Clinical Pediatric Literature Updates

Central Sleep Apnea in Children with Obstructive Sleep Apnea Syndrome and Improvement Following Adenotonsillectomy

Despite the belief that central sleep apneas (CSA’s) are solely related to central nervous system dysfunction, OSAS exerts some influence on the appearance of CSA in children. This retrospective chart review of polysomnography (PSG) data over a 10 year period aimed to demonstrate a positive association between CSA and OSAS in children 1 to 14 years of age without neurological conditions or craniofacial syndromes. A secondary aim was to demonstrate the impact of adenotonsillectomy on the severity of CSA in children with OSAS. There are conflicting mechanisms that try to explain the association between CSA and OSAS.

P-Wave Dispersion as a Simple Tool for Screening Childhood Obstructive Sleep Apnea Syndrome

“P-wave dispersion (PWD) as defined by the difference between the duration of maximum and minimum p-waves has been used to screen for the presence of OSAS in adults. This study looks at the utility of this tool for OSAS screening in children. The authors obtained ECGs from 77 children with documented OSAS by PSG and 44 controls. A cutoff of 26.5 ms provided 89.6% sensitivity and 61.4% specificity. PWD was significantly higher in children with severe OSA even when the authors adjusted for the presence of obesity.”

Outcome of Drug-Induced Sleep Endoscopy-Directed Surgery for Persistent Obstructive Sleep Apnea after Adenotonsillar Surgery

“Drug-induced sleep endoscopy (DISE) can be considered in children with persistent OSAS despite adenotonsillectomy. The authors described sleep-related outcomes in 20 children a year after DISE directed surgery (e.g., turbinate reductions, pharyngoplasty, lingual tonsillectomy, and tonsillectomy revisions). All children demonstrated an improvement in their sleep breathing parameters. Five children had complete resolution of OSAS whereas 15 continue to have persistent OSAS but in the mild range”.

Prenatal, Perinatal, and Early Childhood Factors Associated with Childhood Obstructive Sleep Apnea

“In this study, the authors tested associations between pre and perinatal and early childhood factors and the risk of childhood OSAS from a cohort of 2867 mother-child pairs already enrolled in the Boston Birth Cohort Study. Children conceived by in-vitro fertilization, premature deliveries due to trauma were some of the exclusions. This secondary analysis study demonstrated strong associations between childhood OSAS and prematurity/low birth weight, maternal obesity/diabetes, childhood obesity, and elevated early childhood leptin levels. “

Clinical Predictors of Pediatric Obstructive Sleep Apnea Syndrome

This is a retrospective study in from Taiwan in children with documented OSAS by PSG. The authors sought to determine which clinical signs would be most significant when building a logistic regression model for pediatric AHI. They propose a formula that takes the child BMI, the degree of snoring and nasal obstruction to estimate the AHI. The authors cautioned that their findings warrant further validation in different world regions and in different race populations.

Urine concentrations changes of cysteinyl leukotrienes in non-obese children with obstructive sleep apnea undergoing adenotonsillectomy.

In this study, the authors measure urinary levels of Cysteine Leukotrienes (CysLT) in children with documented severe OSAS by PSG before and after adenotonsillectomy. CysLT has been previously implicated in the development of adenotonsillar hypertrophy and pediatric OSAS. Children with residual OSAS were excluded. A total of 24 children were included for analysis. The authors suggest further studies in order to  determine CysLT as valid biomarker for the presence of OSA in children.

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.

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.

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.

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.