Elevated Morbidity and Health Care Use in Children with Obstructive Sleep Apnea Syndrome

Tarasiuk, Ariel; Greenberg-Dotan, Sari; Simon‐Tuval, Tzahit; Freidman, Bruria; Goldbart, Aviv; Tal, Asher; Reuveni, Haim

doi:10.1164/rccm.200604-577oc

Cited by 156 publications

(108 citation statements)

References 41 publications

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“…Starting early in life, children with OSAS have increased utilisation of healthcare services, mostly related to respiratory morbidity and thus increased societal costs (class III) [112]. Both generic and disease-specific health-related quality of life measures improve after adenotonsillectomy (class I) [113].…”

Section: Decreased Quality Of Lifementioning

confidence: 99%

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

et al. 2015

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This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h, those with an AHI of 1-5 episodes·h −1 and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7). @ERSpublications Management of obstructive sleep disordered breathing in childhood should follow a stepwise approach

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Section: Decreased Quality Of Lifementioning

confidence: 99%

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

et al. 2015

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“…2 An important risk factor for OSA in children is adenotonsillar hypertrophy. 3 Adenotonsillectomy (ATE) is considered first-line treatment 3 and is one of the most common surgical procedures throughout the world.…”

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confidence: 99%

Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT

2017

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BACKGROUND: Adenotonsillectomy (ATE) is a well-established and effective treatment of pediatric obstructive sleep apnea (OSA). In recent years, a more conservative method, adenotonsillotomy (ATT), has gained popularity because it is associated with less postoperative morbidity. Yet no previous randomized study has compared these 2 methods regarding their effectiveness in treating pediatric OSA in terms of polysomnographic data, which was the primary aim of this study. The hypothesis was that ATT is noninferior to ATE after 1 year. METHODS: Seventy-nine children, aged 2 to 6 years, with OSA (Apnea-Hypopnea Index [AHI] 5–30) were randomized to ATT (n = 40) or ATE (n = 39). Polysomnography (PSG) and questionnaire OSA-18 were assessed at baseline and 1 year postsurgery. RESULTS: Mean difference between groups in the primary outcome, change in AHI, was 0.83, 95% confidence interval –3.2 to 4.9, not exceeding the noninferiority margin of 5. After ATE, AHI decreased from median 12.7 (interquartile range 8.3–19.1) to 2.0 (1.2–3.1) and after ATT from 15.8 (8.5–21.2) to 4.0 (1.2–5.1). For both groups, significant improvements of PSG and OSA-18 questionnaire outcomes were observed, with no significant differences between groups. Five children (13%) in the ATT group needed repeated surgery for tonsil regrowth and recurrence of OSA. CONCLUSIONS: The results suggest that ATT is noninferior to ATE in treating pediatric OSA regarding PSG outcomes after 1 year. ATT could be considered an alternative to ATE for treatment of pediatric OSA. However, after ATT, there is a nonnegligible risk of recurrence of OSA, and this should be taken into account when selecting surgical method.

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“…It is associated with significant morbidity that can potentially impact long-term neurocognitive and behavioral development, as well as cardiovascular outcomes and metabolic homeostasis. 10 In the same sense Tarasiuk et al 11 reported that poor school performance and behavior are the most commonly reported consequences of pediatric OSAHS, but this disease has also been associated with cardiovascular morbidity, metabolic consequences and nocturnal enuresis. Children with OSAHS have also shown increased use of health services compared to their peers, with more hospital visits and prescriptions for medications, especially for respiratory infections.…”

Section: Discussionmentioning

confidence: 98%

Relationship between obstructive sleep apnea hypopnea syndrome and neurocognitive changes - case report of a school

Steffani¹,

Carvalho²,

Carvalho³

et al. 2017

IPMRJ

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According to the literature, the syndrome of obstructive sleep apnea or hypopnea (OSAHS) should be taken into account on issues related to the cognitive development of schoolchildren. Due to the considerable number of children who presented consistent complaints about their ability to perform school work, an interdisciplinary team was authorized by the parents to conduct evaluations to identify the relationship between the occurrence of signs of OSAHS and changes in the neurocognitive functions in children that could explain poor school performance. The results observed in the present case study shown 41 (76%) of the 54 evaluated children with difficulties in school work achievement were considered to present characteristic signs of the consequences of OSAHS. The interdisciplinary diagnostic actions in the present case have proven to be effective, low-cost, and easy to apply in a school environment to subsidize prevention and intervention policies and programs that may modify the health conditions and cognitive development of children.

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Elevated Morbidity and Health Care Use in Children with Obstructive Sleep Apnea Syndrome

Abstract: Practitioners should be aware that starting in Year 1 until date of diagnosis, children with OSAS have higher health care use, mostly related to respiratory diseases.

Cited by 156 publications

References 41 publications

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT

Relationship between obstructive sleep apnea hypopnea syndrome and neurocognitive changes - case report of a school

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