Clinical Pediatric Literature Updates

A case-control study of Drug-Induced Sleep Endoscopy (DISE) in pediatric population: A proposal for indications

Adenotonsillar hypertrophy is the most common cause but not the only cause for OSAS in children. This study looked at the role of DISE in 3 different categories of pediatric OSAS, “conventional”, “disproportional” and “persistent” OSAS. All subjects had preoperative confirmatory polysomnograms. The authors observed that, in otherwise healthy children, DISE changed the surgical plan more frequently in children with “disproportional” and “persistent” OSAS. Additional procedures included functional endoscopic sinus surgery (FESS) for polyp removal and pharyngoplasty for lateral pharyngeal wall collapse correction.

https://www.ncbi.nlm.nih.gov/pubmed/?term=29605338

Severe obstructive sleep apnea in children with elevated blood pressure

In summary, habitual snoring is common in children referred for elevated BP, and those with severe OSA are at higher risk of significantly increased BP.

https://www.ncbi.nlm.nih.gov/pubmed/29373256

Altered Regional Brain Cortical Thickness in Pediatric Obstructive Sleep Apnea

Changes in cortical thickness are present in children with OSA and likely indicate disruption to neural developmental processes, including maturational patterns of cortical volume increases and synaptic pruning. Regions with thicker cortices may reflect inflammation or astrocyte activation. Both the thinning and thickening associated with OSA in children may contribute to the cognitive and behavioral dysfunction frequently found in the condition.

https://www.ncbi.nlm.nih.gov/pubmed/29403430

Clinical application of MRI-respiratory gating technology in the evaluation of children with obstructive sleep apnea hypopnea syndrome

“Stenosis of the nasopalatine pharyngeal cavity in children with adenoidal hypertrophy was greatest at the end-expiration phase during sleep. The end-expiratory Sa/Snp obtained by a combination of MRI and respiratory gating technology has potential as an important imaging index for diagnosing and evaluating severity in pediatric OSAHS.”

https://www.ncbi.nlm.nih.gov/pubmed/29369187

The Adenoid Microbiome in Recurrent Acute Otitis Media and Obstructive Sleep Apnea

“Microbes are present on all adenoid specimens, though the microbial profile differs between recurrent AOM and OSA. The clinical significance of these differences remains to be determined.”

https://www.ncbi.nlm.nih.gov/pubmed/29360088

Intermittent nocturnal hypoxia and metabolic risk in obese adolescents with obstructive sleep apnea

“Intermittent nocturnal hypoxia rather than the OAHI was associated with metabolic risk in obese youth after adjusting for WHtR. Measures of abdominal adiposity such as WHtR should be considered in future studies that evaluate the impact of OSA on metabolic health.”

https://www.ncbi.nlm.nih.gov/pubmed/29357088See comment in PubMed Commons below

Mandibular advancement appliances for sleep-disordered breathing in children: A randomized crossover clinical trial

“Wearing an Active MAS overnight, over a short period can be beneficial for SDB children, resulting in a clinically relevant reduction of supine AHI.”

https://www.ncbi.nlm.nih.gov/pubmed/29357293

Cardioventilatory Control in Preterm Born Children and the Risk of Obstructive Sleep Apnea

“The risk for OSA could be stratified according to controller gain, plant gain, cardiorespiratory coupling and gestational age. These findings could guide a personalized care to children at risk for OSA.”

https://www.ncbi.nlm.nih.gov/pubmed/29323933

Severe obstructive sleep disorders in Prader-Willi syndrome patients in southern Italy

“OSA was the predominant sleep-related disorder in our PWS patients, not associated with age or obesity, and appeared more severe than previously reported. Further studies addressing the underlying mechanisms are necessary in larger study populations to better design the most appropriate clinical approach.” What is Known: • Sleep-related patterns and their management are very limited in patients with Prader-Willi syndrome. What is New: • Severe obstructive sleep apnoea is the most frequent sleep-related disorder in our case series.

https://www.ncbi.nlm.nih.gov/pubmed/29318372

Increased Incidence of Obstructive Sleep Apnea in Hospitalized Children following Enterovirus Infection: A Nationwide Population-Based Cohort Study

Children with severe EV infection (i.e. requiring hospitalization) carry a significantly higher risk of developing OSA, particularly in those with allergic rhinitis. As pediatric obstructive sleep apnea is a treatable sleep disorder, we emphasize regular follow-up and early detection in children with EV infection.

https://www.ncbi.nlm.nih.gov/pubmed/29315158