Diagnostic and Therapeutic Approach to Children and Adolescents with Obstructive Sleep Apnea Syndrome (OSA): Recommendations in Emilia-Romagna Region, Italy

Esposito, Susanna; Ricci, Giampiero; Gobbi, Riccardo Gomes; Vicini, Claudio; Caramelli, Fabio; Pizzi, Silvia; Fadda, Agatina; Ferro, Salvatore; Plazzi, Giuseppe

doi:10.3390/life12050739

Cited by 5 publications

(14 citation statements)

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“…Sleep-disordered breathing (SDB) refers to an upper airway dysfunction during sleep characterized by snoring and/or increased respiratory effort secondary to increased upper airway resistance and pharyngeal collapsibility [1][2][3]. Obstructive sleep apnea syndrome (OSA) is the main manifestation of SDB in children [4]. OSA is characterized by partial and prolonged obstruction (hypoventilation) and/or intermittent partial (hypopnea) or complete (apnea) obstruction of the upper airways.…”

Section: Introductionmentioning

confidence: 99%

“…This causes an absence of airflow despite continuous respiratory effort and is usually associated with reduced peripheral oxygen saturation and/or hypercapnia [5]. In children, OSA prevalence is between 2% and 5.7%, and it is more common in males and in preschool age [1][2][3][4]6].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The diagnosis of pediatric OSA can be determined objectively by polysomnography (PSG) or, if polysomnography is not available, by nocturnal pulse oximetry [1][2][3][4][5]. Furthermore, a drug-induced sleep endoscopy (DISE) is a diagnostic tool that could be used to assess the upper airway of snorers and OSA patients in conditions that mimic natural sleep [4]. In addition, a detailed clinical history including nocturnal and diurnal symptoms and specific clinical and anamnestic questionnaires like the Pediatric Sleep Questionnaire [9] or the Teenager STOP-BANG questionnaire [10] can contribute to the diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, a detailed clinical history including nocturnal and diurnal symptoms and specific clinical and anamnestic questionnaires like the Pediatric Sleep Questionnaire [9] or the Teenager STOP-BANG questionnaire [10] can contribute to the diagnosis. During clinical examination, evidence of tonsillar hypertrophy, adenoid facies, dental malocclusion, craniofacial malformations, and neuromuscular or neurological disease should be evaluated because they can be associated with OSA [4]. Based on an objective examination, OSA has three phenotypes [10]: classic phenotype, characterized by adenotonsillar hypertrophy with or without dental and skeletal malocclusion; adult phenotype, characterized by obesity associated or not with aspects of the classical phenotype; congenital phenotype, characterized by craniofacial anomalies associated with genetic syndromes (i.e., Pierre Robin sequence, Crouzon syndrome, Apert syndrome, and Down syndrome).…”

Section: Introductionmentioning

confidence: 99%

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The First-Line Approach in Children with Obstructive Sleep Apnea Syndrome (OSA)

Mussi,

Forestiero,

Zambelli

et al. 2023

JCM

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Obstructive sleep apnea syndrome (OSA) is the main manifestation of sleep-disordered breathing in children. Untreated OSA can lead to a variety of complications and adverse consequences mainly due to intermittent hypoxemia. The pathogenesis of OSA is multifactorial. In children aged 2 years or older, adenoid and/or tonsil hypertrophy are the most common causes of upper airway lumen reduction; obesity becomes a major risk factor in older children and adolescents since the presence of fat in the pharyngeal soft tissue reduces the caliber of the lumen. Treatment includes surgical and non-surgical options. This narrative review summarizes the evidence available on the first-line approach in children with OSA, including clinical indications for medical therapy, its effectiveness, and possible adverse effects. Literature analysis showed that AT is the first-line treatment in most patients with adenotonsillar hypertrophy associated with OSA but medical therapy in children over 2 years old with mild OSA is a valid option. In mild OSA, a 1- to 6-month trial with intranasal steroids (INS) alone or in combination with montelukast with an appropriate follow-up can be considered. Further studies are needed to develop an algorithm that permits the selection of children with OSA who would benefit from alternatives to surgery, to define the optimal bridge therapy before surgery, to evaluate the long-term effects of INS +/− montelukast, and to compare the impact of standardized approaches for weight loss.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The First-Line Approach in Children with Obstructive Sleep Apnea Syndrome (OSA)

Mussi,

Forestiero,

Zambelli

et al. 2023

JCM

Self Cite

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Awareness and attitude among general dentists and orthodontists toward obstructive sleep apnea in children

Arcidiacono,

Santagostini,

Tagliaferri

et al. 2024

Front. Neurol.

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AimThis study aimed to investigate Italian dentists’ knowledge of and attitudes toward obstructive sleep apnea (OSA) in children.MethodsAn anonymous questionnaire was prepared using Google Forms and sent to dentists in Italy through private social platforms. The first part of the questionnaire contained basic demographic data questions, and the second part included items about pediatric OSA.ResultsA total of 125 responses were collected within 1 month. The interviews revealed gaps in undergraduate and post-graduate training on OSA, and consequently, low self-evaluation of knowledge and self-confidence in managing young patients with OSA. Dentists showed unfavorable attitudes and poor knowledge of the general findings, risk factors, and consequences of pediatric OSA but demonstrated good knowledge of the beneficial effects of rapid maxillary expansion. Orthodontists showed a more favorable attitude and better recognition of the craniofacial features associated with OSA. In addition, a comparison was made between dentists who had graduated more than 5 years ago and new graduates, and differences were found in undergraduate education, which was better for new graduates, and a small number of questions were better answered by experienced dentists.ConclusionThis study showed a lack of knowledge about pediatric OSA and its management among Italian dentists, revealing the need to update the dentistry curriculum and organize educational interventions.

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Prioritising Polysomnography in Children with Suspected Obstructive Sleep Apnoea: Key Roles of Symptom Onset and Sleep Questionnaire Scores

Nosetti,

Zaffanello,

Simoncini

et al. 2024

Children

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Background/Objectives: Obstructive Sleep Apnoea Syndrome (OSA) in children disrupts normal breathing patterns and sleep architecture, potentially leading to severe consequences. Early identification and intervention are crucial to prevent these issues. This study explored the relationships between waiting times for polysomnography (PSG), clinical history, patient age at the time of PSG, and PSG outcomes in children. Methods: Two hundred and fourteen children were prospectively enrolled. Data were extracted from medical records regarding the patients’ age at the time of a referral for PSG and their age at the time of its execution. Information on the waiting times for PSG, a diagnosis (primary snoring, mild, moderate, and severe OSA), and a history of snoring and apnoea were also collected. Additional data included medications, surgical interventions, passive smoke exposure, and allergies. The records also included the Paediatric Sleep Questionnaire (PSQ). Results: The patient age at the time of a PSG prescription was lower for patients with a short history of sleep apnoeas (≤12 months; 4.6 (SD 2.6) years) compared to those with a long history (>12 months; 5.5 (SD 2.7) years; p = 0.027). The waiting time from prescription to PSG execution was shorter for patients with a short history of sleep apnoea (4.1 (SD 3.8) months) compared to those with a longer history (5.9 (SD 3.8) months; p = 0.001). A higher frequency of having an adenotonsillectomies before a PSG prescription was observed in the long-history group compared to the short-history group (13.3% vs. 6.9%). Conversely, a higher frequency of adenoidectomies before a PSG prescription was noted in the short-history group compared to the long-history group (9.7% vs. 1.3%). Conclusions: This study found that younger children with a shorter history of OSA are diagnosed and evaluated earlier than older children with a longer history of the condition, suggesting that prolonged symptoms may delay a diagnosis. ENT surgeries also vary among patients, with less invasive procedures (adenoidectomy) being more common in younger children with shorter histories of OSA. The increasing awareness of OSA highlights the need for improved access to diagnostic and treatment resources.

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Diagnostic and Therapeutic Approach to Children and Adolescents with Obstructive Sleep Apnea Syndrome (OSA): Recommendations in Emilia-Romagna Region, Italy

Cited by 5 publications

References 28 publications

The First-Line Approach in Children with Obstructive Sleep Apnea Syndrome (OSA)

The First-Line Approach in Children with Obstructive Sleep Apnea Syndrome (OSA)

Awareness and attitude among general dentists and orthodontists toward obstructive sleep apnea in children

Prioritising Polysomnography in Children with Suspected Obstructive Sleep Apnoea: Key Roles of Symptom Onset and Sleep Questionnaire Scores

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