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Rizzo L, Barbetta E, Ruberti F, Petz M, Tornesello M, Deolmi M, Fainardi V, Esposito S. The Role of Telemedicine in Children with Obstructive Sleep Apnea Syndrome (OSAS): A Review of the Literature. J Clin Med 2024; 13:2108. [PMID: 38610873 PMCID: PMC11012248 DOI: 10.3390/jcm13072108] [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: 02/27/2024] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
The advent of telemedicine marked a significant turning point in the healthcare landscape, introducing a revolutionary approach to the delivery of medical care. Digital technologies easily connect health professionals and patients, overcoming geographical and temporal barriers. Telemedicine has been used for sleep disorders including obstructive sleep apnea syndrome (OSAS) since the mid-1990s. In adult patients with OSAS, telemedicine is helpful both for consultation and diagnosis, the latter obtained through remote recordings of oxygen saturation and further parameters registered with telemonitored respiratory polygraphy or polysomnography. Remote monitoring can be used to follow up the patient and verify adherence to daily treatments including continuous positive airway pressure (CPAP). In children, studies on the role of telemedicine in OSAS are scarce. This narrative review aims to describe the application of telemedicine in children with obstructive sleep apnea syndrome (OSAS), assessing its advantages and disadvantages. In patients with OSA, telemedicine is applicable at every stage of patient management, from diagnosis to treatment monitoring also in pediatric and adolescent ages. While telemedicine offers convenience and accessibility in healthcare delivery, its application in managing OSAS could be associated with some disadvantages, including limitations in physical examination, access to diagnostic tools, and education and counseling; technology barriers; and privacy concerns. The adoption of a hybrid approach, integrating both in-office and virtual appointments, could effectively meet the needs of children with OSAS. However, more studies are needed to fully assess the effectiveness and safety of telemedicine in the pediatric population.
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Affiliation(s)
- Luisa Rizzo
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Elena Barbetta
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Flaminia Ruberti
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Matilde Petz
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marco Tornesello
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Michela Deolmi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Pagel JML, Mattos JL. Allergic Rhinitis and Its Effect on Sleep. Otolaryngol Clin North Am 2024; 57:319-328. [PMID: 37867109 DOI: 10.1016/j.otc.2023.09.003] [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] [Indexed: 10/24/2023]
Abstract
Allergic rhinitis (AR) is associated with increased sleep disturbances in adults and children. Pathogenesis is multifactorial, with nasal obstruction playing a large role. Intranasal corticosteroids, antihistamines, leukotriene inhibitors, and allergen immunotherapy have been demonstrated to relieve self-reported symptoms of sleep impairment. Given the high prevalence of sleep impairment in AR, providers should consider evaluating any patient with AR for sleep disturbances and sleep-disordered breathing.
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Affiliation(s)
- Jessica M L Pagel
- University of Virginia School of Medicine, 1340 Jefferson Park Avenue, Charlottesville, VA 22903, USA
| | - Jose L Mattos
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, 1 Hospital Drive, PO Box 800713, Charlottesville, VA 22908, USA.
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Zhang Y, Leng S, Hu Q, Li Y, Wei Y, Lu Y, Qie D, Yang F. Pharmacological interventions for pediatric obstructive sleep apnea (OSA): Network meta-analysis. Sleep Med 2024; 116:129-137. [PMID: 38460418 DOI: 10.1016/j.sleep.2024.01.030] [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: 11/06/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 03/11/2024]
Abstract
IMPORTANCE Pediatric obstructive sleep apnea (OSA) is a common disease that can have significant negative impacts on a child's health and development. A comprehensive evaluation of different pharmacologic interventions for the treatment of OSA in children is still lacking. OBJECTIVE This study aims to conduct a comprehensive systematic review and network meta-analysis of pharmacological interventions for the management of obstructive sleep apnea in pediatric population. DATA SOURCES PubMed, Web of Science, Embase, The Cochrane Library, and CNKI were searched from 1950 to November 2022 for pediatric OSA. STUDY SELECTION Multiple reviewers included Randomized controlled trials (RCTs) concerning drugs on OSA in children. DATA EXTRACTION AND SYNTHESIS Multiple observers followed the guidance of the PRISMA NMA statement for data extraction and evaluation. Bayesian network meta-analyses(fixed-effect model) were performed to compare the weighted mean difference (WMD), logarithmic odds ratios (log OR), and the surface under the cumulative ranking curves (SUCRA) of the included pharmacological interventions. Our protocol was registered in PROSPERO website (CRD42022377839). MAIN OUTCOME(S) AND MEASURE(S) The primary outcomes were improvements in the apnea/hypopnea index (AHI), while secondary outcomes included adverse events and the lowest arterial oxygen saturation (SaO2). RESULTS 17 RCTs with a total of 1367 children with OSA aged 2-14 years that met the inclusion criteria were eventually included in our systematic review and network meta-analysis. Ten drugs were finally included in the study. The results revealed that Mometasone + Montelukast (WMD-4.74[95%CrIs -7.50 to -2.11], Budesonide (-3.45[-6.86 to -0.15], and Montelukast(-3.41[-5.45 to -1.39] exhibited significantly superior therapeutic effects compared to the placebo concerning apnea hypopnea index (AHI) value with 95%CrIs excluding no effect. Moreover, Mometasone + Montelukast achieved exceptionally high SUCRA values for both AHI (85.0 %) and SaO2 (91.0 %). CONCLUSIONS AND RELEVANCE The combination of mometasone furoate nasal spray and oral montelukast sodium exhibits the highest probability of being the most effective intervention. Further research is needed to investigate the long-term efficacy and safety profiles of these interventions in pediatric patients with OSA.
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Affiliation(s)
- Yuxiao Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Siqi Leng
- Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qian Hu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Yingna Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Yumeng Wei
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - You Lu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Di Qie
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Fan Yang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China.
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Katherine Sylvia R, Gideon David P, Gillian Michelle N, Haytham K. The impact of intranasal corticosteroids in a prospective cohort of children with sleep disordered breathing. Int J Pediatr Otorhinolaryngol 2024; 178:111899. [PMID: 38402717 DOI: 10.1016/j.ijporl.2024.111899] [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: 11/09/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Sleep disordered breathing (SDB) is common in children and the most common reason for adenotonsillectomy. This large observational cohort study from a specialist outpatient clinic describes the impact of intranasal steroids (INS) on symptom improvement and the need for surgery. METHOD Observational cohort study of 568 children assessing the impact of INS using the OSA-5 questionnaire with clinical and surgical outcome measures. RESULTS The mean OSA-5 score at first visit was 7.78. Symptoms were persistent for a median 9 months (range 2-72). 51% underwent a trial of INS with 56% reporting symptomatic improvement. The mean score decreased from 8.2 to 5.5 (p < 0.0001) in those prescribed INS. They had a significantly higher symptom load (p < 0.01), turbinate size (p < 0.005) and history of atopy (p < 0.01) than the non-trial group. The rate of surgery in the non-trial group was 56% compared with 38% in those who had INS (p < 0.001). With increasing symptom burden, the reported improvement with INS and comparative reduction in surgery increased. Baseline OSA-5 scores were predictive of rates of surgery. Atopic status or age did not influence response to INS. CONCLUSION The mean score at first visit and the median duration of symptoms indicated significant persistent symptoms in this cohort. The use of INS improved symptoms of SDB in 56%. The need for surgery in the group that received INS was 38% compared with 56% in those not trialling INS, despite the non-trial group having significantly less symptoms and signs. Symptomatic improvement was not influenced by age or atopic status.
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Affiliation(s)
- Rowe Katherine Sylvia
- Department of General Medicine, Royal Children's Hospital, Flemington Rd Parkville, 3052, Australia.
| | - Pinczower Gideon David
- Department of General Medicine, Royal Children's Hospital, Flemington Rd Parkville, 3052, Australia.
| | - Nixon Gillian Michelle
- Paediatric Sleep Physician, Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia.
| | - Kubba Haytham
- Otolaryngologist, Department of Otolaryngology, Royal Children's Hospital, Flemington Rd Parkville, 3052, Australia; Royal Hospital for Children, 1345 Govan Road Glasgow, G51 4TF, UK, Scotland, UK.
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Springford LR, Griffiths M, Bajaj Y. Management of paediatric sleep-disordered breathing. Br J Hosp Med (Lond) 2024; 85:1-6. [PMID: 38416524 DOI: 10.12968/hmed.2023.0275] [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] [Indexed: 02/29/2024]
Abstract
Paediatric sleep-disordered breathing is a common condition which varies in severity from snoring to obstructive sleep apnoea. Paediatric sleep-disordered breathing is usually diagnosed clinically, with investigations such as polysomnography reserved for more complex cases. Management can involve watching and waiting, medical or adjunct treatments and adenotonsillectomy. National working groups have sought to standardise the pathway for surgery and improve the management of surgical and anaesthetic complications. Current guidelines use age, weight and comorbidities to stratify risk for these surgical cases. This article summarises these recommendations and outlines the important factors that indicate cases that may be more suitable for management in secondary and tertiary units. Appropriate case selection will reduce pressure on tertiary units while maintaining training opportunities in district general hospitals.
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Affiliation(s)
- Laurie R Springford
- Department of Ear, Nose, Throat and Head and Neck Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Yogesh Bajaj
- Department of Ear, Nose, Throat and Head and Neck Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
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Ferati K, Bexheti-Ferati A, Palermo A, Pezzolla C, Trilli I, Sardano R, Latini G, Inchingolo AD, Inchingolo AM, Malcangi G, Inchingolo F, Dipalma G, Mancini A. Diagnosis and Orthodontic Treatment of Obstructive Sleep Apnea Syndrome Children-A Systematic Review. Diagnostics (Basel) 2024; 14:289. [PMID: 38337805 PMCID: PMC10855184 DOI: 10.3390/diagnostics14030289] [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: 12/19/2023] [Revised: 01/04/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a respiratory illness that is associated with recurrent episodes of either partial or full obstruction of the upper airways, or apnea, among other sleep disorders. This study aims to analyze, through a literature review, whether orthodontic treatment can be a good treatment strategy for this type of disorder. We performed a database search on Scopus, Web of Science, and Pubmed with the keywords OSA(S) and orthodontics to select the papers under evaluation. The criteria for inclusion were articles related to OSA(S) children undergoing an orthodontic treatment and clinical studies or case series, excluding systematic reviews, narrative reviews, meta-analyses, adult studies, animal models, and in vitro studies. The screening phase ended with the selection of 16 publications for this work. RME, or rapid maxillary expansion, turned out to be the preferred orthodontic treatment in cases of pediatric OSAS. The goal of this orthodontic procedure is to increase the hard palate's transverse diameter by reopening the mid-palatal suture. Children with maxillary contraction and dental malocclusion typically undergo such a procedure and have excellent results. However, OSAS is a multifactorial disorder; it does not seem related to the morphology of the oral cavity, and therefore, it is not always possible to cope with this problem exclusively through orthodontic treatment.
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Affiliation(s)
- Kenan Ferati
- Faculty of Medicine, University of Tetovo, 1220 Tetovo, North Macedonia; (K.F.); (A.B.-F.)
| | | | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK;
| | - Carmen Pezzolla
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Irma Trilli
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Roberta Sardano
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Giulia Latini
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Alessio Danilo Inchingolo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Angelo Michele Inchingolo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Giuseppina Malcangi
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Francesco Inchingolo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Gianna Dipalma
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Antonio Mancini
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
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Tamir SO, Schwarz Y, Hazan I, Cohen Michael O, Tshori S, Marom T. Medical treatment does not reduce surgery rates in children with adenoid hypertrophy. Int J Pediatr Otorhinolaryngol 2024; 176:111836. [PMID: 38154416 DOI: 10.1016/j.ijporl.2023.111836] [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: 09/05/2023] [Revised: 12/01/2023] [Accepted: 12/22/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE We sought to study adenoidectomy rates in children with adenoid hypertrophy (AH) who were either treated with medical therapy or not during a 2-year follow-up period in a longitudinal population-based study. METHODS We retrospectively identified healthy children aged 1-18 years between 2014 and 2020 with AH diagnosis from the Clalit Health Services database, the largest healthcare maintenance organization in Israel. The main outcome was adenoidectomy alone or in combination with other procedures performed within 2 years after diagnosis. The treatment group consisted of children who received medical therapy, defined as a pharmacy purchase of montelukast, nasal steroid sprays and/or antihistamines (medical therapy aimed to reduce AH) for ≥2 consecutive months, while the control group consisted of untreated children. RESULTS We identified 68,356 unique children with AH, of them 56 % were boys, with a mean age of 4.9 ± 3.3 years. Of them, 5310 (7.7 %) received medical therapy. Overall, 6633 (9.7 %) underwent adenoidectomy within 2 years following diagnosis. There was no significant difference in surgery referral rates between the treatment and the control groups, 10 % vs. 9.7 %, respectively (p = 0.3). When adjusted for age and sex, the likelihood of undergoing adenoidectomy was similar in both groups (HR = 0.98, 95 % CI = 0.90-1.07, p = 0.6). Among operated children, the average time from diagnosis to surgery was statistically significantly longer in the treatment group than in the control group, 346 ± 180 vs 311 ± 175 days (p < 0.001). CONCLUSION Prescribing montelukast, nasal steroids and/or oral antihistamines was not associated with a reduction in adenoidectomy rates and was associated with an average surgery delay of 35 days.
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Affiliation(s)
- Sharon Ovnat Tamir
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Yehuda Schwarz
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Clalit Health Services, Tel Aviv, Israel
| | - Itai Hazan
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Joyce and Irvin Goldman Medical School, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er-Sheva, Israel
| | - Ori Cohen Michael
- Joyce and Irvin Goldman Medical School, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er-Sheva, Israel
| | - Sagi Tshori
- Research Authority, Kaplan Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Clalit Health Services, Tel Aviv, Israel.
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Dékány L, Molnár V, Molnár A, Bikov A, Lázár Z, Bárdos-Csenteri O, Benedek P. Analysis of possible risk factors for the severity of paediatric obstructive sleep apnoea syndrome. Eur Arch Otorhinolaryngol 2023; 280:5607-5614. [PMID: 37758856 PMCID: PMC10620301 DOI: 10.1007/s00405-023-08237-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE This study aimed to determine the effect of body mass index (BMI) percentile, asthma, sex, and age on the paediatric obstructive sleep apnoea (OSA) severity. Furthermore, to determine the possible predictive role of the BMI percentile and age in severe OSA. METHODS This retrospective study included 921 children aged 2-18 years diagnosed with OSA by polysomnography. Analysis of Covariance (ANCOVA), Spearman's correlation, Receiver Operating Characteristics (ROC) analyses were performed and area under the curve (AUC) was determined. RESULTS We observed a significant association between a higher BMI percentile and the severity of OSA (p < 0.001, ρ = 0.15). The correlation also was significant under (p = 0.007, ρ = 0.11) and over 7 (p = 0.0002, ρ = 0.23) years of age. There was no association between the severity of OSA and the presence of asthma (p = 0.9) or sex (p = 0.891), respectively. Age was significantly related to OSA severity (p = 0.01, ρ = 0.08). Although both the BMI percentile (0.59 AUC [0.54-0.65]) and age (0.58 AUC [0.52-0.63]) predicted severe OSA, according to the sensitivity and specificity values of the ROC curve, the association presents a slight clinical relevance. CONCLUSIONS OSA severity is determined by the BMI percentile and age in children; however, these factors are unsuitable for predicting severe OSA in clinical practice. Based on our results, obesity is also a significant risk factor for OSA in younger children. Our study highlights that older, overweight, and obese children have a higher risk for severe OSA.
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Affiliation(s)
- Lea Dékány
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Viktória Molnár
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary.
| | - András Molnár
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - András Bikov
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Zsófia Lázár
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Pálma Benedek
- Sleep Laboratory and Sleep Surgery Unit, Heim Pál National Paediatric Institute, Budapest, Hungary
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Mussi N, Forestiero R, Zambelli G, Rossi L, Caramia MR, Fainardi V, Esposito S. The First-Line Approach in Children with Obstructive Sleep Apnea Syndrome (OSA). J Clin Med 2023; 12:7092. [PMID: 38002704 PMCID: PMC10672526 DOI: 10.3390/jcm12227092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSA) is the main manifestation of sleep-disordered breathing in children. Untreated OSA can lead to a variety of complications and adverse consequences mainly due to intermittent hypoxemia. The pathogenesis of OSA is multifactorial. In children aged 2 years or older, adenoid and/or tonsil hypertrophy are the most common causes of upper airway lumen reduction; obesity becomes a major risk factor in older children and adolescents since the presence of fat in the pharyngeal soft tissue reduces the caliber of the lumen. Treatment includes surgical and non-surgical options. This narrative review summarizes the evidence available on the first-line approach in children with OSA, including clinical indications for medical therapy, its effectiveness, and possible adverse effects. Literature analysis showed that AT is the first-line treatment in most patients with adenotonsillar hypertrophy associated with OSA but medical therapy in children over 2 years old with mild OSA is a valid option. In mild OSA, a 1- to 6-month trial with intranasal steroids (INS) alone or in combination with montelukast with an appropriate follow-up can be considered. Further studies are needed to develop an algorithm that permits the selection of children with OSA who would benefit from alternatives to surgery, to define the optimal bridge therapy before surgery, to evaluate the long-term effects of INS +/- montelukast, and to compare the impact of standardized approaches for weight loss.
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Affiliation(s)
| | | | | | | | | | | | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (N.M.); (R.F.); (G.Z.); (L.R.); (M.R.C.); (V.F.)
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Roushdy MM, jalil AAA, Saeed AM. Mometasone Furoate Use for Recurrent Adenoid Hypertrophy: Randomized Controlled Clinical Trial. Indian J Otolaryngol Head Neck Surg 2023; 75:1639-1646. [PMID: 37636767 PMCID: PMC10447813 DOI: 10.1007/s12070-023-03539-1] [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: 11/19/2022] [Accepted: 01/26/2023] [Indexed: 08/29/2023] Open
Abstract
Background& Objective: Adenoid hypertrophy (AH) in children is one of the most causes of nasal obstruction and is associated with many nasal and respiratory symptoms. Till now, surgery is the main option for managing the associated symptom of AH. The intranasal steroid has an effective role in the control of allergic rhinitis and associated AH. This work aimed to assess the effects of local mometasone on recurrent AH in children. Patients& Methods: A randomized controlled trial enrolled 39 patients aged between 2 and 15 years with recurrent AH. Those patients were randomly subdivided into three groups; group (A) received topical mometasone furoate (MF), group (B) did not receive any medication, and group (C) received topical normal saline. All groups were followed up for 8 weeks. Results: Patients who received Mometasone furoate had temporary relief of adenoid hypertrophy-related symptoms (84.6%) in comparison to the control group and placebo group during the duration of treatment. After cessation of treatment with local steroids, all cases experienced symptoms caused by adenoid hypertrophy, and by the end of the third month of follow up all cases underwent adenoidectomy. Conclusion: Mometasone furoate can temporarily reduce the adenoid size, reducing symptoms related to adenoid hypertrophy.
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Affiliation(s)
| | | | - Ahmed Mahmoud Saeed
- The Department of otolaryngology, Student Hospital, Assiut University, 71515 Assiut, Egypt
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Bariani RCB, Bigliazzi R, de Moura Guimarães T, Tufik S, Moreira GA, Fujita RR. The effects of rapid maxillary expansion on persistent pediatric snoring post-tonsillectomy. Sleep Breath 2023; 27:1227-1235. [PMID: 36251209 DOI: 10.1007/s11325-022-02724-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/05/2022] [Accepted: 09/30/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the short-term effects of rapid maxillary expansion (RME) on the quality of life of children who had persistent snoring post-adenotonsillectomy (AT). METHODS The study included children with maxillary constriction aged 5 to 12 years, two or more years after AT whose parents/guardians reported that they still snored ≥ 5 nights per week. We enrolled children with sleep-disordered breathing, including children with primary snoring and children with obstructive sleep apnea (OSA). All patients underwent laryngeal nasofibroscopy and complete polysomnography. Quality of Life (QOL) Questionnaire (OSA-18), the Pediatric Sleep Questionnaire (PSQ), Conners Abbreviated Scale (CAS), and the Epworth Sleepiness Scale (ESS) were administered before and after RME. RESULTS Of 24 children enrolled, 13 had primary snoring and 11 had OSA. Overall OSA-18 scores were reduced in both groups (intragroup difference, p < 0.001). The PSQ total score, CAS, and ESS were significantly reduced in both groups (p < 0.001) In the evaluation of snoring, there was a reduction due to the treatment effect in both groups (p < 0.001). Daytime sleepiness and attention deficit hyperactivity disorders were also positively affected in both groups. CONCLUSIONS Our study demonstrated the potential benefit of RME in treating children with persistent snoring and transverse maxillary deficiency (TMD). RME can improve snoring and the QOL of children with refractory SDB after AT. TRIAL REGISTRATION ClinicalTrials.gov Identifier: RBR-463byn.
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Affiliation(s)
- Rita Catia Brás Bariani
- Department of Otorhinolaryngology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Thais de Moura Guimarães
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gustavo Antônio Moreira
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Reginaldo Raimundo Fujita
- Department of Otorhinolaryngology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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12
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Zhu Y, Wang S, Yang Y, Shen B, Wang A, Zhang X, Zhang X, Li N, Gao Z, Liu Y, Zhu J, Wei Z, Guan J, Su K, Liu F, Gu M, Yin S. Adenoid lymphocyte heterogeneity in pediatric adenoid hypertrophy and obstructive sleep apnea. Front Immunol 2023; 14:1186258. [PMID: 37283767 PMCID: PMC10239814 DOI: 10.3389/fimmu.2023.1186258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/09/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Adenoid hypertrophy is the main cause of obstructive sleep apnea in children. Previous studies have suggested that pathogenic infections and local immune system disorders in the adenoids are associated with adenoid hypertrophy. The abnormalities in the number and function of various lymphocyte subsets in the adenoids may play a role in this association. However, changes in the proportion of lymphocyte subsets in hypertrophic adenoids remain unclear. Methods To identify patterns of lymphocyte subsets in hypertrophic adenoids, we used multicolor flow cytometry to analyze the lymphocyte subset composition in two groups of children: the mild to moderate hypertrophy group (n = 10) and the severe hypertrophy group (n = 5). Results A significant increase in naïve lymphocytes and a decrease in effector lymphocytes were found in severe hypertrophic adenoids. Discussion This finding suggests that abnormal lymphocyte differentiation or migration may contribute to the development of adenoid hypertrophy. Our study provides valuable insights and clues into the immunological mechanism underlying adenoid hypertrophy.
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Affiliation(s)
- Yaxin Zhu
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengming Wang
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingchao Yang
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bojun Shen
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Anzhao Wang
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoman Zhang
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxu Zhang
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Niannian Li
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenfei Gao
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuenan Liu
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingyu Zhu
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhicheng Wei
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Guan
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kaiming Su
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Liu
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meizhen Gu
- Department of Otolaryngology Head and Neck Surgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shankai Yin
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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13
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Baker A, Grobler A, Davies K, Griffiths A, Hiscock H, Kubba H, Peters RL, Ranganathan S, Rimmer J, Rose E, Rowe K, Simpson CM, Davidson A, Nixon G, Perrett KP. Effectiveness of Intranasal Mometasone Furoate vs Saline for Sleep-Disordered Breathing in Children: A Randomized Clinical Trial. JAMA Pediatr 2023; 177:240-247. [PMID: 36648937 PMCID: PMC9857783 DOI: 10.1001/jamapediatrics.2022.5258] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/24/2022] [Indexed: 01/18/2023]
Abstract
Importance Obstructive sleep-disordered breathing (SDB) in children is characterized by snoring and difficulty breathing during sleep. SDB affects at least 12% of otherwise healthy children and is associated with significant morbidity. Evidence from small clinical trials suggests that intranasal corticosteroids improve SDB as measured by polysomnography; however, the effect on symptoms and quality of life is unclear. Objective To determine whether intranasal mometasone furoate is more effective than intranasal saline for improving symptoms and quality of life in children with SDB. Design, Setting, and Participants The MIST trial was a multicenter, randomized, double-blind, placebo-controlled trial, recruiting participants from June 8, 2018, to February 13, 2020. Children aged 3 to 12 years who were referred to a specialist for significant SDB symptoms were included; exclusions were previous adenotonsillectomy, body mass index greater than the 97th percentile, and severe SDB. Randomization was stratified by site, and data were analyzed on an intention-to-treat basis from October 28, 2020, to September 25, 2022. Interventions Participants were randomly assigned to receive mometasone furoate, 50 μg, or sodium chloride (saline), 0.9%, 1 spray per nostril daily, dispensed in identical bottles. Main Outcomes and Measures The primary outcome was resolution of significant SDB symptoms (ie, reduction to a level no longer requiring referral to a specialist as per the American Academy of Pediatrics guidelines) at 6 weeks, measured by parental report of symptoms using the SDB Score. Results A total of 276 participants (mean [SD] age, 6.1 [2.3] years; 146 male individuals [53%]) were recruited, 138 in each treatment arm. Resolution of significant SDB symptoms occurred in 56 of 127 participants (44%) in the mometasone group and 50 of 123 participants (41%) in the saline group (risk difference, 4%; 95% CI, -8% to 16%; P = .51) with 26 participants lost to follow-up and missing values managed by multiple imputation. The main adverse effects were epistaxis, affecting 12 of 124 participants (9.7%) in the mometasone group and 18 of 120 participants (15%) in the saline group, and nasal itch/irritation, affecting 12 of 124 participants (9.7%) in the mometasone group and 22 of 120 participants (18%) in the saline group. Conclusions and Relevance Results of this randomized clinical trial suggest that there was no difference in treatment effect between intranasal mometasone and saline for the management of SDB symptoms. The results suggest that almost one-half of children with SDB could be initially managed in the primary care setting and may not require referral to specialist services, as is currently recommended. Trial Registration Australian New Zealand Clinical Trials Registry: ANZCTRN12618000448246.
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Affiliation(s)
- Alice Baker
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of General Medicine, Royal Children’s Hospital, Melbourne, Australia
| | - Anneke Grobler
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Karen Davies
- Department of Otolaryngology, Royal Children’s Hospital, Melbourne, Australia
| | - Amanda Griffiths
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Royal Children’s Hospital, Melbourne, Australia
| | - Harriet Hiscock
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Health Services Research Unit, Royal Children’s Hospital, Melbourne, Australia
- Centre for Community Child Health, Royal Children’s Hospital, Melbourne, Australia
| | - Haytham Kubba
- Department of Otolaryngology, Royal Hospital for Children, Glasgow, Scotland
| | - Rachel L. Peters
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Sarath Ranganathan
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Royal Children’s Hospital, Melbourne, Australia
| | - Joanne Rimmer
- Department of Otolaryngology–Head and Neck Surgery, Monash Health, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | - Elizabeth Rose
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Otolaryngology, Royal Children’s Hospital, Melbourne, Australia
- Department of Otolaryngology, University of Melbourne, Melbourne, Australia
| | - Katherine Rowe
- Department of General Medicine, Royal Children’s Hospital, Melbourne, Australia
| | - Catherine M. Simpson
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Centre for Community Child Health, Royal Children’s Hospital, Melbourne, Australia
| | - Andrew Davidson
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne Children’s Trial Centre, Melbourne Children’s, Melbourne, Australia
| | - Gillian Nixon
- Melbourne Children's Sleep Centre, Monash Children’s Hospital, Monash Health, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Kirsten P. Perrett
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne Children’s Trial Centre, Melbourne Children’s, Melbourne, Australia
- Department of Allergy and Immunology, Royal Children’s Hospital, Melbourne, Australia
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14
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Cielo CM, Shults J, Tapia IE. Response. Chest 2023; 163:e149-e150. [PMID: 36894274 DOI: 10.1016/j.chest.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/11/2022] [Indexed: 03/09/2023] Open
Affiliation(s)
- Christopher M Cielo
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Justine Shults
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ignacio E Tapia
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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15
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Ersu R, Chen ML, Ehsan Z, Ishman SL, Redline S, Narang I. Persistent obstructive sleep apnoea in children: treatment options and management considerations. THE LANCET. RESPIRATORY MEDICINE 2023; 11:283-296. [PMID: 36162413 DOI: 10.1016/s2213-2600(22)00262-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/15/2022] [Accepted: 07/05/2022] [Indexed: 10/14/2022]
Abstract
Unresolved obstructive sleep apnoea (OSA) after an adenotonsillectomy, henceforth referred to as persistent OSA, is increasingly recognised in children (2-18 years). Although associated with obesity, underlying medical complexity, and craniofacial disorders, persistent OSA also occurs in otherwise healthy children. Inadequate treatment of persistent OSA can lead to long-term adverse health outcomes beyond childhood. Positive airway pressure, used as a one-size-fits-all primary management strategy for persistent childhood OSA, is highly efficacious but has unacceptably low adherence rates. A pressing need exists for a broader, more effective management approach for persistent OSA in children. In this Personal View, we discuss the use and the need for evaluation of current and novel therapeutics, the role of shared decision-making models that consider patient preferences, and the importance of considering the social determinants of health in research and clinical practice. A multipronged, comprehensive approach to persistent OSA might achieve better clinical outcomes in childhood and promote health equity for all children.
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Affiliation(s)
- Refika Ersu
- Division of Respiratory Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Maida L Chen
- Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Zarmina Ehsan
- Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, Kansas City, MO, USA; Department of Pediatrics, University of Missouri, Kansas City, KS, USA
| | - Stacey L Ishman
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of HealthVine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Indra Narang
- Division of Respiratory Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
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16
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Zhao X, Xu J, Wang MY, Hou ZW, Shi HS, Zhang XX. Effect of oral Xiao-xian decoction combined with acupoint application therapy on pediatric adenoid hypertrophy: A randomized trial. Medicine (Baltimore) 2023; 102:e32804. [PMID: 36749267 PMCID: PMC9901993 DOI: 10.1097/md.0000000000032804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study aimed to observe the clinical effects of Xiao-xian decoction combined with acupoint application therapy (AAT) for treating pediatric adenoid hypertrophy (AH). METHODS We randomly divided 93 AH children into 3 groups: AAT alone; Xiao-xian decoction + AAT; control: Montelukast oral therapy. All participants were treated for a month. We used the traditional Chinese medicine syndrome score to evaluate the clinical efficacy and the obstructive sleep apnea-18 scale to evaluate the quality of life. RESULTS The major symptoms (nasal congestion, open mouth breathing, snoring, and tongue image) and secondary symptoms of patients treated with Xiao-xian decoction + AAT significantly improved compared to before treatment. The pairwise comparison between groups showed that snoring, tongue, secondary symptoms, and total effective rate of the combined treatment group were better than the control and AAT alone. Additionally, the open-mouth breathing, quality of life, and recurrence rate did not differ after treatment. CONCLUSION Oral Xiao-xian decoction combined with AAT significantly improved the symptoms and signs of nasal congestion, open-mouth breathing, snoring, tongue, and quality of life of AH children and may be used as a long-term treatment for AH.
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Affiliation(s)
- Xue Zhao
- Institute of Chinese Medicine Literature, and Culture, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jie Xu
- Peking University Medical Lu Zhong Hospital, Jinan, China
| | - Ming-Yue Wang
- Pediatric Department of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zi-Wei Hou
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hui-Shan Shi
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiao-Xia Zhang
- Institute of Chinese Medicine Literature, and Culture, Shandong University of Traditional Chinese Medicine, Jinan, China
- * Correspondence: Xiao-Xia Zhang, Institute of Chinese Medicine Literature, and Culture, Shandong University of Traditional Chinese Medicine, Jinan 250300, China (e-mail: )
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17
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Sistla SK, Lahane V. OSA 18 Questionnaire: Tool to Evaluate Quality of Life and Efficacy of Treatment Modalities in Pediatric Sleep Disordered Breathing Due to Adenotonsillar Hypertrophy. Indian J Otolaryngol Head Neck Surg 2022; 74:6406-6413. [PMID: 36742702 PMCID: PMC9895508 DOI: 10.1007/s12070-019-01757-0] [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: 07/25/2019] [Accepted: 11/02/2019] [Indexed: 02/07/2023] Open
Abstract
Aims to evaluate quality of life in paediatric SDB due to adenotonsillar hypertrophy and efficacy of treatment modalities (medical and surgical) by using OSA-18 questionnaire. Prospective study, conducted from April 2019 to June 2019, including 42 patients with clinical features suggestive of SDB due to adenotonsillar hypertrophy, in age group of 3-15 years. Nasopharyngoscopy was done to grade adenoid hypertrophy. OSA-18 QOL questionnaire was recorded in all patients and depending upon the severity of impact of QOL and grades of adenoid hypertrophy, patients were categorized into two groups. Group 1 received medical treatment and group 2 underwent adenotonsillectomy. Questionnaire was again recorded after 4 weeks. Pretreatment and post-treatment total mean and individual domain scores were compared. Paired t tests was used to evaluate results. Group 1 included 16 children with mild to moderate impact and received medical management. Pretreatment mean OSA-18 score of 70.31 was improved to 33.5. Group 2 enrolled 26 patients with severe impact, were subjected to adenotonsillectomy. Pretreatment and post-treatment mean score were 95.88 and 24.92 respectively. Both groups showed statistically significant improvement in all individual domains and total mean OSA-18 scores indicating improvement in QOL after treatment and efficacy of medical management for mild-moderate SDB and surgery for severe cases. OSA-18 questionnaire is self-administered and disease specific screening tool for early diagnosis and evaluation of QOL before and after treatment. It also helps to categorize patients for advocating appropriate treatment and to evaluate efficacy of treatment modalities.
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Affiliation(s)
- Srinivas Kishore Sistla
- Department of ENT and Head Neck Surgery, Star Hospital, B Block, Banjara Hill Road No 10, Hyderabad, Telengana India
| | - Vaibhav Lahane
- Department of ENT and Head Neck Surgery, Star Hospital, B Block, Banjara Hill Road No 10, Hyderabad, Telengana India
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18
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Hassan F, Ross K. Treatment of Intranasal Corticosteroids for OSA Syndrome. Chest 2022; 162:961-962. [DOI: 10.1016/j.chest.2022.08.2236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022] Open
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19
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Bilgili AM, Durmaz HÖ, Dilber M. Efficacy of Topical Azelastine and Fluticasone Dipropionate Combination in Children With Adenoid Hypertrophy. EAR, NOSE & THROAT JOURNAL 2022; 102:28-34. [PMID: 36053218 DOI: 10.1177/01455613221123860] [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: 11/17/2022] Open
Abstract
OBJECTIVE Adenoid hypertrophy (AH) is one of the common childhood diseases. Surgical and non-surgical treatment of AH in children is planned according to the severity of symptoms and associated complications. In recent years, treatment methods with intranasal sprays have been reported quite frequently in uncomplicated cases. We aim to evaluate the effectiveness of a new combination of azelastine - fluticasone (AZE-FLU) (137mcg azelastine and 50mcg fluticasone) nasal spray in children with uncomplicated AH. METHODS Sixty-five children diagnosed with AH were included in the study. The mean age of the children was 7.42 ± 2.26 (4-13 years). The cohort consisted of 29 males and 36 females. All children were evaluated clinically and endoscopically. AZE-FLU nasal spray was applied to both nostrils twice a day for three months. Adenoid/choana ratio and symptom scores were evaluated before treatment and at the end of the 12th week. RESULTS At the end of 24 weeks of AZE-FLU application, there was a statistically significant decrease in both adenoid/choana ratio and symptom scores. While the initial adenoid/choana (A/C) score was 3.57 ± 0.58, it decreased to 1.74 ± 0.61 following treatment. A dramatic decrease in total symptom scores was observed. The total symptom score average was 15.63 ± 1.28 before treatment, while it was 2.31 ± 1.4 after the treatment with the difference being statistically significant (P < .01). CONCLUSION In this study, the effectiveness of AZE-FLU nasal spray on AH was investigated for the first time. This treatment provides an effective alternative to the surgical approach in children with uncomplicated adenoid hypertrophy. Using this protocol, 96% of patients were removed from the surgery list. LEVEL OF EVIDENCE is IV.
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Affiliation(s)
- Ahmet Mert Bilgili
- Medical Faculty Department of Otolaryngology, 64188Cyprus International University, Lefkoşe, Cyprus
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20
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Economou NT, Ferini-Strambi L, Steiropoulos P. Sleep-Related Drug Therapy in Special Conditions: Children. Sleep Med Clin 2022; 17:531-542. [PMID: 36150812 DOI: 10.1016/j.jsmc.2022.06.015] [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: 10/14/2022]
Abstract
Pharmacologic treatment of the most common pediatric sleep disorders lacks evidence, and alternative methods, which have been proved to alleviate the symptoms, are preferred in most cases. The implementation of specific guidelines is of great importance because sleep disorders in children are not rare and they can negatively affect children's development and their cognitive and social skills. This article summarizes the current therapeutic management of sleep disorders in children, bearing in mind the absence of evidence-based guidelines on this topic.
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Affiliation(s)
- Nicholas-Tiberio Economou
- Sleep Unit, Department of Psychiatry, University of Athens, 74 Vas Sofias Avenue, Athens 11528, Greece; Enypnion Sleep-Epilepsy Center, Bioclinic Hospital Athens, 15 M. Geroulanou Street, Athens 11524, Greece
| | - Luigi Ferini-Strambi
- Division of Neuroscience, University Vita-Salute San Raffaele, Via Stamira d'Ancona 20, Milan 20127, Italy
| | - Paschalis Steiropoulos
- Department of Pulmonology, Medical School, Democritus University of Thrace, University Campus, Dragana, Alexandroupolis 68100, Greece.
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21
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Mahboub B, Kharaba Z, Ramakrishnan RK, Sharif Askari NS, Salameh LI, Alhariri HS, Vats MG, Erabia WT, Alshawamreh EM, Alfoteih Y, Mogas AK, Halwani R, Hamid Q. Continuous positive airway pressure therapy suppresses inflammatory cytokines and improves glucocorticoid responsiveness in patients with obstructive sleep apnea and asthma: A case-control study. Ann Thorac Med 2022; 17:166-172. [PMID: 35968397 PMCID: PMC9374121 DOI: 10.4103/atm.atm_37_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 11/09/2022] Open
Abstract
CONTEXT Asthma and obstructive sleep apnea (OSA) are prevalent respiratory disorders that frequently coexist. Continuous positive airway pressure (CPAP) therapy is the standard treatment for OSA. However, its effects on systemic inflammation and glucocorticoid responsiveness in OSA patients with asthma are largely unknown. AIMS To examine the potential role of CPAP therapy in reducing systemic inflammation and improving glucocorticoid responsiveness in asthmatic patients with OSA. SETTINGS AND DESIGN A case-control study was conducted at the respiratory and sleep clinics involving patients with OSA and patients with asthma and OSA. METHODS The levels of inflammatory asthma biomarkers (interleukin [IL]-4, IL-17A, IL-8, IL-2, and interferon-γ [IFN-γ]), and glucocorticoid receptors (GR)-α and GR-β, were determined to compare systemic inflammation and glucocorticoid responsiveness between pre- and post-1-month CPAP treatment in both groups. STATISTICAL ANALYSIS The Wilcoxon signed-rank test was used to compare inflammatory biomarkers before and after CPAP therapy. P < 0.05 considered statistically significant. The analysis was performed using SPSS. RESULTS Recruited patients (n = 47), 51% (n = 24) had OSA and 49% (n = 23), had OSA with asthma. Interestingly, the blood levels of IL-17 and IL-8 were significantly decreased post-CPAP therapy in OSA patients, whereas IL-4, IL-17, and IFN-γ were significantly reduced post-CPAP treatment in OSA patients with asthma. Remarkably, CPAP therapy improved glucocorticoid responsiveness in asthmatic patients with OSA, but not in the OSA group and an increase in the GR-α/GR-β ratio was noted post-CPAP therapy. CONCLUSIONS Continuous positive airway pressure therapy improved responsiveness to glucocorticoid treatment and demonstrated a suppressive effect on proinflammatory cytokines in asthmatics with OSA.
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Affiliation(s)
- Bassam Mahboub
- Department of Respiratory and Sleep Medicine, Rashid Hospital, Dubai Health Authority, Dubai
- Tissue Injury and Repair Research Group, Sharjah Institute for Medical Research – College of Medicine, University of Sharjah, Sharjah
| | - Zelal Kharaba
- Department of Clinical Pharmacy, College of Pharmacy, Al-Ain University, Abu Dhabi
- School of Pharmacy, Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Rakhee K. Ramakrishnan
- Tissue Injury and Repair Research Group, Sharjah Institute for Medical Research – College of Medicine, University of Sharjah, Sharjah
| | - Narjes Saheb Sharif Askari
- Tissue Injury and Repair Research Group, Sharjah Institute for Medical Research – College of Medicine, University of Sharjah, Sharjah
| | - Laila Ibraheem Salameh
- Department of Respiratory and Sleep Medicine, Rashid Hospital, Dubai Health Authority, Dubai
- Tissue Injury and Repair Research Group, Sharjah Institute for Medical Research – College of Medicine, University of Sharjah, Sharjah
| | - Hassan Saber Alhariri
- Department of Respiratory and Sleep Medicine, Rashid Hospital, Dubai Health Authority, Dubai
| | - Mayank G. Vats
- Department of Respiratory and Sleep Medicine, Rashid Hospital, Dubai Health Authority, Dubai
| | - Wafa Taleb Erabia
- Department of Respiratory and Sleep Medicine, Rashid Hospital, Dubai Health Authority, Dubai
| | | | - Yassen Alfoteih
- Department of Dental Surgery, City University College of Ajman, Ajman, United Arab Emirates
| | - Andrea K. Mogas
- Meakins Christie Laboratories, McGill University, Montreal, QC, Canada
| | - Rabih Halwani
- Tissue Injury and Repair Research Group, Sharjah Institute for Medical Research – College of Medicine, University of Sharjah, Sharjah
| | - Qutayba Hamid
- Tissue Injury and Repair Research Group, Sharjah Institute for Medical Research – College of Medicine, University of Sharjah, Sharjah
- Meakins Christie Laboratories, McGill University, Montreal, QC, Canada
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22
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Iadprapal T, Anuntaseree W, Pruphetkaew N, Ruangnapa K, Saelim K, Prasertsan P. Outcomes of Intranasal Corticosteroid Treatment and Associated Factors in Children With Clinically Diagnosed Obstructive Sleep Apnea. SLEEP MEDICINE RESEARCH 2022. [DOI: 10.17241/smr.2022.01270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background and Objective Many studies have supported the potential effect of anti-inflammatory medications treatment for childhood obstructive sleep apnea (OSA). This study aimed to evaluate the outcomes of intranasal corticosteroid treatment in children with OSA symptoms and adenoid hypertrophy (AH), and to identify factors associated with the treatment outcome.Methods This retrospective study included children aged 1–15 years who snored, had sleeprelated symptoms, and received intranasal corticosteroid treatment for 4–16 weeks. Treatment outcome was considered a success if all symptoms were completely resolved or if the child still snored without sleep-related symptoms; treatment was considered a failure if the child still snored and had concomitant sleep-related symptoms.Results Among the 328 eligible children, 109 (33.2%) experienced treatment failure. The age of the children was significantly higher in the failure group than in the success group (median [interquartile range], 5.5 [3.4, 8.4] vs. 4.2 [3.2, 6.3]; p = 0.004). The percentage of children with allergic rhinitis (AR) symptoms at follow-up visit was also significantly higher in the failure group than in the success group (44% vs. 27.9% with mild AR and 9.2% vs. 4.1% with moderateto-severe AR, p < 0.001). Multiple logistic regression revealed a significant association between treatment failure and older age (odds ratio [95% confidence interval], 1.13 [1.04–1.23]) and presence of mild AR (2.29 [1.39–3.77]) and moderate-to-severe AR (3.17 [1.20–8.39]).Conclusions Among children with OSA and AH, one-third experienced treatment failure, and the associated factors were older age and presence of AR symptoms.
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23
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Dawson D, Patterson M, Patel A, Vickery C. Where does Allergy Management Fit in Obstructive Sleep Apnea? CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Esposito S, Ricci G, Gobbi R, Vicini C, Caramelli F, Pizzi S, Fadda A, Ferro S, Plazzi G. Diagnostic and Therapeutic Approach to Children and Adolescents with Obstructive Sleep Apnea Syndrome (OSA): Recommendations in Emilia-Romagna Region, Italy. Life (Basel) 2022; 12:739. [PMID: 35629406 PMCID: PMC9146195 DOI: 10.3390/life12050739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnoea syndrome (OSA) in paediatrics is a rather frequent pathology caused by pathophysiological alterations leading to partial and prolonged obstruction (hypoventilation) and/or intermittent partial (hypopnoea) or complete (apnoea) obstruction of the upper airways. Paediatric OSA is characterised by daytime and night-time symptoms. Unfortunately, there are few data on shared diagnostic-therapeutic pathways that address OSA with a multidisciplinary approach in paediatric age. This document summarizes recommendations from the Emilia-Romagna Region, Italy, developed in order to provide the most appropriate tools for a multidisciplinary approach in the diagnosis, treatment and care of paediatric patients with OSA. The multidisciplinary group of experts distinguished two different 'step' pathways, depending on the age group considered (i.e., under or over two years). In most cases, these pathways can be carried out by the primary care paediatrician, who represents the first filter for approaching the problem. For this reason, it is essential that the primary care paediatrician receives adequate training on how to formulate the diagnostic suspicion of OSA and on what criteria to use to select patients to be sent to the hospital centre. The relationship between the paediatrician of the patient and her/his parents must see a synergy of behaviour between the various players in order to avoid uncertainty about the diagnostic and therapeutic decisions as well as the follow-up phase. The definition and evaluation of the organizational process and outcome indicators of the developed flow-chart, and the impact of its implementation will remain fundamental.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, 43126 Parma, Italy
| | - Giampiero Ricci
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Riccardo Gobbi
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Piertoni Hospital, 47121 Forlì, Italy; (R.G.); (C.V.)
| | - Claudio Vicini
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Piertoni Hospital, 47121 Forlì, Italy; (R.G.); (C.V.)
| | - Fabio Caramelli
- Pediatric Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Silvia Pizzi
- Dentistry Unit, Department of Medicine and Surgery, Centro Universitario di Odontoiatria, University of Parma, 43126 Parma, Italy;
| | - Agatina Fadda
- Direzione Generale Cura della Persona, Salute e Welfare, Emilia-Romagna Region, 40128 Bologna, Italy; (A.F.); (S.F.)
| | - Salvatore Ferro
- Direzione Generale Cura della Persona, Salute e Welfare, Emilia-Romagna Region, 40128 Bologna, Italy; (A.F.); (S.F.)
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy;
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
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25
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Damian A, Gozal D. Innovations in the Treatment of Pediatric Obstructive Sleep Apnea. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:339-350. [PMID: 36217094 DOI: 10.1007/978-3-031-06413-5_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Obstructive sleep apnea affects a large proportion of otherwise healthy children in the context of interactions between craniofacial elements, adenotonsillar hypertrophy and other anatomical factors, and neuromuscular reflexes of the upper airway. In light of the adverse consequences of sleep apnea, it is important not only to proceed with early diagnosis but also to implement adequate treatment that is guided by the pathophysiological determinants of the disease in each child. Here, we will describe the current standard of care approaches to the treatment of pediatric obstructive sleep apnea, and will also explore novel management strategies that should enable more personalized therapy in the near future.
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Affiliation(s)
- Allan Damian
- Department of Neurology, University of Missouri School of Medicine, Columbia, MO, USA
- Comprehensive Sleep Medicine Program, University of Missouri School of Medicine, Columbia, MO, USA
| | - David Gozal
- Comprehensive Sleep Medicine Program, University of Missouri School of Medicine, Columbia, MO, USA.
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA.
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26
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Duan H, Xia L, Lan Q. Efficacy and safety of fluticasone propionate nasal spray in treatment ofadenoidal hypertrophic snoring in children. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e21052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
| | - Li Xia
- Zhejiang Xiaoshan Hospital, China
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27
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Nixon GM, Perrett KP. Limited evidence for anti-inflammatory medications for obstructive sleep apnoea in children. J Paediatr Child Health 2021; 57:2019-2021. [PMID: 34490679 DOI: 10.1111/jpc.15731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Gillian M Nixon
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Kirsten P Perrett
- Melbourne Children's Trial Centre, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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28
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Kajiyama T, Komori M, Hiyama M, Kobayashi T, Hyodo M. Changes during medical treatments before adenotonsillectomy in children with obstructive sleep apnea. Auris Nasus Larynx 2021; 49:625-633. [PMID: 34840035 DOI: 10.1016/j.anl.2021.11.001] [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: 08/10/2021] [Revised: 09/28/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The severity of pediatric obstructive sleep apnea (OSA) can vary from mild to very severe (AHI ≥ 30 events/h) with the seasons. The efficacy of medical treatment has been investigated in cases of mild and moderate pediatric OSA, but not in severe cases thoroughly. METHODS Our prospective cohort study involved 205 children who visited our outpatient clinic between December 2014 and May 2020. We performed home sleep tests after the initial visit, and then polysomnography after optimizing the control of rhinitis, sinusitis, adenoid hypertrophy, and tonsillitis by using medical treatments. RESULTS The respective proportions of patients who improved to obstructive AHI (O-AHI) < 1/h or who proceeded to surgery were 43.4% and 62.3% in mild cases; 43.3% and 52.2% in moderate cases; 30.2% and 68.4% in severe cases; and 0.0% and 100% in very severe cases. Additionally, nadir SaO2 improved significantly between before and after medical treatment in both O-AHI < 1/h and O-AHI ≥ 1/h patients (respectively p < 0.0001, p = 0.0009). The lowest nadir SaO2 before medical treatment was 74% in patients in whom O-AHI was normalized after medical treatments. CONCLUSION Medical treatment instituted before a surgical decision is made can provide substantial benefits and avoid unnecessary surgery if there is time for such treatments. In contrast, it may be difficult to normalize the O-AHI in pediatric patients with very severe OSA or a nadir SaO2 of less than 74% by medical treatment.
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Affiliation(s)
- Taihei Kajiyama
- Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masahiro Komori
- Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Japan.
| | - Mariko Hiyama
- Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Taisuke Kobayashi
- Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masamitsu Hyodo
- Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Japan
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29
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Cavaliere M, De Luca P, De Bonis E, Maurizi R, Cassandro C, Ralli M, Cassandro E, Scarpa A. Partial intracapsular tonsillectomy in the treatment of pediatric obstructive sleep apnea/hypopnea syndrome: a prospective study with 5-year follow-up. Eur Arch Otorhinolaryngol 2021; 279:3089-3093. [PMID: 34628549 PMCID: PMC9072457 DOI: 10.1007/s00405-021-07119-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/23/2021] [Indexed: 11/14/2022]
Abstract
Objective To assess efficacy and safety of tonsil reduction with bipolar forceps electrocautery as treatment of paediatric obstructive sleep apnea/hypopnea syndrome (OSAHS). Study design Prospective interventional study. Methods Two hundred and sixty-three children aged 4–10 years with OSAHS and an apnea hypopnea index (AHI) > 3 were enrolled from March 2013 to January 2016. Pre-operative evaluation included oropharyngeal clinical examination with fiberoptic nasopharyngoscopy, OSA-18 questionnaire and overnight sleep study. All children were treated with adenoidectomy and tonsillotomy with bipolar forceps. OSA-18 questionnaire and overnight sleep study were performed 30 days after surgery. Results Pre-operative average of the OSA-18 questionnaires was of 70.3 (SD = 9.7); 30-day post-operative score was 23.15 (SD = 8.2; p = 0.045). Pre-operative average Apnea Hypopnea Index (AHI) score was 9.41 (SD = 4.1); 30-day post-operative average of AHI score was of 1.75 (SD = 0.8; p = 0.012). Oxygen Desaturation Index (ODI) rate changed from 7.39 (SD = 4) to 1.34 (30-day post-operative) (SD = 4.7; p = 0.085). NADIR rate changed from 79% (SD = 6.32) to 90% (30-day post-operative) (SD = 5.18; p = 0.00012). Peri- and post-operative complications in our sample were mainly pain (average 75 doses of paracetamol), while bleeding did not occur (0%). All patients received a follow-up examination 5 years after surgery to evaluate tonsil size; at this time-point, a reduction in tonsil size from 3.6 (3–4; SD = 4.2) to 1.3 (1–2; SD = 5.5) was found, while tonsil regrowth was observed in five children (2%). Conclusion This study showed that partial tonsillotomy with bipolar forceps electrocautery associated to adenoidectomy is an effective technique in treating OSAHS symptoms in children and ensures less complications in terms of hemorrhage, postoperative pain and infections compared to traditional adenotonsillectomy. The very low tonsillar regrowth rate reported in this study may support the routine use of this technique.
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Affiliation(s)
- Matteo Cavaliere
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Pietro De Luca
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.
| | - Egidio De Bonis
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Riccardo Maurizi
- Department of Clinical Sciences and Translational Medicine, Otorhinolaryngology Unit, Tor Vergata University of Rome, Rome, Italy
| | | | - Massimo Ralli
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Ettore Cassandro
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Alfonso Scarpa
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
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30
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Gozal D, Ismail M, Brockmann PE. Alternatives to surgery in children with mild OSA. World J Otorhinolaryngol Head Neck Surg 2021; 7:228-235. [PMID: 34430830 PMCID: PMC8356096 DOI: 10.1016/j.wjorl.2021.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/17/2021] [Accepted: 03/18/2021] [Indexed: 12/01/2022] Open
Abstract
Precision medicine requires coordinated and integrated evidence-based combinatorial approaches so that diagnosis and treatment can be tailored to the individual patient. In this context, the treatment approach to mild obstructive sleep apnea (OSA) is fraught with substantial debate as to what is mild OSA, and as to what constitutes appropriate treatment. As such, it is necessary to first establish a proposed consensus of what criteria need to be employed to reach the diagnosis of mild OSA, and then examine the circumstances under which treatment is indicated, and if so, whether and when anti-inflammatory therapy (AIT), rapid maxillary expansion (RME), and/or myofunctional therapy (MFT) may be indicated.
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Affiliation(s)
- David Gozal
- Department of Child Health and Child Health Research Institute, and MU Women and Children's Hospital, University of Missouri School of Medicine, Columbia, MO, USA
| | - Mahmoud Ismail
- Department of Neurology and Sleep Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Pablo E Brockmann
- Department of Pediatric Cardiology and Pulmonology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Pediatric Sleep Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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31
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Halawani M, Alkhaldi A, Almajed A, Almutairi A, Alrashed M, Albakeet N, Alshiha W, Aldibasi O, Alshammari J. Safety and Efficacy of Maxitrol in Pediatric Age Group Below Two Years With Adenoid Hypertrophy: A Retrospective Cohort Study. Cureus 2021; 13:e14736. [PMID: 34079682 PMCID: PMC8162137 DOI: 10.7759/cureus.14736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Adenoid hypertrophy, a common condition in children, represents one of the common indications for surgery in pediatrics. Medical treatment alone is not effective, and most of the time patients are managed by surgical removal of the adenoid. The aim of this study is to assess the safety and efficacy of intranasal Maxitrol® drops (Novartis Pharmaceuticals, Basel, Switzerland) in pediatric patients with adenoid hypertrophy aged less than two years and to document any side effects during its use. Methods This retrospective cohort study was conducted at King Abdullah Specialist Children's Hospital (KASCH). We reviewed the charts of 86 pediatric patients aged less than two years who were diagnosed with adenoid hypertrophy between 2015 and 2018. Patients were grouped according to the type of intervention (use of Maxitrol®, and no use). The follow-up time was up to one year. Results Out of 86 patients, 55 (63.9%) patients had adenoid hypertrophy alone and 31 (36.1%) had adenoid hypertrophy plus another disease. Patients with obstructive sleep apnea symptoms (p=0.026) and grade of adenoid (p=0.040) showed a significant relationship with surgery booking after one year. The probability of booking for surgery for those who used Maxitrol® was 1.394 times higher than for those who were not using it (odds ratio [OR]=1.394; 95% confidence interval [CI]=0.549-3.537). Suppression of growth and eye complications were not reported in any of our patients. Conclusion In this small sample, the use of Maxitrol® in the pediatric age group below two years with adenoid hypertrophy was safe and effective in relieving nasal symptoms; however, eventually, surgery was needed in most of our patients. Suppression of growth and eye complications were not reported in any of our patients during the follow-up time.
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Affiliation(s)
- Mohammed Halawani
- Otolaryngology Head & Neck Surgery, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, SAU
| | - Abdullah Alkhaldi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdullah Almajed
- Otolaryngology Head & Neck Surgery, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, SAU
| | - Ahmed Almutairi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Maali Alrashed
- Otolaryngology Head & Neck Surgery, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, SAU
| | - Nouf Albakeet
- Otolaryngology Head & Neck Surgery, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, SAU
| | - Wala Alshiha
- Otolaryngology Head & Neck Surgery, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, SAU
| | - Omar Aldibasi
- Biostatistics and Bioinformatics, King Abdullah International Medical Research Center (KAIMRC), Riyadh, SAU
| | - Jaber Alshammari
- Otolaryngology Head & Neck Surgery, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, SAU
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32
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Leung TN, Cheng JW, Chan AK. Paediatrics: how to manage obstructive sleep apnoea syndrome. Drugs Context 2021; 10:dic-2020-12-5. [PMID: 33828609 PMCID: PMC8007210 DOI: 10.7573/dic.2020-12-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/19/2021] [Indexed: 02/02/2023] Open
Abstract
Obstructive sleep apnoea syndrome (OSAS) is defined as the intermittent reduction or cessation of airflow due to partial or complete obstruction of the upper airway during sleep. Paediatric OSAS has specific contributing factors, presenting symptoms and management strategies in various age groups. Untreated OSAS can lead to detrimental effects on neurocognitive development and cardiovascular and metabolic functions of a growing child. In the past decade, practice guidelines have been developed to guide the evaluation and management of OSAS. This article provides a narrative review on the current diagnostic and treatment options for paediatric OSAS. Alternative diagnostic tools other than the standard polysomnography are discussed. Adenotonsillectomy is considered the first-line therapy yet it is not suitable for treatment of all OSAS cases. Nocturnal non-invasive positive airway pressure ventilation is effective and could be the priority treatment for patients with complex comorbidities, residual OSAS post-adenotonsillectomy or obesity. However, intolerance and non-adherence are major challenges of positive airway pressure therapy especially in young children. There is increasing evidence for watchful waiting and other gentler alternative treatment options in mild OSAS. The role of anti-inflammatory drugs as the primary or adjunctive treatment is discussed. Other treatment options, including weight reduction, orthodontic procedures and myofunctional therapy, are indicated for selected patients. Nevertheless, the successful management of paediatric OSAS often requires a multidisciplinary team approach.
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Affiliation(s)
- Theresa Nh Leung
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong SAR, China
| | - James Wch Cheng
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong SAR, China
| | - Anthony Kc Chan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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33
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Bhattacharjee R. Question 5: Which children with OSA should be considered for medical therapy? Paediatr Respir Rev 2021; 37:64-67. [PMID: 33342726 DOI: 10.1016/j.prrv.2020.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Rakesh Bhattacharjee
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.
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34
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Ostroumova OD, Isaev RI, Kotovskaya YV, Tkacheva ON. [Drugs affecting obstructive sleep apnea syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:46-54. [PMID: 33076645 DOI: 10.17116/jnevro202012009146] [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: 01/20/2023]
Abstract
Sleep-disordered breathing is one of the most common sleep-associated disorders. At the same time, their prevalence tends to increase with age. One of the most common forms of respiratory failure during sleep is obstructive sleep apnea syndrome (OSA), which is characterized by repeated episodes of cessation of breathing or a significant decrease in respiratory flow while maintaining respiratory effort as a result of obstruction of the upper respiratory tract. Drugs have different effects on OSA. There are drugs that worsen OSA, drugs that do not affect OSA, and drugs that improve OSA. Benzodiazepines, opioids, muscle relaxants, and male hormones adversely affect OSA. Also of clinical interest are drugs that do not affect OSA and can even potentially improve respiratory function during sleep. These include anti-inflammatory drugs, diuretics, bronchodilators, acetylcholinesterase inhibitors, antiparkinsonian, decongestant drugs, drugs for intranasal use, topical soft tissue lubricant, female sex hormones. Finally, the effect of a number of drugs on OSA is not definitively established and requires further study (benzodiazepine receptor agonist hypnotics, angiotensin-converting enzyme inhibitors, opiate receptor antagonists, antidepressants, proton-pump inhibitors, TNF-α antagonists, glutamate receptor antagonists, drugs for the treatment of acromegaly, drugs for the treatment of narcolepsy). Raising awareness of doctors of different specialties about the impact of various drugs on OSA can not only prevent the deterioration of respiratory distress during sleep, but also, with a rational individual approach, makes it possible to even improve the quality of sleep and blood saturation, thereby contributing to a more favorable course of OSA and the underlying disease.
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Affiliation(s)
- O D Ostroumova
- Pirogov Russian National Research Medical University, Moscow, Russia.,Russian Clinical and Research Center of Gerontology, Moscow, Russia
| | - R I Isaev
- Russian Gerontological Research and Clinical Center, Moscow, Russia
| | - Yu V Kotovskaya
- Russian Gerontological Research and Clinical Center, Moscow, Russia
| | - O N Tkacheva
- Russian Gerontological Research and Clinical Center, Moscow, Russia
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35
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Bariani RCB, Guimarães TM, Cappellette M, Moreira G, Fujita RR. The impact of positive airway pressure on midface growth: a literature review. Braz J Otorhinolaryngol 2020; 86:647-653. [PMID: 32595077 PMCID: PMC9422541 DOI: 10.1016/j.bjorl.2020.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/06/2020] [Accepted: 05/13/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The treatment of obstructive sleep apnea with positive airway pressure in children is restricted due to concerns that it could affect maxilla growth over time. OBJECTIVE To undertake a systematic review of the literature about the long-term impact of using a positive airway pressure mask on the midface in growing individuals. METHODS The literature search was conducted in September 2019 using the keywords ("long-term" OR "long term" OR "side effects" OR longitudinal) AND (children OR child OR preschool OR adolescents OR adolescent OR infant OR infants) AND (craniofacial OR "mid-face" OR midface OR midfacial OR facial OR maxillary) AND ("airway pressure" OR ventilation) in the databases PubMed, Web of Science and Lilacs. The search included papers published in English, until September 2019, on the effects of positive airway pressure on midfacial growth. RESULTS The search strategy identified five studies: two case reports, two cross-sectional studies and one retrospective cohort study. All studies evaluated the long-term effects of a using a nasal mask on the midface in children and adolescents; four showed midface hypoplasia and one no showed difference post- treatment compared to a control. CONCLUSION Most of the studies demonstrated that long-term use of nasal positive airway pressure in childhood/adolescence is associated with midface hypoplasia.
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Affiliation(s)
- Rita Catia Brás Bariani
- Universidade Federal de São Paulo (Unifesp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil.
| | - Thais Moura Guimarães
- Universidade Federal de São Paulo (Unifesp), Departamento de Psicobiologia, São Paulo, SP, Brazil
| | - Mario Cappellette
- Universidade Federal de São Paulo (Unifesp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Gustavo Moreira
- Universidade Federal de São Paulo (Unifesp), Departamento de Psicobiologia, São Paulo, SP, Brazil
| | - Reginaldo Raimundo Fujita
- Universidade Federal de São Paulo (Unifesp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
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Nguyen DK, Liang J, Durr M. Topical nasal treatment efficacy on adult obstructive sleep apnea severity: a systematic review and meta-analysis. Int Forum Allergy Rhinol 2020; 11:153-161. [PMID: 32713164 DOI: 10.1002/alr.22658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Nasal obstruction is a common complaint in patients with sleep-disordered breathing and obstructive sleep apnea (OSA). Although topical nasal treatments (TNTs) have been shown to reduce nasal resistance and improve nasal obstruction, there is conflicting evidence regarding the role of TNTs in adult OSA. In this systematic review and meta-analysis we aim to evaluate the role of TNTs in adults with OSA. Data sources used included PubMed, Ovid MEDLINE, and Cochrane Central, from January 2001 to July 2019. METHODS Inclusion criteria were English-language studies containing original data on TNTs in adults (≥18 years) with OSA (apnea-hypopnea index [AHI] ≥5). Exclusion criteria were case reports, studies without outcome measures, and concurrent non-TNT treatment for OSA. Two investigators independently reviewed all articles and performed quality assessment using validated tools. Meta-analysis and quality assessment were performed. RESULTS Of the 2180 abstracts identified, 8 studies met inclusion criteria. TNTs included decongestants (4 of 8 studies), corticosteroids (3 of 8), and antihistamines (1 of 8). Outcome measures included AHI (8 of 8), respiratory distress index (RDI; 1 of 8), oxygen-desaturation index (ODI; 3 of 8), minimum SaO2 (MinSaO2 ; 4 of 8), nasal resistance (4 of 8), endoscopic sinus surgery (4 of 8 studies) and standardized rhinoconjunctivitis quality of life questionnaire scores (1 of 8 studies). Qualitatively, all studies showed trends toward improving objective and subjective measures of OSA, although the significance of these improvements varied across studies. A meta-analysis was performed in 5 studies, but TNTs did not reveal a significant change in AHI (p > 0.05). CONCLUSION TNTs may improve minimum oxygen saturation, ODI, RDI, and subjective/quality-of-life measures. Allergic patients may have more improvement in OSA measures compared with nonallergic patients. Future studies are indicated to accurately determine the efficacy of TNTs.
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Affiliation(s)
| | - Jonathan Liang
- Otolaryngology, Kaiser Permanente Northern California, Oakland, CA
| | - Megan Durr
- Otolaryngology, Kaiser Permanente Northern California, Oakland, CA
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Childhood Obstructive Sleep Apnea: from Diagnosis to Therapy—an Update. CURRENT SLEEP MEDICINE REPORTS 2020. [DOI: 10.1007/s40675-020-00182-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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38
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Alternative Approaches to Adenotonsillectomy and Continuous Positive Airway Pressure (CPAP) for the Management of Pediatric Obstructive Sleep Apnea (OSA): A Review. SLEEP DISORDERS 2020; 2020:7987208. [PMID: 32695520 PMCID: PMC7355373 DOI: 10.1155/2020/7987208] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/09/2020] [Indexed: 12/21/2022]
Abstract
Continuous positive airway pressure (CPAP) is considered first-line treatment in the management of pediatric patients without a surgically correctible cause of obstruction who have confirmed moderate-to-severe obstructive sleep apnea (OSA). The evidence supports its reduction on patient morbidity and positive influence on neurobehavioral outcome. Unfortunately, in clinical practice, many patients either refuse CPAP or cannot tolerate it. An update on alternative approaches to CPAP for the management of OSA is discussed in this review, supported by the findings of systematic reviews and recent clinical studies. Alternative approaches to CPAP and adenotonsillectomy for the management of OSA include weight management, positional therapy, pharmacotherapy, high-flow nasal cannula, and the use of orthodontic procedures, such as rapid maxillary expansion and mandibular advancement devices. Surgical procedures for the management of OSA include tongue-base reduction surgery, uvulopalatopharyngoplasty, lingual tonsillectomy, supraglottoplasty, tracheostomy, and hypoglossal nerve stimulation. It is expected that this review will provide an update on the evidence available regarding alternative treatment approaches to CPAP for clinicians who manage patients with pediatric OSA in daily clinical practice.
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Yu W, Sarber KM, Howard JJM, Huang G, Hossain MM, Heubi CH, Lu X, Simakajornboon N. Children with Down syndrome and mild OSA: treatment with medication versus observation. J Clin Sleep Med 2020; 16:899-906. [PMID: 32043964 DOI: 10.5664/jcsm.8358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
STUDY OBJECTIVES Children with Down syndrome (DS) have a high prevalence of obstructive sleep apnea (OSA). Anti-inflammatory medications have been shown to be an effective treatment for mild OSA in otherwise healthy children. However, the efficacy in children with DS and mild OSA has not been investigated. Our aim was to examine the polysomnographic changes of children with DS and mild OSA treated with medication. METHODS A retrospective chart review was performed in children with DS (< 18 years) and mild OSA (obstructive apnea-hypopnea index ≤ 5 events/h) diagnosed by polysomnography (PSG) between 2006 and 2018. Patients were included if they were treated with medications (intranasal corticosteroids and/or montelukast) or by observation with a duration of at least 3 months and had baseline and follow-up PSGs. Demographic data, comorbid diagnoses, and PSG data were collected and analyzed. RESULTS Forty-five children met inclusion criteria. In the medication group, 29 children were identified. The median age was 7.4 years (interquartile range [IQR] 4.9-9.3). In the observation group, 16 children were identified. The median age was 4.0 years (IQR 3.2-5.3). The median time from baseline to follow-up PSG was 14.0 months (IQR 10.0-22.9) for the medication group and 10.5 months (IQR 6.5-33.5) for the observation group. There were no significant changes in the median obstructive apnea-hypopnea index from the baseline to follow-up PSG in either the medication group (2.8 [IQR 2.2-3.6) versus 3.5 [IQR 1.4-4.8) events/h; P = .25) or the observation group (2.3 [IQR 1.3-3.1] versus 2.9 [IQR 1.9-6.8] events/h; P = .12). Similarly, there were no significant differences in apnea-hypopnea index, oxygen nadir or end-tidal carbon dioxide between the groups (P = .07-1). CONCLUSIONS In our cohort, medication therapy did not significantly improve polysomnographic measures in children with DS and mild OSA. Several factors such as hypotonia and relative macroglossia may explain the ineffectiveness of medical therapy for OSA in this population. Further prospective studies are necessary to confirm these results and to evaluate if a subgroup of DS children may benefit from medical therapy.
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Affiliation(s)
- Wenwen Yu
- Department of Oral and Cranio-maxillofacial Surgery, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kathleen M Sarber
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Guixia Huang
- 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
| | - Christine H Heubi
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Xiaofeng Lu
- Department of Oral and Cranio-maxillofacial Surgery, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Narong Simakajornboon
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Kuhle S, Urschitz MS. Anti-inflammatory medications for the treatment of pediatric obstructive sleep apnea. Paediatr Respir Rev 2020; 34:35-36. [PMID: 32245548 DOI: 10.1016/j.prrv.2020.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Stefan Kuhle
- Perinatal Epidemiology Research Unit, Departments of Pediatrics and Obstetrics & Gynaecology, Dalhousie University, Halifax, NS, Canada.
| | - Michael S Urschitz
- Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
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Gozal D, Tan HL, Kheirandish-Gozal L. Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision. J Clin Med 2020; 9:jcm9030888. [PMID: 32213932 PMCID: PMC7141493 DOI: 10.3390/jcm9030888] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/06/2020] [Accepted: 03/18/2020] [Indexed: 12/18/2022] Open
Abstract
Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care.
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Affiliation(s)
- David Gozal
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA;
- Correspondence:
| | - Hui-Leng Tan
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK;
| | - Leila Kheirandish-Gozal
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA;
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Lin SY, Su YX, Wu YC, Chang JZC, Tu YK. Management of paediatric obstructive sleep apnoea: A systematic review and network meta-analysis. Int J Paediatr Dent 2020; 30:156-170. [PMID: 31680340 DOI: 10.1111/ipd.12593] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) affects many children, and adenotonsillar hypertrophy is the most common cause of paediatric OSA. AIM Despite the growing treatment options, there is no comprehensive comparison of all interventions. We aimed to compare and rank the effectiveness of various treatments in a network meta-analysis. DESIGN Literature was searched from inception to 13 May 2018 for paediatric OSA with adenotonsillar hypertrophy. The outcomes were the changes in apnoea-hypopnea index (AHI), oxyhaemoglobin desaturation index (ODI), and lowest arterial oxygen saturation (SaO2 ). Frequentist approach to network meta-analysis was used. Treatment hierarchy was summarized according to the surfaces under the cumulative ranking curves. RESULTS Fourteen trials comprising 1064 paediatric OSA participants evaluating ten interventions (adenotonsillectomy, adenotonsillectomy + pharyngoplasty, adenotonsillotomy, antimicrobial therapy, steroids, leukotriene receptor antagonists [LTRAs], steroids + LTRAs, rapid maxillary expansion [RME], placebo, and no treatment) were identified for network meta-analysis. In terms of effectiveness in AHI reduction, surgical approach was still the most effective intervention than no treatment. RME was one of the most effective interventions to improve lowest SaO2 . No comparisons showed statistical significance in reducing ODI. CONCLUSIONS Irrespective of the intervention used, complete resolution of OSA was not achieved in most trials.
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Affiliation(s)
- Shih-Ying Lin
- Department of Dentistry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Xuan Su
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Jenny Zwei-Chieng Chang
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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仇 书, 刘 大, 钟 建. [Interpretation of French Society of ENT guidelines on the roles of the various treatment options in childhood obstructive sleep apnea-hypopnea syndrome]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:97-100. [PMID: 32086910 PMCID: PMC10128403 DOI: 10.13201/j.issn.1001-1781.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Indexed: 06/10/2023]
Abstract
The French Society of ENT and Head Neck Surgery(SFORL)present the guidelines on the roles of the various treatment options in childhood obstructive sleep apnea in May 2018,this paper is the interpretation of the guidelines.
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Affiliation(s)
- 书要 仇
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Otolaryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 大波 刘
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Otolaryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 建文 钟
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Otolaryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
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Kuhle S, Hoffmann DU, Mitra S, Urschitz MS. Anti-inflammatory medications for obstructive sleep apnoea in children. Cochrane Database Syst Rev 2020; 1:CD007074. [PMID: 31978261 PMCID: PMC6984442 DOI: 10.1002/14651858.cd007074.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is characterised by partial or complete upper airway obstruction during sleep. Approximately 1% to 4% of children are affected by OSA, with adenotonsillar hypertrophy being the most common underlying risk factor. Surgical removal of enlarged adenoids or tonsils is the currently recommended first-line treatment for OSA due to adenotonsillar hypertrophy. Given the perioperative risk and an estimated recurrence rate of up to 20% following surgery, there has recently been an increased interest in less invasive alternatives to adenotonsillectomy. As the enlarged adenoids and tonsils consist of hypertrophied lymphoid tissue, anti-inflammatory drugs have been proposed as a potential non-surgical treatment option in children with OSA. OBJECTIVES To assess the efficacy and safety of anti-inflammatory drugs for the treatment of OSA in children. SEARCH METHODS We identified trials from searches of the Cochrane Airways Group Specialised Register, CENTRAL and MEDLINE (1950 to 2019). For identification of ongoing clinical trials, we searched ClinicalTrials.gov and the World Health Organization (WHO) trials portal. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing anti-inflammatory drugs against placebo in children between one and 16 years with objectively diagnosed OSA (apnoea/hypopnoea index (AHI) ≥ 1 per hour). DATA COLLECTION AND ANALYSIS Two authors independently performed screening, data extraction, and quality assessment. We separately pooled results for the comparisons 'intranasal steroids' and 'montelukast' against placebo using random-effects models. The primary outcomes for this review were AHI and serious adverse events. Secondary outcomes included the respiratory disturbance index, desaturation index, respiratory arousal index, nadir arterial oxygen saturation, mean arterial oxygen saturation, avoidance of surgical treatment for OSA, clinical symptom score, tonsillar size, and adverse events. MAIN RESULTS We included five trials with a total of 240 children aged one to 18 years with mild to moderate OSA (AHI 1 to 30 per hour). All trials were performed in specialised sleep medicine clinics at tertiary care centres. Follow-up time ranged from six weeks to four months. Three RCTs (n = 137) compared intranasal steroids against placebo; two RCTs compared oral montelukast against placebo (n = 103). We excluded one trial from the meta-analysis since the patients were not analysed as randomised. We also had concerns about selective reporting in another trial. We are uncertain about the difference in AHI (MD -3.18, 95% CI -8.70 to 2.35) between children receiving intranasal corticosteroids compared to placebo (2 studies, 75 participants; low-certainty evidence). In contrast, children receiving oral montelukast had a lower AHI (MD -3.41, 95% CI -5.36 to -1.45) compared to those in the placebo group (2 studies, 103 participants; moderate-certainty evidence). We are uncertain whether the secondary outcomes are different between children receiving intranasal corticosteroids compared to placebo: desaturation index (MD -2.12, 95% CI -4.27 to 0.04; 2 studies, 75 participants; moderate-certainty evidence), respiratory arousal index (MD -0.71, 95% CI -6.25 to 4.83; 2 studies, 75 participants; low-certainty evidence), and nadir oxygen saturation (MD 0.59%, 95% CI -1.09 to 2.27; 2 studies, 75 participants; moderate-certainty evidence). Children receiving oral montelukast had a lower respiratory arousal index (MD -2.89, 95% CI -4.68 to -1.10; 2 studies, 103 participants; moderate-certainty evidence) and nadir of oxygen saturation (MD 4.07, 95% CI 2.27 to 5.88; 2 studies, 103 participants; high-certainty evidence) compared to those in the placebo group. We are uncertain, however, about the difference in desaturation index (MD -2.50, 95% CI -5.53 to 0.54; 2 studies, 103 participants; low-certainty evidence) between the montelukast and placebo group. Adverse events were assessed and reported in all trials and were rare, of minor nature (e.g. nasal bleeding), and evenly distributed between study groups. No study examined the avoidance of surgical treatment for OSA as an outcome. AUTHORS' CONCLUSIONS There is insufficient evidence for the efficacy of intranasal corticosteroids for the treatment of OSA in children; they may have short-term beneficial effects on the desaturation index and oxygen saturation in children with mild to moderate OSA but the certainty of the benefit on the primary outcome AHI, as well as the respiratory arousal index, was low due to imprecision of the estimates and heterogeneity between studies. Montelukast has short-term beneficial treatment effects for OSA in otherwise healthy, non-obese, surgically untreated children (moderate certainty for primary outcome and moderate and high certainty, respectively, for two secondary outcomes) by significantly reducing the number of apnoeas, hypopnoeas, and respiratory arousals during sleep. In addition, montelukast was well tolerated in the children studied. The clinical relevance of the observed treatment effects remains unclear, however, because minimal clinically important differences are not yet established for polysomnography-based outcomes in children. Long-term efficacy and safety data on the use of anti-inflammatory medications for the treatment of OSA in childhood are still not available. In addition, patient-centred outcomes like concentration ability, vigilance, or school performance have not been investigated yet. There are currently no RCTs on the use of other kinds of anti-inflammatory medications for the treatment of OSA in children. Future RCTs should investigate sustainability of treatment effects, avoidance of surgical treatment for OSA, and long-term safety of anti-inflammatory medications for the treatment of OSA in children and include patient-centred outcomes.
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Affiliation(s)
- Stefan Kuhle
- Dalhousie UniversityDepartments of Pediatrics and Obstetrics & GynaecologyHalifaxNSCanada
| | - Dorle U Hoffmann
- University Medical Centre of the Johannes Gutenberg UniversityDivision of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)Langenbeckstrausse 1MainzRhineland‐PalatinateGermany55131
| | - Souvik Mitra
- Dalhousie University & IWK Health CentreDepartments of Pediatrics, Community Health & EpidemiologyG‐2214, 5850/5980 University AvenueHalifaxNova ScotiaCanadaB3K 6R8
| | - Michael S Urschitz
- University Medical Centre of the Johannes Gutenberg UniversityDivision of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)Langenbeckstrausse 1MainzRhineland‐PalatinateGermany55131
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Kubba H, Rowe K, Pinczower G, Sloane R, Waterham M, Weiss E, Harwood R. Our experience of a paediatrician‐led clinic for the medical management of children with obstructive sleep‐disordered breathing. Clin Otolaryngol 2019; 45:190-196. [DOI: 10.1111/coa.13479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/08/2019] [Accepted: 11/09/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Haytham Kubba
- Department of Otolaryngology Royal Children's Hospital Parkville Vic. Australia
| | - Katherine Rowe
- Department of General Paediatrics Royal Children's Hospital Parkville Vic. Australia
| | - Gideon Pinczower
- Department of General Paediatrics Royal Children's Hospital Parkville Vic. Australia
| | - Robert Sloane
- Department of General Paediatrics Royal Children's Hospital Parkville Vic. Australia
| | - Michelle Waterham
- Department of General Paediatrics Royal Children's Hospital Parkville Vic. Australia
| | - Emma Weiss
- Department of General Paediatrics Royal Children's Hospital Parkville Vic. Australia
| | - Rachel Harwood
- Department of General Paediatrics Royal Children's Hospital Parkville Vic. Australia
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Howard JJM, Sarber KM, Yu W, Smith DF, Tikhtman RO, Simakajornboon N, Ishman SL. Outcomes in children with down syndrome and mild obstructive sleep apnea treated non-surgically. Laryngoscope 2019; 130:1828-1835. [PMID: 31603543 DOI: 10.1002/lary.28325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 08/27/2019] [Accepted: 09/06/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Nasal steroids, oral anti-leukotrienes and supplemental oxygen are effective in the treatment of mild obstructive sleep apnea (OSA) in otherwise healthy children. However, their efficacy is unknown in children with Down syndrome (DS). Here we examine the effect of single medication therapy versus observation versus oxygen on polysomnographic outcomes in these children. METHODS We reviewed children (<18 years) diagnosed with DS and mild OSA (obstructive apnea-hypopnea index [oAHI] ≥1 to <5 events/hour) treated non-surgically (with supplemental oxygen, one medication, or observation) between 2012 and 2017. Demographic data, comorbid diagnoses, and pre- and posttreatment polysomnograms were analyzed. We assessed pre- and posttreatment oAHI, oxyhemoglobin saturation nadir, percent total sleep time (%TST) in rapid eye movement (REM), and end-tidal carbon dioxide (ETCO2 ) >50 mmHg. RESULTS Twenty-four children met inclusion criteria; 10 treated with medication, one with oxygen, and 13 with observation (baseline oAHI was 3.5, 3.3, and 2.9 events/hour, respectively). There was no significant change in oAHI, oxyhemoglobin saturation nadir, ETCO2 , or percent TST in REM after treatment for any treatment group (P = .21-.94). There was no association between reported symptoms and AHI severity or change in AHI. OSA resolved in one patient treated with observation and two treated with medication, but worsened in two each in the medication and observation groups. Resolution of OSA occurred in 20% treated with medication, 7.7% with observation, and 0% with oxygen (P = .82). CONCLUSION In our cohort, resolution of mild OSA was low. This suggests that consideration should be given to multimodality treatments in children with DS and mild OSA. Prospective studies will help establish effectiveness in this cohort. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1828-1835, 2020.
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Affiliation(s)
- Javier J M Howard
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Kathleen M Sarber
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Wenwen Yu
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - David F Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Raisa O Tikhtman
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Narong Simakajornboon
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Stacey L Ishman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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Gulotta G, Iannella G, Vicini C, Polimeni A, Greco A, de Vincentiis M, Visconti IC, Meccariello G, Cammaroto G, De Vito A, Gobbi R, Bellini C, Firinu E, Pace A, Colizza A, Pelucchi S, Magliulo G. Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3235. [PMID: 31487798 PMCID: PMC6765844 DOI: 10.3390/ijerph16183235] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/19/2019] [Accepted: 08/25/2019] [Indexed: 12/27/2022]
Abstract
The obstructive sleep apnea syndrome (OSAS) represents only part of a large group of pathologies of variable entity called respiratory sleep disorders (RSD) which include simple snoring and increased upper airway resistance syndrome (UARS). Although the etiopathogenesis of adult OSAS is well known, many aspects of this syndrome in children are still debated. Its prevalence is about 2% in children from 2 to 8 years of age, mostly related to the size of the upper airways adenoid tissue. Several risk factors linked to the development of OSAS are typical of the pediatric age. The object of this paper is to analyze the state of the art on this specific topic, discussing its implications in terms of diagnosis and management.
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Affiliation(s)
- Giampiero Gulotta
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
| | - Giannicola Iannella
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy.
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy.
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
- Ear-Nose-Throat & Audiology Unit, University of Ferrara, 44121 Ferrara, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillo Facial Sciences, University "Sapienza", 00185 Rome, Italy
| | - Antonio Greco
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
| | | | | | - Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Riccardo Gobbi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Chiara Bellini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Elisabetta Firinu
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Annalisa Pace
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
| | - Andrea Colizza
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
| | - Stefano Pelucchi
- Ear-Nose-Throat & Audiology Unit, University of Ferrara, 44121 Ferrara, Italy
| | - Giuseppe Magliulo
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
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Tam YY, Shao IH, Wu CC, Hsieh ML. The impact of intranasal fluticasone on patients with obstructive sleep apnea: a prospective study. Braz J Otorhinolaryngol 2019; 87:152-156. [PMID: 31521518 PMCID: PMC9422482 DOI: 10.1016/j.bjorl.2019.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 06/26/2019] [Accepted: 07/22/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Obstructive sleep apnea is the most common type of sleep apnea, which is caused by complete or partial obstructions of the upper airway. Nasal obstruction is also considered as one of the independent risk factors of obstructive sleep apnea. Objective Patients with obstructive sleep apnea. Methods We enrolled patients with obstructive sleep apnea from June to December 2015 and treated them with intranasal corticosteroid spray for four weeks. Several parameters were obtained before and after the treatment, including Nasal Obstruction Symptom Evaluation scores, Pittsburgh Sleep Quality Index questionnaire and Epworth Sleepiness Scale questionnaire. Results Fifty patients completed questionnaires prior to and following the intranasal fluticasone treatments. The average age was 39.7 ± 15.6 y, with a male to female ratio of 3:2. The post-treatment Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Nasal Obstruction Symptom Evaluation scores all indicated a decrease compared to pre-treatment scores, from 10.4 to 8.74, 7.86 to 6.66 and 9.08 to 6.48, respectively. A significant decrease was observed in the Nasal Obstruction Symptom Evaluation ≥10 group in all three categories, but not in the Nasal Obstruction Symptom Evaluation <10 group. Conclusions Intranasal fluticasone treatment may be useful for patients with nasal obstruction-related obstructive sleep apnea to improve sleep quality and limit daytime dysfunction.
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Affiliation(s)
- Yuan-Yun Tam
- Taoyuan General Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Ministry of Health and Welfare, Taoyuan City, Taiwan
| | - I-Hung Shao
- Chang Gung University, Linkou Chang Gung Memorial Hospital, Department of Surgery, Division of Urology, Taoyuan City, Taiwan
| | - Chia-Chen Wu
- Chang Gung University, Linkou Chang Gung Memorial Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Taoyuan City, Taiwan
| | - Ming-Li Hsieh
- Chang Gung University, Linkou Chang Gung Memorial Hospital, Department of Surgery, Division of Urology, Taoyuan City, Taiwan.
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New Options in Pediatric Obstructive Sleep Apnea. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00245-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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50
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Sun YL, Zheng HT, Tao JL, Jiang MC, Hu CC, Li XM, Yuan B. Effectiveness and safety of Chinese herbal medicine for pediatric adenoid hypertrophy: A meta-analysis. Int J Pediatr Otorhinolaryngol 2019; 119:79-85. [PMID: 30684690 DOI: 10.1016/j.ijporl.2019.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Chinese herbal medicine has been gradually used to treat pediatric adenoid hypertrophy. This meta-analysis were conducted to evaluate the clinical efficacy and safety of Chinese herbal medicine in the treatment of pediatric adenoid hypertrophy. METHODS Randomized controlled trials involving Chinese herbal medicine in the treatment of pediatric adenoid hypertrophy were identified from Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Chinese National Knowledge Infrastructure, Chinese Biomedical Database, Wanfang Database and VIP Information Database. The methodological quality of trials was evaluated with Cochrane Handbook criteria, and the Cochrane Collaboration's Review Manager 5.3 software was used for Meta-analysis. RESULTS A total of 13 valid articles involving 1038 patients were included. The meta-analysis showed that: Compared with western medicine treatment, Chinese herbal medicine significantly improved clinical efficacy (RR = 1.33, 95% CI [1.24,1.43]), and significantly decreased A/N ratio (MD = -0.04,95%CI [-0.05,-0.03]). Chinese herbal medicine also prominently improved the quality of life (MD = -4.77,95%CI [-8.35,-1.20]). Meanwhile, it dramatically improved snoring (MD = -0.46,95%CI [-0.62,-0.30]); mouth breathing (MD = -0.52,95%CI [-0.66,-0.39]); nasal obstruction (MD = -0.56,95%CI [-0.68,-0.45]). CONCLUSION Chinese herbal medicine has good clinical efficacy and safety on pediatric adenoid hypertrophy, which need to be confirmed by high quality, multiple-centre, large sample randomized controlled trials.
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Affiliation(s)
- Ya-Lei Sun
- Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Pediatrics, Nanjing, China.
| | - Hai-Tao Zheng
- Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Pediatrics, Nanjing, China.
| | - Jia-Lei Tao
- Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Pediatrics, Nanjing, China.
| | - Ming-Chen Jiang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Pediatrics, Nanjing, China.
| | - Chan-Chan Hu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Pediatrics, Nanjing, China.
| | - Xin-Min Li
- Department of Integrated Chinese and Western Medicine, Henan University of Chinese Medicine, Zhengzhou, China.
| | - Bin Yuan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Pediatrics, Nanjing, China.
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