1
|
Kim MJ, Bae SH, Lee SM, Lee KH, Kim DK. Effect of Adenotonsillectomy on Attention in Korean Children With Sleep-Disordered Breathing. Clin Exp Otorhinolaryngol 2018; 11:199-204. [PMID: 29774697 PMCID: PMC6102337 DOI: 10.21053/ceo.2018.00115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 02/23/2018] [Accepted: 03/07/2018] [Indexed: 11/28/2022] Open
Abstract
Objectives Pediatric sleep-disordered breathing (SDB) is a common debilitating disorder that can adversely affect the attention and academic performance of school-age children. Unfortunately, only a few studies have examined the effect of SDB treatment on attention in pediatric populations. Therefore, the aim of this study was to prospectively investigate the effect of SDB treatment on attention in children. Methods This study consecutively enrolled SDB children with adenotonsillar hypertrophy. All subjects underwent standard-of-care treatment (adenotonsillectomy or close observation) and were evaluated using a computerized comprehensive attention test at the initial visit. Comprehensive attention tests consisted of both sustained and divided attention tasks. Each completed task was assigned an attention score, which was based on the number of omission or commission errors. The comprehension attention test was repeated 1 year later. Results A total of 171 children who underwent adenotonsillectomy and 32 children who did not undergo adenotonsillectomy were included in this study. At baseline, there was no significant difference according to the score of all type comprehension attention tests between children in the adenotonsillectomy group and in the observation group. One year after treatment, children in the adenotonsillectomy group had significantly improved scores in all attention tasks. Children in the observation group had only significant improvement in omission errors on sustained attention tasks. Meanwhile, the attention score based on commission errors of divided attention tasks was significantly worse than at baseline for those. Conclusion Our study showed that adenotonsillectomy may be helpful in improving attention in children with SDB.
Collapse
Affiliation(s)
- Min Jae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Sung Hee Bae
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Sung Min Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Kang Hyun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.,Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea
| |
Collapse
|
2
|
Julien-Marsollier F, Salis P, Abdat R, Diallo T, Van Den Abbelle T, Dahmani S. Predictive factors of early postoperative respiratory complications after tonsillectomy in children with unidentified risks for this complication. Anaesth Crit Care Pain Med 2017; 37:439-445. [PMID: 29033358 DOI: 10.1016/j.accpm.2017.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 06/15/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Tonsillectomy is considered as a therapeutic option in obstructive sleep apnoea syndrome (OSAS). Postoperative respiratory failure is a complication that can require respiratory support. The main objective of our study is to determine risk factors of postoperative respiratory complications in children undergoing tonsillectomy. MATERIAL AND METHODS This is a retrospective single centre observational study including patients with unanticipated postoperative respiratory failure. Patients with a planned preoperative intensive care admission were excluded (age is lower than 2 years, overweight (>95% percentile of BMI), moderate or severe asthma, major medical conditions). Those patients were compared with randomly selected control patients. Factors studied were: age, weight, indication of surgery, ASA status, preoperative illness conditions, durations of surgery and anaesthesia and administered medications. Statistics used a univariate analysis and a multivariate logistic regression. RESULTS Eight hundred and five patients underwent adenotonsillectomy during the study period and 25 developed postoperative respiratory failure. These patients were compared to 103 non-complicated control patients. Age (<4 years), weight (<18kg), indication of surgery (as SOAS), laryngomalacia, stable and minor congenital cardiac malformation and duration of anaesthesia were found statistically associated. Multivariate analysis found that weight <18kg is a risk factor associated with the occurrence of postoperative respiratory failure. Overall the model shows a strong accuracy with an area under the curve of ROC analysis of 0.9 [95% confidence interval: 0.85-0.95]. DISCUSSION Our study found that weight <18kg is a major risk factor for predicting a postoperative respiratory complication.
Collapse
Affiliation(s)
- Florence Julien-Marsollier
- Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France
| | - Pierre Salis
- Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France
| | - Rachida Abdat
- Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France
| | - Thierno Diallo
- Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France
| | - Thierry Van Den Abbelle
- Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France; Department of Ent-Nose and Throat Surgery, Robert Debré University Hospital, AP-HP, 75019 Paris, France; UMR Inserm U 676, Robert Debré University Hospital, 75019 Paris, France
| | - Souhayl Dahmani
- Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France; Department of Ent-Nose and Throat Surgery, Robert Debré University Hospital, AP-HP, 75019 Paris, France.
| |
Collapse
|
3
|
Kim DK, Rhee CS, Han DH, Won TB, Kim DY, Kim JW. Treatment of allergic rhinitis is associated with improved attention performance in children: the Allergic Rhinitis Cohort Study for Kids (ARCO-Kids). PLoS One 2014; 9:e109145. [PMID: 25330316 PMCID: PMC4201447 DOI: 10.1371/journal.pone.0109145] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/28/2014] [Indexed: 01/27/2023] Open
Abstract
Background It has been well known that pediatric allergic rhinitis was associated with poor performance at school due to attention deficit. However, there were no cohort studies for the effect of treatment of allergic rhinitis on attention performance in pediatric population. Thus, the aim of this study was to investigate whether attention performance was improved after treatment in children with allergic rhinitis. Methods In this ARCO-Kids (Allergic Rhinitis Cohort Study for Kids), consecutive pediatric patients with rhinitis symptoms underwent a skin prick test and computerized comprehensive attention test. According to the skin prick test results, the children were diagnosed as allergic rhinitis or non- allergic rhinitis. All of the patients were regularly followed up and treated with oral medication or intranasal corticosteroid sprays. The comprehensive attention tests consisted of sustained and divided attention tasks. Each of the tasks was assessed by the attention score which was calculated by the number of omission and commission errors. The comprehension attention test was repeated after 1 year. Results A total of 797 children with allergic rhinitis and 239 children with non-allergic rhinitis were included. Initially, the attention scores of omission and commission errors on divided attention task were significantly lower in children with allergic rhinitis than in children with non-allergic rhinitis. After 1 year of treatment, children with allergic rhinitis showed improvement in attention: commission error of sustained (95.6±17.0 vs 97.0±16.6) and divided attention task (99.1±15.8 vs 91.8±23.5). Meanwhile, there was no significant difference of attention scores in children with non-allergic rhinitis. Conclusions Our study showed that management of allergic rhinitis might be associated with improvement of attention.
Collapse
Affiliation(s)
- Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
- * E-mail:
| | - Chae Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea, Republic of Korea
| | - Doo Hee Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea, Republic of Korea
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea, Republic of Korea
| | - Dong-Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea, Republic of Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| |
Collapse
|
4
|
Laryngeal pathologies as an etiologic factor of obstructive sleep apnea syndrome in children. Int J Pediatr Otorhinolaryngol 2013; 77:573-5. [PMID: 23333286 DOI: 10.1016/j.ijporl.2012.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 12/05/2012] [Accepted: 12/14/2012] [Indexed: 11/21/2022]
Abstract
Obstructive sleep apnea syndrome is a chronic condition of airway obstruction, common in children, with known clinical consequences. The etiology of OSAS in children stems from a combination of obstructing structural factors and neuromotor factors. In children, tonsilar hypertrophy accounts for this condition in most cases, however, in about 20% of the cases, other causes are involved. For the treatment of apnea in children, adenotonsillectomy is the most commonly performed procedure, though we should indicate the treatment according to its underlying cause. The aim of this paper is to highlight other possible apnea etiologies, contributing to appropriate diagnosis and treatment. We present two cases of patients with apnea of unusual origin: one of respiratory dystonia and another of supraglottic stenosis as the causative factor of obstructive sleep apnea. In conclusion, we emphasize the need for the ENT to perform detailed research on the etiology of apnea, for individualized treatment.
Collapse
|
5
|
Kaciński M, Budziszewska B, Lasoń W, Zając A, Skowronek-Bała B, Leśkiewicz M, Kubik A, Basta-Kaim A. Level of S100B protein, neuron specific enolase, orexin A, adiponectin and insulin-like growth factor in serum of pediatric patients suffering from sleep disorders with or without epilepsy. Pharmacol Rep 2012; 64:1427-33. [DOI: 10.1016/s1734-1140(12)70940-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/09/2012] [Indexed: 11/29/2022]
|
6
|
Montgomery-Downs HE, Ramadan HH, Clawges HC, McBean AL, Insana SP, Santy EE. Digital oral photography for pediatric tonsillar hypertrophy grading. Int J Pediatr Otorhinolaryngol 2011; 75:841-3. [PMID: 21514678 DOI: 10.1016/j.ijporl.2011.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 03/18/2011] [Accepted: 03/24/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tonsillar hypertrophy contributes to pediatric disorders, including obstructive sleep apnea. The goal was to determine the utility of digital photographs for pediatric tonsillar grading. METHODS Using Brodsky's grading scale, 41 children (3.0-14.6 years) had in-person tonsil grading during a routine pediatric ENT physical examination. Oral photographs were obtained with a standard single-lens reflex digital camera and graded by the same ENT physician and by an independent Pediatrician. RESULTS In-person and photograph gradings were highly correlated, but also differed significantly. Yet photograph gradings did not differ between physicians, suggesting that photographs provide unique, consistent information to different clinicians. Discrepancies between in-person and photograph gradings were not explained by child age. CONCLUSION Static images may provide experts more time for mental calculations and may therefore provide a superior estimation of tonsil size. Photographs should be considered for remote use, as well as a potentially better alternative to current in vivo estimates.
Collapse
|
7
|
Snow A, Gozal D, Valdes R, Jortani SA. Urinary proteins for the diagnosis of obstructive sleep apnea syndrome. Methods Mol Biol 2010; 641:223-241. [PMID: 20407950 DOI: 10.1007/978-1-60761-711-2_13] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Approximately 2-3% of all children in the United States suffer from obstructive sleep apnea (OSA). This condition is characterized by repeated events of partial or complete obstruction of the upper airways during sleep leading to recurring episodes of hypercapnia, hypoxemia, and arousal throughout the night as well as snoring, which afflicts 7-10% of all children. Since clinical history and physical examination are unreliable in the differentiation between children with OSA and children with primary snoring (PS) who have no apparent alteration in sleep architecture, current diagnostic approaches for OSA require an overnight sleep study (ONP). ONP is onerous, relatively unavailable, labor intensive, and inconvenient, leading to long waiting periods and unnecessary delays in diagnosis and treatment. Development of noninvasive biomarker(s) capable of reliably distinguishing children with PS from those with OSA would greatly facilitate timely screening and diagnosis of OSA in children. Therefore, we hypothesized that proteomic strategies in the urine may permit the identification of biomarker(s) that reliably screen for OSA. In this study, time-of-flight mass spectrometry was used to profile proteins in the first morning void urines from children. We discovered that urocortins are increased in OSA and provide a noninvasive approach for quick and convenient diagnosis otf OSA in snoring children.
Collapse
Affiliation(s)
- Ayelet Snow
- University of Louisville, Louisville, KY, USA
| | | | | | | |
Collapse
|
8
|
Schwengel DA, Sterni LM, Tunkel DE, Heitmiller ES. Perioperative management of children with obstructive sleep apnea. Anesth Analg 2009; 109:60-75. [PMID: 19535696 DOI: 10.1213/ane.0b013e3181a19e21] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Obstructive sleep apnea syndrome (OSA) affects 1%-3% of children. Children with OSA can present for all types of surgical and diagnostic procedures requiring anesthesia, with adenotonsillectomy being the most common surgical treatment for OSA in the pediatric age group. Thus, it is imperative that the anesthesiologist be familiar with the potential anesthetic complications and immediate postoperative problems associated with OSA. The significant implications that the presence of OSA imposes on perioperative care have been recognized by national medical professional societies. The American Academy of Pediatrics published a clinical practice guideline for pediatric OSA in 2002, and cited an increased risk of anesthetic complications, though specific anesthetic issues were not addressed. In 2006, the American Society of Anesthesiologists published a practice guideline for perioperative management of patients with OSA that noted the pediatric-related risk factor of obesity, and the increased perioperative risk associated with adenotonsillectomy in children younger than 3 yr. However, management of OSA in children younger than 1 yr-of-age was excluded from the guideline, as were other issues related specifically to the pediatric patient. Hence, many questions remain regarding the perioperative care of the child with OSA. In this review, we examine the literature on pediatric OSA, discuss its pathophysiology, current treatment options, and recognized approaches to perioperative management of these young and potentially high-risk patients.
Collapse
Affiliation(s)
- Deborah A Schwengel
- Johns Hopkins Medical Institutions, Johns Hopkins University School of Medicine, Department of Anesthesiology/Critical Care Medicine, 600 North Wolfe St., Blalock 1412, Baltimore, MD 21287-8711, USA.
| | | | | | | |
Collapse
|
9
|
Kuhle S, Urschitz MS, Eitner S, Poets CF. Interventions for obstructive sleep apnea in children: A systematic review. Sleep Med Rev 2009; 13:123-31. [DOI: 10.1016/j.smrv.2008.07.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
10
|
The role of the nasopharyngeal airway for obstructive sleep apnea in syndromic craniosynostosis. J Craniofac Surg 2008; 19:659-63. [PMID: 18520380 DOI: 10.1097/scs.0b013e31816ae386] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Syndromic craniosynostosis is known to be associated with obstructive sleep apnea (OSA), which can often present in infancy. Although multifactorial, a predominant contributing factor is midface hypoplasia. Nasal continuous positive airway pressure has proven to be an effective treatment modality but may be poorly tolerated in certain cases. This study looks at the effectiveness of bypassing midface obstruction with a nasopharyngeal airway (NPA). Twenty-seven children with syndromic craniosynostosis with confirmed moderate to severe OSA were initially treated with an NPA. The mean age of NPA insertion was 12.3 months (range, 0.5-48 mo). Seventeen had severe OSA, and 10 had moderate OSA preinsertion. Post-NPA insertion, 26 of 27 children (96%) demonstrated an improvement in sleep severity scores, resulting in 3 with moderate OSA and 24 with mild OSA. There was a significant improvement in mean oxygen saturation, mean number of saturation dips greater than 4% per hour, percentage time spent less than 90% SpO2, and number of pulse rate rises per hour. There were no significant differences in mean pulse rate. The NPA was well tolerated by this patient group, with 24 of 26 children retaining it for at least 6 weeks. We believe that an NPA is therefore an effective first-line treatment modality in the management of OSA in children with syndromic craniosynostosis. It is well tolerated by the patient and may obviate the need for continuous positive airway pressure or tracheostomy.
Collapse
|
11
|
Halbower AC, Ishman SL, McGinley BM. Childhood obstructive sleep-disordered breathing: a clinical update and discussion of technological innovations and challenges. Chest 2008; 132:2030-41. [PMID: 18079240 DOI: 10.1378/chest.06-2827] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Childhood sleep-disordered breathing (SDB) has been known to be associated with health and cognitive impacts for more than a century, and yet our understanding of this disorder is in its infancy. Neuropsychological consequences in children with snoring or subtle breathing disturbances not meeting the traditional definition of sleep apnea suggest that "benign, or primary snoring" may be clinically significant, and that the true prevalence of SDB might be underestimated. There is no standard definition of SDB in children. The polysomnographic technology used in many sleep laboratories may be inadequate to diagnose serious but subtle forms of clinically important airflow limitation. In the last several years, advances in digital technology as well as new observational studies of respiratory and arousal patterns in large populations of healthy children have led to alternative views of what constitutes sleep-related breathing and arousal abnormalities that may refine our diagnostic criteria. This article reviews our knowledge of childhood SDB, highlights recent advances in technology, and discusses diagnostic and treatment strategies that will advance the management of children with pediatric SDB.
Collapse
Affiliation(s)
- Ann C Halbower
- Department of Pediatrics, John Hopkins University, Baltimore, MD, USA.
| | | | | |
Collapse
|
12
|
Ahmed I, Thorpy MJ. CLASSIFICATION OF SLEEP DISORDERS. Continuum (Minneap Minn) 2007. [DOI: 10.1212/01.con.0000275603.69539.cd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|