Pediatric Obstructive Sleep Apnea From Pedscases.com

This podcast is a good brief review of OSA. The PDF transcript of the show is an excellent quick review.

Pediatric Obstructive Sleep Apnea
by Steffany.Charles Nov 28, 2017 from Pedscases.com:

This podcast presents an approach to the management of obstructive sleep apnea (OSA) in children. In this episode, listeners will learn about the pathophysiology of OSA and common causes in the pediatric population, steps to evaluating OSA in a pediatric patient, the role of a PSG in diagnosing OSA, as well as treatment options for OSA.

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Here are some excerpts from the podcast:

While snoring and mouth breathing during sleep are hallmarks of OSA, most children with these symptoms do not have OSA so it is important to understand the clinical manifestations of OSA
and how it is diagnosed in children. Differences in the pathophysiology of OSA in children also
means that the treatment approach to OSA in children is different than that for adults.

The prevalence of OSA in the pediatric population is 1 to 4 percent. The incidence is equal among males and females. OSA can present at any age, however the peak incidence is commonly seen in children between two and six years of age due to the rapid growth of tonsil and adenoid tissues compared to the underlying airway, resulting in a relative size discrepancy. In children who are otherwise healthy, adenotonsillar hypertrophy and obesity remain the two major risk factors for OSA.

A questionnaire, such as The Pediatric Sleep Questionnaire [link is to the PDF of the questionnaire], published by Chervin et al,may [be] helpful as a screening tool.

The diagnostic criteria for pediatric OSA requires both clinical and sleep study findings; defined
by the American Academy of Sleep Medicine (AASM).
• Clinical Criteria: Presence of 1 or more of:
1. Snoring
2. Laboured, paradoxical or obstructed                     breathing during sleep
3. Sleepiness, hyperactivity, behavioural or              learning issues
• Sleep Study Criteria: Presence of one or                 both of the following:
1. AHI > 2 events/hour
2. Pattern of obstructive hypoventilation: at             least 25% of total sleep time with PaCO2 >
50 mm Hg with snoring, flattening of nasal          pressure, or paradoxical thoracoabdominal          motion

Severity is determined by the AHI. A higher AHI indicates more severe OSA. A rough guide that
may not relate to complications or treatment response is:
• Mild: AHI 1–4.9 events/h
• Moderate: AHI 5—9.9 events/h
• Severe: AHI > 10 events/h

There are two questionnaires that have been validated against polysomnography for the
diagnosis of OSA in children. The Pediatric Sleep Questionnaire [Resource 2 below], was developed by Chervin and colleagues. A study of this scale found that a positive screen correctly classified
approximately 85% of a sample of children 2-18 years of age. A 3-item scale developed by
Brouilette and colleagues (often referred to as the Brouilette score), correctly classified approximately 95% of children 1-10 years of age. The validation of both scales included a relatively small sample of children and did not include many children with comorbidities or complex medical illness.

Treatment options include watchful waiting, medical management, surgery and non-invasive
ventilation.*

*See p 6 of the show notes PDF for details.

Take Home Points:
To conclude this podcast, let’s review a few key take-home points:
1. Obstructive sleep apnea is the most common sleep related breathing disorder in
children.
2. The most common symptom of OSA is snoring, however the majority of children who snore do not have OSA. Other important symptoms include daytime somnolence and behavior problems. These can be evaluated using a screening questionnaire.
3. Polysomnography is the gold standard for diagnosing OSA.
4. If access to polysomnography is not possible or limited, there is a role for other forms of
objective testing such as questionnaires, overnight oximetry, or home sleep apnea
testing. Some form of objective testing is likely better than none.
5. The treatment of OSA is determined on a case-by-case basis and includes [watchful waiting,] medications such as intranasal steroids or leukotriene receptor antagonists, surgery such as adenotonsillectomy, and home CPAP.

Additional Resources:

(1) Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Pediatrics. 2012 Sep;130(3):e714-55. doi: 10.1542/peds.2012-1672. Epub 2012 Aug 27.

This article has been cited by over 100 PubMed Central articles.

(2) Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems [PubMed Abstract]. Sleep Med. 2000 Feb 1;1(1):21-32.

The above article has been cited by over 100 PubMed Central articles.

(3) Sleep Disorders
by Nikytha.Antony Dec 12, 2015 from Pedscases.com:

This episode discusses sleep physiology and common sleep disorders in children. By the end of the podcast, you should be able to describe sleep physiology and stages, list the sleep needs for different age groups, describe the best practices for sleep hygiene and understand common sleep disorders.

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