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Gileles-Hillel A, Bhattacharjee R, Gorelik M, Narang I. Advances in Sleep-Disordered Breathing in Children. Clin Chest Med 2024; 45:651-662. [PMID: 39069328 DOI: 10.1016/j.ccm.2024.03.004] [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: 07/30/2024]
Abstract
Pediatric sleep-disordered breathing disorders are a group of common conditions, from habitual snoring to obstructive sleep apnea (OSA) syndrome, affecting a significant proportion of children. The present article summarizes the current knowledge on diagnosis and treatment of pediatric OSA focusing on therapeutic and surgical advancements in the field in recent years. Advancements in OSA such as biomarkers, improving continuous pressure therapy adherence, novel pharmacotherapies, and advanced surgeries are discussed.
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Affiliation(s)
- Alex Gileles-Hillel
- Neonatal Pulmonology Service, Pediatric Pulmonary and Sleep Unit; Pediatric Division, Hadassah Medical Center, Jerusalem 911111, Israel; The Faculty of Medicine, Hebrew University of Jerusalem; The Wohl Translational Research Institute, Hadassah Medical Center, Kiryat Hadassah, Ein Kerem, Jerusalem 911111, Israel.
| | - Rakesh Bhattacharjee
- Division of Respiratory Medicine, Department of Pediatrics, Rady Children's Hospital, UCSD, San Diego, CA 92123, USA
| | - Michael Gorelik
- Division of Pediatric Otolaryngology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Indra Narang
- Division of Respiratory Medicine, Faculty Development and EDI, Department of Paediatrics, Translational Medicine, Research Institute, Hospital for Sick Children; Department of Paediatrics, University of Toronto, 51 Banff Road, Toronto M4S2V6, Canada
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Trandafir C, Couloigner V, Chatelet F, Fauroux B, Luscan R. Lingual Tonsillectomy as Part of a DISE-Directed Multilevel Upper Airway Surgery to Treat Complex Pediatric OSA: A Safe and Appropriate Procedure. Otolaryngol Head Neck Surg 2024. [PMID: 39148289 DOI: 10.1002/ohn.947] [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: 01/13/2024] [Revised: 07/15/2024] [Accepted: 08/03/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE To study the efficiency of lingual tonsillectomy (LT) as part of multilevel surgery in children with complex obstructive sleep apnea (OSA). To evaluate the safety and the outcomes of LT. STUDY DESIGN Retrospective case series. SETTING Pediatric tertiary care academic center. METHODS We included all children operated for LT to treat complex OSA, from January 2018 to June 2022. All patients underwent a protocolized drug-induced sleep endoscopy (DISE) followed by a coblation LT, associated with the treatment of all other obstructive sites. Patient demographics, medical history, surgery, and outcomes were reviewed. The efficiency of LT was analyzed exclusively in patients with a preoperative and postoperative sleep study. RESULTS One hundred twenty-three patients were included. Median age was 8 years (interquartile range, IQR [3-12]). Sixty-five (53%) patients had Down syndrome, 22 (18%) had a craniofacial malformation, and 8 (7%) were obese. LT was associated with adenoidectomy (n = 78, 63%), partial tonsillectomy (n = 70, 57%), inferior turbinoplasty/turbinectomy (n = 59, 48%), epiglottoplasty (n = 92, 75%), and/or expansion pharyngoplasty (n = 2, 2%). Eighty-nine patients underwent a sleep study before and after surgery. The median apnea-hypopnea index (AHI) decreased from 18 events/h (IQR [9-36]) before surgery to 3 events/h (IQR [1-5]) after surgery (P < .001) (patients with a postoperative AHI <1.5 events/h, n = 31, 35%, and an AHI <5 events/h, n = 32, 36%). Seventeen out of 30 (57%) patients could be weaned from continuous positive airway pressure after surgery. Two patients had a postoperative hemorrhage and 2 patients required a transient postoperative reintubation. CONCLUSION In children with complex OSA, LT as part of a DISE-directed multilevel upper airway surgery, was a very efficient and safe procedure.
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Affiliation(s)
- Cornelia Trandafir
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Vincent Couloigner
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
| | - Florian Chatelet
- Faculté de Médecine, Université Paris Cité, Paris, France
- Department of Otolaryngology, AP-HP, Hôpital Lariboisière, Paris, France
| | - Brigitte Fauroux
- Pediatric Sleep and Noninvasive Ventilation Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
- EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris Cité University, Paris, France
| | - Romain Luscan
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
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Senthilvel E, Jawad K, Gearhart AM, Naidugari JR, El-Kersh K. Adenotonsillectomy outcomes in children with down syndrome and obstructive sleep apnea: a single center study. Sleep Breath 2024:10.1007/s11325-024-03085-2. [PMID: 38896208 DOI: 10.1007/s11325-024-03085-2] [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: 12/20/2023] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE This study aimed to evaluate polysomnographic (PSG) outcomes of tonsillectomy and adenoidectomy (T&A) in children with Down Syndrome (DS) and OSA, and the difference in PSG outcomes of T&A between children with DS and age- and gender-matched normally developing (non-DS) children. METHODS This was a single center retrospective study that included children with DS and OSA who underwent T&A and had pre-operative and post-operative PSG. The baseline and the differences of pre- and post-operative PSG variables were compared with those of an age- and gender-matched group of non-DS children. RESULTS Forty-eight children with DS were included in the study; the median age was 5 years (IQR 5.5), 58% were males, and the median BMI was 18.2 (IQR 3.3). There was statistically significant improvement noted between pre-operative and post-operative OAHI 17.9 ± 26.7 vs. 9.1 ± 13.6 (p = 0.022) and non-REM AHI 13.9 ± 19.7 vs. 6.9 ± 14.2 (p = 0.027). However, there were no significant changes in sleep architecture, oxygen desaturation nadir, or CO2 levels. 54.2% of the DS children continued to have moderate to severe OSA after T&A. Univariate logistic regression showed that for every 1% increase in oxygen desaturation nadir, the odds of having residual moderate or severe OSA decreased by 28% (p = 0.002) compared to the cured and mild OSA groups. There was no significant pre- and post-operative differences in PSG variables noted in 16 children with DS compared to age- and gender-matched non-DS children. CONCLUSION Despite the overall significant reduction of OAHI in children with DS and OSA who underwent T&A, there was a residual moderate to severe OSA in about half of the included children. Oxygen desaturation nadir was a predicting factor for persistent moderate to severe OSA. There were no significant pre- and post-operative PSG differences in between DS children compared to non-DS children.
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Affiliation(s)
- Egambaram Senthilvel
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, 9880 Angies Way Suite 300, Louisville, KY, KY40241, USA.
| | - Kahir Jawad
- Department of Pediatrics, Norton Children's Research Institute, Affiliated with University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Alessandra M Gearhart
- Department of Pulmonary, Critical Care and Sleep Medicine, Oklahoma State University, Tulsa, OK, USA
| | - Janki R Naidugari
- University of Louisville School of Medicine, Louisville, Kentucky,, USA
| | - Karim El-Kersh
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
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Maksimoski M, Li C. Surgical Management of Pediatric Obstructive Sleep Apnea Beyond Tonsillectomy & Adenoidectomy: Tongue Base and Larynx. Otolaryngol Clin North Am 2024; 57:431-445. [PMID: 38523050 DOI: 10.1016/j.otc.2024.02.005] [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: 03/26/2024]
Abstract
Pediatric patients with persistent obstructive sleep apnea (OSA) after adenotonsillectomy often have additional sites of upper airway obstruction such as the tongue base or larynx. Sleep endoscopy and cross-sectional, dynamic imaging can be used to direct surgical management of persistent OSA. The tongue base is one of the most common sites of obstruction in children with persistent OSA, especially for patients with Trisomy 21. Lingual tonsillectomy, tongue suspension, and/or posterior midline glossectomy may be used to address lingual tonsil hypertrophy and tongue base obstruction. Epiglottopexy and/or supraglottoplasty may be used to address laryngomalacia and epiglottic prolapse resulting in OSA.
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Affiliation(s)
- Matthew Maksimoski
- Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2018, Cincinnati, OH 45229, USA
| | - Carol Li
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2018, Cincinnati, OH 45229, USA.
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Williamson A, Morrow VR, Carr MM, Coutras SW. Safety and efficacy of lingual tonsillectomy in multilevel airway surgery for pediatric obstructive sleep apnea. J Clin Sleep Med 2024; 20:189-199. [PMID: 37707284 PMCID: PMC10835779 DOI: 10.5664/jcsm.10816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
STUDY OBJECTIVES Prior studies have demonstrated the efficacy of lingual tonsillectomy in treating pediatric obstructive sleep apnea. The goal of this study is to describe the postoperative outcomes following lingual tonsillectomy as a part of drug-induced sleep endoscopy-directed multilevel sleep surgery. METHODS A retrospective review was performed for pediatric patients with obstructive sleep apnea who underwent lingual tonsillectomy as a part of drug-induced sleep endoscopy-directed sleep surgery. Data collected included age, sex assigned at birth, body mass index z-score, polysomnography results, past medical and surgical history, and postoperative outcomes. RESULTS A total of 174 patients were included in the study with a mean age of 8.29 ± 3.49 years (range 1.89-15.62) and mean preoperative apnea-hypopnea index of 7.88 ± 13.42 (range 1.10-123.40). Complications occurred in 26 patients (14.9%) including 14 patients (8.0%) requiring emergency department visit or readmission and 12 patients (6.9%) experiencing postoperative bleeding. Asthma (P = .033) and developmental delay (P = .016) correlated with postoperative complications. For patients with preoperative and postoperative polysomnography data (n = 145; 83.3%), there was significant improvement (P < .001) in apnea-hypopnea index with a mean postoperative apnea-hypopnea index of 4.02 ± 7.81 (range 0.00-54.46). Surgical failure, defined as postoperative apnea-hypopnea index ≥ 5, was identified in 25 patients (17.2%). Surgical failure was associated with body mass index z-score > 2 (P = .025) and Trisomy 21 (P = .005). CONCLUSIONS This study highlights the promising surgical success rate of drug-induced sleep endoscopy-directed lingual tonsillectomy in multilevel sleep surgery (82.8%) and infrequent complications including postoperative bleeding (6.9%) and readmission (2.3%). CITATION Williamson A, Morrow VR, Carr MM, Coutras SW. Safety and efficacy of lingual tonsillectomy in multilevel airway surgery for pediatric obstructive sleep apnea. J Clin Sleep Med. 2024;20(2):189-199.
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Affiliation(s)
- Adrian Williamson
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia
| | - Vincent R. Morrow
- Department of Orthopaedics, West Virginia University, Morgantown, West Virginia
| | - Michele M. Carr
- Department of Otolaryngology–Head Neck Surgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York
| | - Steven W. Coutras
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia
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Williamson A, McArdle EH, Morrow VR, Zalzal HG, Carr MM, Coutras SW. Base of Tongue Surgery and Pediatric Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2023; 168:839-847. [PMID: 35439065 DOI: 10.1177/01945998221094211] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/22/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Drug-induced sleep endoscopy-directed lingual tonsillectomy and midline posterior glossectomy have been employed for the treatment of obstructive sleep apnea in children. The purpose of this study is to evaluate outcomes in children undergoing lingual tonsillectomy, midline posterior glossectomy, or combined base of tongue reduction procedures for obstructive sleep apnea. STUDY DESIGN Case series with chart review. SETTING Tertiary care academic medical center. METHODS A case series was performed with chart review of pediatric patients with obstructive sleep apnea who underwent base of tongue surgery as directed by drug-induced sleep endoscopy. Pre- and postoperative obstructive apnea-hypopnea index (oAHI) was compared. Age, sex, body mass index z score, and medical history were also evaluated. RESULTS A total of 168 children were included, with a mean ± SD age of 8.3 ± 3.6 years. Of these patients, 101 underwent lingual tonsillectomy alone; 25, midline posterior glossectomy alone; and 42, both. Their mean oAHI improvement was 3.52 ± 8.39, 2.55 ± 5.59, and 3.70 ± 6.07, respectively. Each surgical group experienced significant improvement in sleep apnea when pre- and postoperative oAHI was compared (P < .01). Overall surgical success, as defined by oAHI <1 (or <5 without clinical symptoms), was 75% (126 patients). CONCLUSION When guided by drug-induced sleep endoscopy, pediatric tongue base surgery can significantly improve oAHI and thus demonstrates promising success in treating pediatric obstructive sleep apnea.
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Affiliation(s)
- Adrian Williamson
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Erica H McArdle
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Vincent R Morrow
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Habib G Zalzal
- Department of Otolaryngology-Head and Neck Surgery, Children's National Hospital, Washington, DC, USA
| | - Michele M Carr
- Department of Otolaryngology-Head Neck Surgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA
| | - Steven W Coutras
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
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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: 16] [Impact Index Per Article: 16.0] [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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Ishman SL, Maturo S, Schwartz S, McKenna M, Baldassari CM, Bergeron M, Chernobilsky B, Ehsan Z, Gagnon L, Liu YCC, Smith DF, Stanley J, Zalzal H, Dhepyasuwan N. Expert Consensus Statement: Management of Pediatric Persistent Obstructive Sleep Apnea After Adenotonsillectomy. Otolaryngol Head Neck Surg 2023; 168:115-130. [PMID: 36757810 PMCID: PMC10105630 DOI: 10.1002/ohn.159] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/03/2022] [Accepted: 08/13/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To develop an expert consensus statement regarding persistent pediatric obstructive sleep apnea (OSA) focused on quality improvement and clarification of controversies. Persistent OSA was defined as OSA after adenotonsillectomy or OSA after tonsillectomy when adenoids are not enlarged. METHODS An expert panel of clinicians, nominated by stakeholder organizations, used the published consensus statement methodology from the American Academy of Otolaryngology-Head and Neck Surgery to develop statements for a target population of children aged 2-18 years. A medical librarian systematically searched the literature used as a basis for the clinical statements. A modified Delphi method was used to distill expert opinion and compose statements that met a standardized definition of consensus. Duplicate statements were combined prior to the final Delphi survey. RESULTS After 3 iterative Delphi surveys, 34 statements met the criteria for consensus, while 18 statements did not. The clinical statements were grouped into 7 categories: general, patient assessment, management of patients with obesity, medical management, drug-induced sleep endoscopy, surgical management, and postoperative care. CONCLUSION The panel reached a consensus for 34 statements related to the assessment, management and postoperative care of children with persistent OSA. These statements can be used to establish care algorithms, improve clinical care, and identify areas that would benefit from future research.
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Affiliation(s)
- Stacey L. Ishman
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stephen Maturo
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Seth Schwartz
- Virginia Mason Medical Center, Seattle, Washington, USA
| | - Margo McKenna
- University of Rochester Medical Center/Golisano Children’s Hospital, Rochester, New York, USA
| | - Cristina M. Baldassari
- Eastern Virginia Medical School/Children’s Hospital of the King’s Daughter, Norfolk, Virginia, USA
| | - Mathieu Bergeron
- Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | | | - Zarmina Ehsan
- University of Missouri—Kansas City, Kansas City, Missouri, USA
| | - Lisa Gagnon
- Yale University/Connecticut Pediatric Otolaryngology, New Haven, Connecticut, USA
| | - Yi-Chun Carol Liu
- Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas, USA
| | - David F. Smith
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeffrey Stanley
- University of Michigan Health/Michigan Medicine, Ann Arbor, Michigan, USA
| | - Habib Zalzal
- Children’s National Health System, Washington, District of Columbia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Fujita K, Huang T, Rohrbaugh T, Trott K. Demographic factors associated with postoperative polysomnography for pediatric patients with persistent obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2023; 164:111428. [PMID: 36587586 DOI: 10.1016/j.ijporl.2022.111428] [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: 06/06/2022] [Revised: 12/01/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
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Sharma AV, Padhya T, Nallu S. Management of Pediatric Obstructive Sleep Apnea After Failed Tonsillectomy and Adenoidectomy. Adv Pediatr 2022; 69:95-105. [PMID: 35985719 DOI: 10.1016/j.yapd.2022.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pediatric obstructive sleep apnea (OSA) represents a different entity from its adult counterpart and therefore requires a different therapeutic approach. Adenotonsillectomy (AT) is the primary treatment of pediatric OSA, and evidence shows it is very effective. However, there is a growing understanding that residual OSA is common, and next steps for patients who fail primary AT are less certain. This article reviews current methods of evaluating and treating these complex patients.
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Affiliation(s)
- Abhay Varun Sharma
- Department of Otolaryngology Head and Neck Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Boulevard, MDC 73 Tampa, FL 33612, USA.
| | - Tapan Padhya
- Department of Otolaryngology Head and Neck Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Boulevard, MDC 73 Tampa, FL 33612, USA
| | - Sagarika Nallu
- USF Health Department of Pediatrics, Division of Neurology, 13101 Bruce B Downs Boulevard, Tampa, FL 33612, USA
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Ji C, Yang H, Wu X, Hong Y. Comparison of perioperative indicators, treatment efficacy, and postoperative complications between tonsillotomy and tonsillectomy for children with obstructive sleep apnea hypopnea syndrome. Rev Assoc Med Bras (1992) 2022; 68:775-779. [PMID: 35766690 PMCID: PMC9575901 DOI: 10.1590/1806-9282.20211285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study aimed to compare the perioperative indicators, treatment efficacy, and postoperative complications between tonsillotomy and tonsillectomy for children with obstructive sleep apnea hypopnea syndrome. METHODS A total of 134 children with obstructive sleep apnea hypopnea syndrome were divided into tonsillotomy group (n=66) and tonsillectomy group (n=68). The tonsillotomy group received tonsillotomy treatment with a power cutter, while the tonsillectomy group received tonsillectomy treatment. The perioperative indicators, treatment efficacy, and postoperative complications were compared between the two groups. RESULTS There was no significant difference in operative time between the two groups (p>0.05), with significant difference in amount of blood loss, postoperative Visual Analogue Scale score, food intake amount, and general diet-taking starting time between the two groups (p<0.05). The total effective rate of treatment had no significant difference between the two groups (p>0.05). There was significant difference in postoperative bleeding, upper respiratory tract infection, and pharyngeal scar grade between the two groups (p<0.05). CONCLUSIONS Compared with tonsillectomy treatment for children with obstructive sleep apnea hypopnea syndrome, tonsillotomy treatment is more beneficial to optimize the perioperative indicators, relieve the postoperative pain, facilitate the postoperative recovery, and reduce the postoperative complications, which is worthy of clinical promotion.
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Affiliation(s)
- Chenqi Ji
- Zhongshan Hospital Affiliated to Xiamen University, Department of Otorhinolaryngology Head and Neck Surgery - Xiamen, China
| | - Haibin Yang
- Zhongshan Hospital Affiliated to Xiamen University, Department of Otorhinolaryngology Head and Neck Surgery - Xiamen, China
| | - Xiaoli Wu
- Zhongshan Hospital Affiliated to Xiamen University, Department of Otorhinolaryngology Head and Neck Surgery - Xiamen, China
| | - Yongjun Hong
- Zhongshan Hospital Affiliated to Xiamen University, Department of Otorhinolaryngology Head and Neck Surgery - Xiamen, China
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Abstract
Pediatric obstructive sleep apnea (OSA) is a common entity that can cause both daytime and nighttime issues. Children with symptoms should be screened for OSA. If possible, polysomnography should be performed to evaluate symptomatic children. Depending on the severity, first-line options for treatment of pediatric OSA may include observation, weight loss, medication, or surgery. Even after adenotonsillectomy, about 20% of children will have persistent OSA. Sleep endoscopy and cine MRI are tools that may be used to identify sites of obstruction, which in turn can help in the selection of site-specific treatment.
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Affiliation(s)
- Pakkay Ngai
- Division of Pediatric Pulmonology, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Children's Health, 30 Prospect Avenue, WFAN 3rd Floor, Hackensack, NJ 07601, USA
| | - Michael Chee
- Division of Pediatric Otolaryngology, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Children's Health, 30 Prospect Avenue, WFAN PC-311, Hackensack, NJ 07601, USA.
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13
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Considerations in Surgical Management of Pediatric Obstructive Sleep Apnea: Tonsillectomy and Beyond. CHILDREN 2021; 8:children8110944. [PMID: 34828657 PMCID: PMC8623402 DOI: 10.3390/children8110944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA) is an increasingly recognized disorder with a reported incidence of 5.7% in children. Tonsillectomy (with or without adenoidectomy) in pediatric OSA in otherwise healthy non-obese children has a success rate of approximately 75%. However, the cure rate reported for all children undergoing tonsillectomy varies from 51% to 83%. This article reviews the history of tonsillectomy, its indications, techniques, various methods, risks, and successes. The article also explores other surgical options in children with residual OSA post-tonsillectomy.
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Chen H, Huang X, Ye Y, Luo Y, Huang Y, Li X. Muscle type of palatopharyngeal muscle in children with severe obstructive sleep apnea. J Clin Sleep Med 2021; 16:1523-1529. [PMID: 32441247 DOI: 10.5664/jcsm.8588] [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] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To investigate the fiber-type distribution in palatopharyngeal muscle via adenosine triphosphatase and quantitative real-time polymerase chain reaction in children with severe obstructive sleep apnea (OSA). METHODS Study participants were 12 children with severe OSA and 15 children with simple snoring as the control group. Both groups were diagnosed by polysomnography and treated with tonsillectomy. The samples of palatopharyngeus muscle were studied under adenosine triphosphatase staining and quantitative real-time polymerase chain reaction to classify the different fiber types. RESULTS There were no differences in baseline age, body mass index, tonsil size, or sleep stage constitution between the 2 groups. Dominance (>60%) of type I fiber was observed both in children with simple snoring (3/15, 20%) and in those with severe OSA (1/12, 8.3%) via adenosine triphosphatase staining. Predominance of type II fibers was seen in 3/15 (20%) in the control group and 6/12 (50%) in the severe OSA group, respectively. Type grouping was also seen in 8/15 (53.3%) in non-OSA and 6/12 (50%) in severe OSA groups, respectively. There was no difference in distribution of subtype fibers assessed by quantitative real-time polymerase chain reaction between the 2 groups; the mean percentages of type I fibers were 25.8% ± 19.5% and 20.9% ± 16.6%, respectively (P > .05), similar to type IIa fibers (35.2% ± 23.4% and 40.9% ± 28.8%) (P > .05). There was a decrease in the percentage of type I fibers between children younger and older than 12 years (P < 0.05), although this was not due to OSA (P > 0.05). CONCLUSIONS There were no specific changes via adenosine triphosphatase staining or a difference in distribution of subtype fibers via quantitative real-time polymerase chain reaction between children with severe pediatric OSA and those with simple snoring, whereas the percentage of type I fiber decreased dynamically due to age but not OSA. CLINICAL TRIAL REGISTRATION Registry: Chinese Clinical Trials Registry; Name: A study of the mechanism of the conversion of upper airway expasion muscle's fiver types of OSA patient which may be mediated by estrogen-related receptor alpha; URL: https://www.chictr.org.cn/showproj.aspx?proj=6144; Identifier: ChiCTR-CCC-13003415.
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Affiliation(s)
- Huaihong Chen
- Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoxing Huang
- Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanqing Ye
- Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yunfang Luo
- Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuanshou Huang
- Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiangping Li
- Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Li C, Kou YF, Ishman SL. Pediatric OSA: Evidence-Based Review of Treatment Results. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Gerdung C, Rodriguez-Lopez S, Palkowski S, Keto-Lambert D, Sebastianski M, Castro Codesal ML. Does non-invasive ventilation change metabolic markers in children with obstructive sleep apnoea? A systematic review and meta-analysis study protocol. BMJ Open 2020; 10:e039655. [PMID: 32830118 PMCID: PMC7445331 DOI: 10.1136/bmjopen-2020-039655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) is not only common within paediatrics but is associated with critical childhood metabolic morbidity such as obesity, cardiovascular disease and glucose tolerance impairment. Increasing evidence suggests an association between childhood OSA and metabolic syndrome such as markers of cardiovascular disease, systemic hypertension, glucose intoleranceand increased lipid profile. Recent studies have targeted changes in metabolic markers in children using non-invasive ventilation (NIV) but no systematic reviews are available to summarise this emerging evidence. The purpose of this systematic review is to provide systematic synthesis of the evidence on the effect of NIV use on metabolic markers in children with OSA. METHODS AND ANALYSIS A systematic search of electronic databases and grey literature will include paediatric interventional studies (random controlled trials, cohort studies) with and without a comparison group. Two reviewers will independently undertake the two step process of title/abstract and full-text screening. Data will be extracted and assessed, with aggregate data being reported. When the data allow, meta-analysis will be performed. ETHICS AND DISSEMINATION There are no ethical concerns with this systematic review, as data have previously been published. This review will inform clinicians taking care of children with OSA and obesity/metabolic syndrome about the potential effects of NIV therapies on metabolic markers and has the potential to change the approach to childhood OSA and obesity. Results of this systematic review will be submitted for dissemination in abstract and manuscript form.
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Affiliation(s)
- Christopher Gerdung
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Sara Rodriguez-Lopez
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Stefan Palkowski
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Diana Keto-Lambert
- Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
- University of Alberta Faculty of Medicine and Dentistry Department of Pediatrics, Edmonton, Alberta, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
- University of Alberta Faculty of Medicine and Dentistry Department of Pediatrics, Edmonton, Alberta, Canada
| | - Maria Luisa Castro Codesal
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
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Evans SS, Pattisapu P, Parikh SR. Persistent OSA After Adenotonsillectomy in CPAP-Intolerant Children: What To Do Next? Laryngoscope 2020; 131:950-951. [PMID: 32668018 DOI: 10.1002/lary.28839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Sean S Evans
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A.,Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Prasanth Pattisapu
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A.,Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Sanjay R Parikh
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A.,Seattle Children's Hospital, Seattle, Washington, U.S.A
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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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Martinez-Monedero R, Danielian A, Angajala V, Dinalo JE, Kezirian EJ. Methodological Quality of Systematic Reviews and Meta-analyses Published in High-Impact Otolaryngology Journals. Otolaryngol Head Neck Surg 2020; 163:892-905. [PMID: 32450783 DOI: 10.1177/0194599820924621] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the methodological quality of intervention-focused systematic reviews (SRs) and meta-analyses (MAs) published in high-impact otolaryngology journals. DATA SOURCES Ovid Medline, Embase, and Cochrane Library. REVIEW METHODS A comprehensive search was performed for SR and MA citations from 2012 to 2017 in the 10 highest impact factor otolaryngology journals. Abstracts were screened to identify published manuscripts in which the authors indicated clearly that they were performing an SR or MA. Applying a modified typology of reviews, 4 reviewers characterized the review type as SR, MA, or another review type. A simplified version of the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2) tool was used to assess the reporting and methodological quality of the SRs and MAs that were focused on interventions. RESULTS Search and abstract screening generated 499 manuscripts that identified themselves as performing an SR or MA. A substantial number (85/499, 17%) were review types other than SRs or MAs, including 34 (7%) that were literature reviews. In total, 236 SRs and MAs focused on interventions. Over 50% of these SRs and MAs had weaknesses in at least 3 of the 16 items in the AMSTAR 2, and over 40% had weaknesses in at least 2 of the 7 critical domains. Ninety-nine percent of SRs and MAs provided critically low confidence in the results of the reviews. CONCLUSION Intervention-focused SRs and MAs published in high-impact otolaryngology journals have important methodological limitations that diminish confidence in the results of these reviews.
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Affiliation(s)
- Rodrigo Martinez-Monedero
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
| | - Arman Danielian
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Varun Angajala
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Jennifer E Dinalo
- Health Sciences Libraries, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Eric J Kezirian
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
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20
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Update on hypoglossal nerve stimulation in children with down syndrome and obstructive sleep apnea. Laryngoscope 2020; 130:E263-E267. [DOI: 10.1002/lary.28138] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/04/2019] [Accepted: 05/28/2019] [Indexed: 11/07/2022]
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21
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Guilleminault C, Hervy-Auboiron M, Huang YS, Li K, Amat P. [Obstructive sleep-disordered breathing and orthodontics. An interview with Christian Guilleminault, Michèle Hervy-Auboiron, Yu-Shu Huang and Kasey Li]. Orthod Fr 2019; 90:215-245. [PMID: 34643512 DOI: 10.1051/orthodfr/2019038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | | | - Yu-Shu Huang
- Department of Pediatric Psychiatry and Sleep Center, Chang Gung Memorial Hospital, No. 5, Fusing St, Kwei-Shan Township, Taoyuan Country, 333, Taiwan
| | - Kasey Li
- 1900 University Ave #105, East Palo Alto, CA 94303, États-Unis
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Diagnostic techniques and surgical outcomes for persistent pediatric obstructive sleep apnea after adenotonsillectomy: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2019; 121:179-187. [PMID: 30925395 DOI: 10.1016/j.ijporl.2019.02.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy of upper airway surgery for children with persistent obstructive sleep apnea after adenotonsillectomy and to assess sleep study outcomes when Drug Induced Sleep Endoscopy, Cine MRI, or other imaging procedure is performed to assist in identifying the location of obstruction and planning surgery. METHODS Systematic review and meta-analysis was performed. Inclusion criteria was English-language studies with original data including pediatric patients with persistent OSA after T&A. Exclusion criteria included case reports and lack of pre and post-operative sleep study data. Data Sources were PubMed, Cochrane Central, and Embase from 2000 to 2018. PRISMA standards were followed for the selection and review of articles. The Newcastle-Ottawa Quality Assessment scale was used to score the quality of evidence of the studies. All manuscripts were reviewed independently by two investigators. Primary outcome measures were apnea-hypopnea index and minimum oxygen saturation. Data was pooled using a random-effects model. RESULTS Of the 1902 abstracts identified, 11 studies (214 patients) met inclusion criteria for systematic review, 5 with Drug Induced Sleep Endoscopy as the diagnostic technique, 4 with Cine MRI, and 2 with MRI/CT. All studies were case series. Most subjects had syndromic comorbidities and/or obesity. Ten studies (198 patients) were included in the meta-analysis. Overall, there was a change in apnea hypopnea index of -6.51 (95% CI, -8.17 to - 4.85; p < 0.001) and an increase in minimum oxygen saturation by 3.24% (95% CI, 1.49%-4.98%; p < 0.001) following surgical intervention. Both Drug Induced Sleep Endoscopy and Cine MRI directed surgeries resulted in significant improvement in sleep study parameters. The two techniques could not be directly compared due to significant differences in co-morbidity rates between patients. CONCLUSIONS Surgery for pediatric persistent obstructive sleep apnea improves apnea hypopnea index and minimum oxygen saturation but does not resolve the disease. This is true when both Drug Induced Sleep Endoscopy and Cine MRI findings were used to direct surgery.
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Merna C, Lin HW, Bhattacharyya N. Clinical Characteristics, Complications, and Reasons for Readmission following Lingual Tonsillectomy. Otolaryngol Head Neck Surg 2019; 160:619-621. [DOI: 10.1177/0194599819827820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This brief communication regards the indications and complications for and rates of readmission following lingual tonsillectomy. The National Readmissions Database (NRD) 2013-2014 was queried for all cases of lingual tonsillectomy occurring from 2013 to 2014. Among 602 lingual tonsillectomies (mean age 36.5 years, 58.2% male), the common indications for surgery were obstructive sleep apnea (58.7%), lingual tonsil hypertrophy/infection (18.8%), and neoplasia (15.9%). Overall, 49 (8.2%) of the cases were readmitted (95% confidence interval, 4.8%-13.5%), with an average readmission duration of 3.0 days and average readmission cost of $25.4K. The most common diagnoses at readmission were bleeding (1.9% of all lingual tonsillectomy cases); dysphagia (1.7%); fever, nausea, vomiting, or diarrhea (1.6%); acute pain (1.6%); and airway obstruction (1.4%). There were no mortalities during primary or subsequent admissions. Lingual tonsillectomy across age groups is relatively free of adverse events, with overall readmission and complication rates similar to those of palatine tonsillectomy.
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Affiliation(s)
- Catherine Merna
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California at Irvine, Orange, California, USA
| | - Harrison W. Lin
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California at Irvine, Orange, California, USA
| | - Neil Bhattacharyya
- Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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Liming BJ, Ryan M, Mack D, Ahmad I, Camacho M. Montelukast and Nasal Corticosteroids to Treat Pediatric Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2018; 160:594-602. [DOI: 10.1177/0194599818815683] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To systematically review the literature on anti-inflammatory medications for treating pediatric obstructive sleep apnea and perform meta-analysis of the available data. Data Sources PubMed/MEDLINE and 4 additional databases. Review Methods Three authors independently and systematically searched through June 28, 2018, for studies that assessed anti-inflammatory therapy for treatment of pediatric obstructive sleep apnea (OSA). Data were compiled and analyzed using Review Manager 5.3 (Nordic Cochrane Centre). Results After screening 135 studies, 32 were selected for review with 6 meeting inclusion criteria. In total, 668 patients aged 2 to 5 years met inclusion criteria for meta-analysis. Of these, 5 studies (166 children) that evaluated montelukast alone as treatment for pediatric OSA found a 55% improvement in the apnea-hypopnea index (AHI) (mean [SD] 6.2 [3.1] events/h pretreatment and 2.8 [2.7] events/h posttreatment; mean difference [MD] of −2.7 events/h; 95% confidence interval [CI], –5.6 to 0.3) with improvement in lowest oxygen saturation (LSAT) from 89.5 (6.9) to 92.1 (3.6) (MD, 2.2; 95% CI, 0.5-4.0). Two studies (502 children) observing the effects of montelukast with intranasal corticosteroids on pediatric OSA found a 70% improvement in AHI (4.7 [2.1] events/h pretreatment and 1.4 [1.0] events/h posttreatment; MD of −4.2 events/h; 95% CI, –6.3 to −2.0), with an improvement in LSAT from 87.8 (3.1) to 92.6 (2.2) (MD, 4.8; 95% CI, 4.5-5.1). Conclusions Treatment with montelukast and intranasal steroids or montelukast alone is potentially beneficial for short-term management of mild pediatric OSA.
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Affiliation(s)
- Bryan J. Liming
- Otolaryngology Head and Neck Surgery, Tripler Army Medical Center, Hawaii, USA
| | - Matthew Ryan
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Douglas Mack
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Iram Ahmad
- Department of Otolaryngology, Stanford University, Stanford, California, USA
| | - Macario Camacho
- Otolaryngology Head and Neck Surgery, Tripler Army Medical Center, Hawaii, USA
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Stark TR, Pozo-Alonso M, Daniels R, Camacho M. Pediatric Considerations for Dental Sleep Medicine. Sleep Med Clin 2018; 13:531-548. [DOI: 10.1016/j.jsmc.2018.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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