Clinical Pediatric Literature Updates

Outcomes of adenoidectomy-alone in patients less than 3-years old.

Adenoidectomy-alone is a surgical option for young children given its low risk compared to adenotonsillectomy. This retrospective cohort study from Pittsburgh, Pennsylvania, addresses specific outcomes such as the rate of further surgical revisions and or tonsillectomy in children younger than three years of age. Thirty-five percent of children identified in this cohort (n=148) required additional surgical interventions within approximately 24 months of follow-up after adenoidectomy-alone. The most common procedure was adenotonsillectomy. Risk factors associated with residual symptoms following surgery were gastroesophageal reflux and tonsil size.

https://www.ncbi.nlm.nih.gov/pubmed/29447890

Evaluating the effects of general anesthesia on sleep in children undergoing elective surgery: an observational case–control study

In this study, general anesthesia did not result in disturbed sleep or associated negative behavioral changes in otherwise healthy children undergoing elective surgeries of low complexity. Physicians can advise parents that a child’s surgery and associated generalanesthetic exposure may not result in significant changes in postoperative sleep patterns.

 

https://www.ncbi.nlm.nih.gov/pubmed/29741674

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