Indian Journal of Sleep Medicine

Register      Login

VOLUME 14 , ISSUE 2 ( April-June, 2019 ) > List of Articles

REVIEW ARTICLE

Pediatric Obstructive Sleep Apnea: A Review of Approach to Management

Sweta Kumari, Jyoti Bagla, Aarushi Singla

Keywords : Adenotonsillectomy, Apnea-hypopnea index, Continuous positive airway pressure, Literature review, Obstructive sleep apnea

Citation Information : Kumari S, Bagla J, Singla A. Pediatric Obstructive Sleep Apnea: A Review of Approach to Management. Indian Sleep Med 2019; 14 (2):32-37.

DOI: 10.5005/jp-journals-10069-0035

License: CC BY-NC 4.0

Published Online: 01-12-2018

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Pediatric sleep apnea is an underestimated and often ignored childhood morbidity which is on rise with an increasing prevalence of obesity. Obstructive sleep apnea (OSA) constitutes the bulk of the pediatric sleep-disordered breathing with a fewer proportion of children suffering from central or mixed sleep apnea. OSA often leads to growth failure, cardiovascular dysfunction, behavioral problems, poor learning, and quality of life. Systematic evaluation of the apnea along with appropriate management modality gives an opportunity to gain the short-term and long-term health. This review is focused on the management of OSA in the pediatric age group. Treatment decisions are guided by detailed evaluation findings like anatomic malformation, degree of functional impairment, and sleep study findings.


HTML PDF Share
  1. American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed., Darien, IL: American Academy of Sleep Medicine; 2014.
  2. American Thoracic Society. Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 1996 Feb;153(2):866–878. DOI: 10.1164/ajrccm.153.2.8564147.
  3. Bixler EO, Vgontzas AN, et al. Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep 2009 Jun;32(6):731–736. DOI: 10.1093/sleep/32.6.731.
  4. Li AM, So HK, et al. Epidemiology of obstructive sleep apnoea syndrome in Chinese children: a two-phase community study. Thorax 2010;65(11):991–997. DOI: 10.1136/thx.2010.134858.
  5. O’Brien LM, Holbrook CR, et al. Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder. Pediatrics 2003 Mar;111(3):554–563. DOI: 10.1542/peds.111.3.554.
  6. Huang YS, Guilleminault C. Pediatric Obstructive Sleep Apnea: Where Do We Stand? Adv Otorhinolaryngol 2017;80:136–144. DOI: 10.1159/000470885.
  7. Mallampati SR, Gatt SP, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985 Jul;32(4):429–434. DOI: 10.1007/BF03011357.
  8. Friedman M, Salapatas AM, et al. Updated Friedman Staging System for Obstructive Sleep Apnea. Adv Otorhinolaryngol 2017;80:41–48. DOI: 10.1159/000470859.
  9. Kumar HV, Schroeder JW, et al. Mallampati score and pediatric obstructive sleep apnea. J Clin Sleep Med 2014 Sep 15;10(9):985–990. DOI: 10.5664/jcsm.4032.
  10. Trivedi M, ElMallah M, et al. Pediatric Obstructive Sleep Apnea and Asthma: Clinical Implications. Pediatr Ann 2017 Sep 1;46(9):e332–e335. DOI: 10.3928/19382359-20170815-03.
  11. Park DY, Choi JH, et al. Correlations between pediatric obstructive sleep apnea and longitudinal growth. Int J Pediatr Otorhinolaryngol 2018 Mar;106:41–45. DOI: 10.1016/j.ijporl.2018.01.001.
  12. Beck SE, Marcus CL. Pediatric polysomnography. Sleep Med Clin 2009 Sep;4(3):393–406. DOI: 10.1016/j.jsmc.2009.04.007.
  13. Chervin RD, Hedger K, et al. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med 2000 Feb 1;1(1):21–32. DOI: 10.1016/S1389-9457(99)00009-X.
  14. Michelet D, Julien-Marsollier F, et al. Accuracy of the sleep-related breathing disorder scale to diagnose obstructive sleep apnea in children: a meta-analysis. Sleep Med 2019 Feb;54:78–85. DOI: 10.1016/j.sleep.2018.09.027.
  15. Kohler M, Lushington K, et al. Obesity and risk of sleep related upper airway obstruction in Caucasian children. J Clin Sleep Med 2008 Apr 15;4(2):129–136. DOI: 10.1159/000470859.
  16. Van Hoorenbeeck K, Franckx H, et al. Weight loss and sleep-disorderedbreathing in childhood obesity: effects on inflammation and uric acid. Obesity (Silver Spring) 2012 Jan;20(1):172–177. DOI: 10.1038/oby.2011.282.
  17. Marcus CL, Moore RH, et al. Childhood Adenotonsillectomy Trial (CHAT). A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 2013 Jun 20;368(25):2366–2376. DOI: 10.1056/NEJMoa1215881.
  18. Venekamp RP, Hearne BJ, et al. Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children. Cochrane Database Syst Rev 2015 Oct; 14(10):CD011165. DOI: 10.1002/14651858.CD011165.pub2.
  19. Zhang L, Mendoza-Sassi RA, et al. Intranasal corticosteroids for nasal airway obstruction in children with moderate to severe adenoidal hypertrophy. Cochrane Database Syst Rev 2008 Jul;16(3):CD006286. DOI: 10.1002/14651858.CD006286.pub2.
  20. Chan CC, Au CT, et al. Intranasal corticosteroids for mild childhood obstructive sleep apnea–a randomized, placebo-controlled study. Sleep Med 2015 Mar;16(3):358–363. DOI: 10.1016/j.sleep.2014.10.015.
  21. Kheirandish-Gozal L, Gozal D. Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics 2008 Jul;122(1):e149–e155. DOI: 10.1542/peds.2007-3398.
  22. Tsaoussoglou M, Lianou L, et al. Cysteinyl leukotriene receptors in tonsillar B- and T-lymphocytes from children with obstructive sleep apnea. Sleep Med 2012 Aug;13(7):879–885. DOI: 10.1016/j.sleep.2012.03.010.
  23. Tsaoussoglou M, Hatzinikolaou S, et al. Expression of leukotriene biosynthetic enzymes in tonsillar tissue of children with obstructive sleep apnea: a prospective nonrandomized study. JAMA Otolaryngol Head Neck Surg 2014 Oct;140(10):944–950. DOI: 10.1001/jamaoto.2014.1936.
  24. Kheirandish-Gozal L, Bandla HP, et al. Montelukast for Children with Obstructive Sleep Apnea: Results of a Double-Blind, Randomized, Placebo-Controlled Trial. Ann Am Thorac Soc 2016 Oct;13(10):1736–1741. DOI: 10.1513/AnnalsATS.201606-432OC.
  25. Kheirandish-Gozal L, Bhattacharjee R, et al. Antiinflammatory therapy outcomes for mild OSA in children. Chest 2014 Jul;146(1):88–95. DOI: 10.1378/chest.13-2288.
  26. Kheirandish L, Goldbart AD, et al. Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics 2006 Jan;117(1):e61–e66. DOI: 10.1542/peds.2005-0795.
  27. Huang J, Pinto SJ, et al. Upper airway collapsibility and genioglossus activity in adolescents during sleep. Sleep 2012 Oct 1;35(10):1345–1352. DOI: 10.5665/sleep.2110.
  28. Mihai R, Vandeleur M, et al. Autotitrating CPAP as a Tool for CPAP Initiation for Children. J Clin Sleep Med 2017 May 15;13(5):713–719. DOI: 10.5664/jcsm.6590.
  29. Marcus CL, Ward SL, et al. Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea. J Pediatr 1995 Jul;127(1):88–94. DOI: 10.1016/S0022-3476(95)70262-8.
  30. Marcus CL, Rosen G, et al. Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatrics 2006 Mar;117(3):e442–e451. DOI: 10.1542/peds.2005-1634.
  31. Friedman O, Chidekel A, et al. Postoperative bilevel positive airway pressure ventilation after tonsillectomy and adenoidectomy in children–a preliminary report. Int J Pediatr Otorhinolaryngol 1999 Dec 15;51(3):177–180. DOI: 10.1016/S0165-5876(99)00260-8.
  32. Chervin RD, Theut S, et al. Compliance with nasal CPAP can be improved by simple interventions. Sleep 1997 Apr;20(4):284–289. DOI: 10.1093/sleep/20.4.284.
  33. Hawkins S, Huston S, et al. High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea. J Clin Sleep Med 2017 Aug 15;13(8):981–989. DOI: 10.5664/jcsm.6700.
  34. Joseph L, Goldberg S, et al. High-Flow Nasal Cannula Therapy for Obstructive Sleep Apnea in Children. J Clin Sleep Med 2015 Sep 15;11(9):1007–1010. DOI: 10.5664/jcsm.5014.
  35. Guilleminault C, Nino-Murcia G, et al. Alternative treatment to tracheostomy in obstructive sleep apnea syndrome: nasal continuous positive airway pressure in young children. Pediatrics 1986 Nov;78(5):797–802.
  36. Mitchell RB, Archer SM, et al. Clinical Practice Guideline: Tonsillectomy in Children (Update). Otolaryngol Head Neck Surg 2019 Feb;160(Suppl 1):S1–S42.
  37. Huang YS, Guilleminault C, et al. Treatment outcomes of adenotonsillectomy for children with obstructive sleep apnea: a prospective longitudinal study. Sleep 2014 Jan 1;37(1):71–76. DOI: 10.5665/sleep.3310.
  38. Baldassari CM, Mitchell RB, et al. Pediatric obstructive sleep apnea and quality of life: a meta-analysis. Otolaryngol Head Neck Surg 2008 Mar;138(3):265–273. DOI: 10.1016/j.otohns.2007.11.003.
  39. Costa DJ, Mitchell R. Adenotonsillectomy for obstructive sleep apnea in obese children: a meta-analysis. Otolaryngol Head Neck Surg 2009;140:455–460. DOI: 10.1016/j.otohns.2008.12.038.
  40. Marcus CL, Brooks LJ, et al. American Academy of Pediatrics. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012 Sep;130(3):576–584. DOI: 10.1542/peds.2012-1671.
  41. Ulualp SO. Modified expansion sphincter pharyngoplasty for treatment of children with obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg 2014;140(9):817–822. DOI: 10.1001/jamaoto.2014.1329.
  42. Pirelli P, Saponara M, et al. Rapid maxillary expansion in children with obstructive sleep apnea syndrome. Sleep 2004 Jun 15;27(4):761–766. DOI: 10.1093/sleep/27.4.761.
  43. Villa MP, Malagola C, et al. Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12-month follow-up. Sleep Med 2007 Mar;8(2):128–134. DOI: 10.1016/j.sleep.2006.06.009.
  44. Villa MP, Evangelisti M, et al. Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing? Sleep Breath 2017 Dec;21(4):1025–1032. DOI: 10.1007/s11325-017-1489-2.
  45. Guilleminault C, Huang YS, et al. Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep Med 2013 Jun;14(6):518–525. DOI: 10.1016/j.sleep.2013.01.013.
  46. Villa MP, Brasili L, et al. Oropharyngeal exercises to reduce symptoms of OSA after AT. Sleep Breath 2015 Mar;19(1):281–289. DOI: 10.1007/s11325-014-1011-z.
  47. Kureshi SA, Gallagher PR, et al. Pilot study of nasal expiratory positive airway pressure devices for the treatment of childhood obstructive sleep apnea syndrome. J Clin Sleep Med 2014 Jun 15;10(6):663–669. DOI: 10.5664/jcsm.3796.
  48. Chan DK, Jan TA, et al. Effect of obesity and medical comorbidities on outcomes after adjunct surgery for obstructive sleep apnea in cases of adenotonsillectomy failure. Arch Otolaryngol Head Neck Surg 2012 Oct;138(10):891–896. DOI: 10.1001/2013.jamaoto.197.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.