Sleep Research & Treatment Center, Penn State Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - S. L. Calhoun
- Sleep Research & Treatment Center, Penn State Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - J. Gaines
- Sleep Research & Treatment Center, Penn State Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - A. N. Vgontzas
- Sleep Research & Treatment Center, Penn State Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - D. Liao
- Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - E. O. Bixler
- Sleep Research & Treatment Center, Penn State Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, PA, USA
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Keefe KR, Patel PN, Levi JR. The shifting relationship between weight and pediatric obstructive sleep apnea: A historical review. Laryngoscope 2018; 129:2414-2419. [PMID: 30474230 DOI: 10.1002/lary.27606] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES For more than a century, pediatric obstructive sleep apnea (OSA) was associated with failure to thrive. However, that association has faded over the last few decades. A 21st century child with OSA is much more likely to be overweight than underweight. This raises the question: Has pediatric OSA changed over time, or has the rise of childhood obesity in the United States created a new, separate disease? This literature review explores the historical shift in the relationship between weight and OSA, and the associated changes in treatment. RESULTS We demonstrate a clear transition in the prevalence of failure to thrive and obesity in the OSA literature in the mid-2000s. What is less clear is whether these two clinical phenotypes should be considered two distinct diseases, or whether subtle differences in one set of pathophysiologic pathways-adenotonsillar hypertrophy, altered inflammation, and increased energy expenditure-can lead to divergent metabolic outcomes. More research is needed to fully elucidate the pathophysiology of OSA in children with obesity. CONCLUSIONS We may need new and different treatments for obesity-associated OSA as adenotonsillectomy-which is effective at reversing failure to thrive in OSA-is not as effective at treating OSA in children with obesity. One option is drug-induced sleep endoscopy, which could personalize and improve surgical treatment of OSA. There is some evidence that therapies used for OSA in adults (e.g., weight loss and positive airway pressure) are also helpful for overweight/obese children with OSA. Laryngoscope, 129:2414-2419, 2019.
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Affiliation(s)
| | - Prachi N Patel
- Boston University School of Medicine, Boston, Massachusetts
| | - Jessica R Levi
- Boston University School of Medicine, Boston, Massachusetts.,Department of Otolaryngology, Boston University Medical Center, Boston, Massachusetts, U.S.A
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46
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Pulse wave amplitude and heart period variability in children with upper airway obstruction. Sleep Med 2018; 50:55-62. [DOI: 10.1016/j.sleep.2018.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 11/23/2022]
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47
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O'Brien DC, Desai Y, Swanson RT, Parekh U, Schubart J, Carr MM. Sleep study indices and early post-tonsillectomy outcomes. Am J Otolaryngol 2018; 39:623-627. [PMID: 30017372 DOI: 10.1016/j.amjoto.2018.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate the relationships between preoperative sleep study findings of children undergoing adenotonsillectomy anesthesia emergence time, recovery room time, and length of stay. STUDY DESIGN Retrospective case series with chart review. SETTING Tertiary care children's hospital. SUBJECTS AND METHODS All children aged 1-17 years who had undergone adenotonsillectomy between 2013 and 2016 were included. Apnea-hypopnea index (AHI), central apnea index (CAI), oxygen saturation nadir, and end-tidal carbon dioxide were compared with the in-operating room times, recovery room time, and length of stay. RESULTS Three hundred and fourteen patients with a mean age of 6.67 (95% CI 6.25-7.09) years were included. Mean AHI was 9.14 (95% CI 7.33-10.95), mean CI was 0.88 (95% CI 0.50-1.26), mean oxygen saturation nadir was 82.9% (95% CI 81.41-84.32), mean end-tidal carbon dioxide was 50.3 (95% CI 49.39-51.15). Mean emergence time was 16 min (95% CI 15:11-17:13 min), recovery room time was 66 min (95% CI 1:00-1:11 h), and length of stay was 25.7 h (95% CI 21:43-30:00 h). When controlled for age, gender and BMI, linear regression showed that children with a higher AHI had a significantly longer operating room and operative times (p < 0.001), emergence time (p < 0.001) and length of stay (p = 0.01). CAI was related to shorter total operating room times (p = 0.03). AHI, oxygen saturation nadir, CAI and end-tidal carbon dioxide were not associated with recovery room time. CONCLUSION Preoperative sleep study indices are associated with longer in-operating room times and length of stay, and can be useful in planning operating room and hospital flow.
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Affiliation(s)
- Daniel C O'Brien
- Department of Otolaryngology-Head and Neck Surgery, 4520 Health Science Center South, PO Box 9200, West Virginia University, Morgantown, WV, USA
| | - Yuti Desai
- Drexel University, 3141 Chestnut St, Philadelphia, PA 19104, USA
| | - Robert T Swanson
- Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Uma Parekh
- Penn State Department of Anesthesia, 500 University Drive, Hershey, PA 17033, USA
| | - Jane Schubart
- Penn State Departments of Surgery and Public Health, 500 University Drive, Hershey, PA 17033, USA
| | - Michele M Carr
- Department of Otolaryngology-Head and Neck Surgery, 4520 Health Science Center South, PO Box 9200, West Virginia University, Morgantown, WV, USA.
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AKCAN FA, Bayram Akcan H, Dündar Y, Uluat A, Karakuş E. The Histopathological Effect of Topical Nasal Corticosteroids on Adenoid Tissue. KONURALP TIP DERGISI 2018. [DOI: 10.18521/ktd.365710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Van Eyck A, De Guchtenaere A, Van Gaal L, De Backer W, Verhulst SL, Van Hoorenbeeck K. Clinical Predictors of Residual Sleep Apnea after Weight Loss Therapy in Obese Adolescents. J Pediatr 2018; 196:189-193.e1. [PMID: 29502877 DOI: 10.1016/j.jpeds.2017.12.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/06/2017] [Accepted: 12/19/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To investigate clinical factors that could predict residual sleep-disordered breathing (SDB) after weight loss. STUDY DESIGN Obese subjects between 10 and 19 years of age were recruited while entering an in-patient weight loss treatment program. All subjects underwent anthropometry and sleep screening using a portable device at baseline and after 4-6 months of therapy. Sleep and International Study of Asthma and Allergies in Childhood questionnaires were completed at baseline. RESULTS A total of 339 patients were included. Median age was 15.4 years (10.1-19.1). Body mass index z score at baseline was 2.75 ± 0.42, and 35% of subjects were boys. SDB was present in 32%. After a mean decrease in body mass index z score of 32%, residual SDB was found in 20% of subjects with SDB at baseline. Subjects with more severe SDB (OR 1.18; CI 1.01-1.34; P = .02) and respiratory allergies (OR 7.85; CI 1.20-51.39; P = .03) were at higher risk of developing residual SDB, unlike age, sex, and anthropometric variables. CONCLUSIONS Weight loss was successful for treating SDB in 80% of patients. More severe SDB and the presence of respiratory allergies at baseline were associated with a higher risk of residual SDB after weight loss.
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Affiliation(s)
- Annelies Van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
| | | | - Luc Van Gaal
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium; Department of Endocrinology, Diabetology, and Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - Wilfried De Backer
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium; Department of Pulmonology, Antwerp University Hospital, Edegem, Belgium
| | - Stijn L Verhulst
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
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Abstract
Abstract
Background: Sleep-disordered breathing (SDB) has been a rapidly increasing health problem in Thai. Its effect on quality of life of Thai patients has not been adequately addressed. Objective: Determine the relationship between SDB and self-reported general health status in Thai patients. Materials and methods: A descriptive and cross-sectional study was used. Two hundred and sixtyeight patients (195 men and 73 women, age: 16-82 years) are recruited from King Chulalongkorn Memorial Hospital between January 2006 and December 2007. A health profile was obtained by self-administered questionnaire. SDB severity was assessed using an attended single-night comprehensive polysomnography. Results: SDB was not directly associated with the general health status. Presence of excessive daytime sleepiness, which was the major symptom of obstructive sleep apnea, was associated with a decrease in all domains of Short Form 36. Age, sex, and body mass index were also related to a lower physical function. Hypertension and excessive daytime sleepiness were associated with the severity of SDB. Conclusion: SDB is indirectly related to a lower general health status, and this relationship is of clinical significance.
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