How do we recognize the child with OSAS?

Abstract

Obstructive sleep-disordered breathing includes a spectrum of clinical entities with variable severity ranging from primary snoring to obstructive sleep apnea syndrome (OSAS). The clinical suspicion for OSAS is most often raised by parental report of specific symptoms and/or abnormalities identified by the physical examination which predispose to upper airway obstruction (e.g., adenotonsillar hypertrophy, obesity, craniofacial abnormalities, neuromuscular disorders). Symptoms and signs of OSAS are classified into those directly related to the intermittent pharyngeal airway obstruction (e.g., parental report of snoring, apneic events) and into morbidity resulting from the upper airway obstruction (e.g., increased daytime sleepiness, hyperactivity, poor school performance, inadequate somatic growth rate or enuresis). History of premature birth and a family history of OSAS as well as obesity and African American ethnicity are associated with increased risk of sleep-disordered breathing in childhood. Polysomnography is the gold standard method for the diagnosis of OSAS but may not be always feasible, especially in low-income countries or non-tertiary hospitals. Nocturnal oximetry and/or sleep questionnaires may be used to identify the child at high risk of OSAS when polysomnography is not an option. Endoscopy and MRI of the upper airway may help to identify the level(s) of upper airway obstruction and to evaluate the dynamic mechanics of the upper airway, especially in children with combined abnormalities. Pediatr Pulmonol. 2017;52:260-271. © 2016 Wiley Periodicals, Inc.

When and why to treat the child who snores?

“…The present state‐of‐the‐art review is the second in a series of three articles discussing recent advances in the diagnosis and management of OSAS. The first article of the series focused on the recognition of the child with OSAS (“How do we recognize the child with OSAS?”) . The aim of the present article is to summarize findings of key studies based on which the clinician will (i) identify children with OSAS who may get the most benefit from treatment interventions; (ii) recognize clinical parameters that are associated with increased likelihood of spontaneous improvement or resolution of OSAS without treatment interventions; (iii) give guidance to parents whose children have primary snoring, that is, they have no recognizable apneas, hypopneas, or gas exchange abnormalities during sleep.…”

Efficacy of minimally invasive tonsil surgery for treatment of obstructive sleep apnea-hypopnea syndrome in children

“…The incidence rate of OSAHS in children is 1–3%, presenting a rising trend and no difference between genders (11 –13). This study confirmed that there was no statistical difference in terms of age and gender proportion for pediatric patients with different disease severities.…”

Preoperative identification of children at high risk of obstructive sleep apnea

“…Despite its shortcomings, oximetry is a simple, economical, and readily available tool which can be easily performed at home. Although a negative oximetry study cannot rule out OSA, the perioperative risk of respiratory complications is low for a healthy child with a history of snoring who has had negative or inconclusive oximetry score . As such, overnight oximetry should be considered a practical tool to identify at‐risk children of postoperative complications, although the aforementioned limitations need to be acknowledged.…”

“…Despite this poor correlation between severity of sleep‐disordered breathing as measured by a PSG and the clinical signs and symptom appears being well recognized, it remains essential that every evaluation of a child with suspected OSA begins with a thorough history including consideration of parental concerns of a child's sleep breathing. Indeed, a snoring history should be a component of all routine health assessments of any child.…”