Obstructive Sleep Apnea in Children Under 3 Years of Age

Rayasam, Swathi; Johnson, Romaine F.; Lenahan, Danielle; Abijay, Claire; Mitchell, Ron B.

doi:10.1002/lary.29536

Cited by 15 publications

(7 citation statements)

References 21 publications

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“…The pattern of UA collapse varied with age: dynamic UA obstruction such as laryngomalacia was highly prevalent below 6 months of age whereas the prevalence of adenotonsillar hypertrophy was more commonly observed above 18 months of age. A finding in line with previous reports illustrating a change in UA behavior in the first years of life 13,14 . The higher rate of dynamic UA collapse in very young children is clinically relevant because there is an inherent possibility of spontaneous improvement, and a subgroup of children may outgrow their condition.…”

Section: Discussionsupporting

confidence: 91%

Role of upper airway evaluation in the multidisciplinary management of obstructive sleep apnea in children below two years of age

Blancke,

Platteau,

Slosse

et al. 2024

Pediatric Pulmonology

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BackgroundDiagnosis and treatment of obstructive sleep apnea (OSA) in infants and young children is challenging because of its clinical heterogeneity and lack of age‐specific guidelines.AimWe report the management and treatment outcome of OSA in children below 2 years of age. Treatment decisions were based upon the pattern of upper airway (UA) obstruction, clinical presentation and OSA severity.MethodsRetrospective, non‐randomized observational cohort study at a tertiary center. Children with OSA who underwent an UA evaluation (drug‐induced sleep endoscopy or direct laryngoscopy) were included.ResultsWe studied 100 patients, 57 boys and 43 girls, age 0.72 years (0.0–2.0) and OSA confirmed by polysomnography. Multilevel UA collapse was present in 26%, (adeno)tonsillar hypertrophy in 31% and 21% had laryngomalacia. Laryngomalacia was more common in children below 6 months of age and adenotonsillar hypertrophy was observed mainly in children >1.5 year of age. Surgical and nonsurgical treatment guided by UA findings, improved OSA severity at group level with a significant reduction (p < 0.001) in obstructive apnea/hypopnea index from 10.8/h (2.1–99.1) to 1.7/h (0.0–73.0), an improvement in mean oxygen saturation from 96.9% (88.9–98.4) to 97.4% (92.3–99.0), in minimal oxygen saturation from 85.4% (37.0–96.0) to 88.8% (51.0–95.5) and oxygen desaturation index from 5.1/h (0.2–52.0) to 1.3/h (0.0–47.8).ConclusionMultidisciplinary management of young children with OSA guided by the pattern of UA obstruction and OSA severity, reduces OSA severity. The pattern of UA obstruction changes in the first 2 years of life from a dynamic collapse to structural abnormalities.

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Section: Discussionsupporting

confidence: 91%

Role of upper airway evaluation in the multidisciplinary management of obstructive sleep apnea in children below two years of age

Blancke,

Platteau,

Slosse

et al. 2024

Pediatric Pulmonology

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“…22 The proportion of Hispanic and African Americans in this study is similar to other reported studies from our institution suggesting that there are no differences in race/ethnicity between underweight and normal-weight children with OSA. [23][24][25] In underweight children, we found height to be negatively correlated with the presence of OSA. Similar findings have been reported in other studies on OSA in children.…”

Section: Discussionmentioning

confidence: 64%

“…We report that tonsillar hypertrophy is a predictor of OSA in underweight children undergoing PSG for suspected OSA (in 55% of children with OSA vs 24% in those without OSA; Table 1 ). Several studies have shown a positive correlation between tonsillar hypertrophy and OSA in children 22‐26 . Less clear is the association between the degree of tonsillar hypertrophy and OSA severity.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown a positive correlation between tonsillar hypertrophy and OSA in children. [22][23][24][25][26] Less clear is the association between the degree of tonsillar hypertrophy and OSA severity. In a systematic review, the correlation between tonsillar hypertrophy and OSA was described as ''weak'' or nonexistent.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Obstructive Sleep Apnea in Underweight Children

Johnson

Leavitt

Daram

et al. 2021

Otolaryngol.--head neck surg.

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Objectives To determine predictors of obstructive sleep apnea (OSA) in underweight children and to describe the demographic, clinical, and polysomnographic characteristics of an ethnically diverse population of underweight children with OSA. Study Design Case-control study. Setting University of Texas Southwestern Medical Center and Children’s Medical Center of Dallas Methods Underweight children aged 2 to 18 years who underwent a polysomnogram for suspected OSA between January 2014 and December 2020 were included. Underweight was defined as body mass index <5th percentile per Centers for Disease Control and Prevention guidelines. Children with apnea-hypopnea index <1.0 served as a control group. Univariate and multiple logistic regression analysis was used to determine the predictors of OSA. Significance was set at P < .05. Results An overall 124 children met inclusion criteria: mean age, 6.4 years; 50% female; 44% Hispanic, 31% African American, and 18% Caucasian. A total of 83 children had OSA (apnea-hypopnea index ≥1.0). Height was negatively correlated with OSA (odds ratio, 0.94; 95% CI, 0.88-0.99; P = .02) while allergic rhinitis (odds ratio, 2.97; 95% CI, 1.24-7.08; P = .01) and tonsillar hypertrophy (odds ratio, 3.38; 95% CI, 1.42-8.02; P = .01) were predictors for the presence of OSA. No demographic or clinical characteristics were predictors for severe OSA. Conclusion Underweight children with OSA, as compared with those without OSA, are more likely to have decreased height, tonsillar hypertrophy, and allergic rhinitis. There are no predictors of severe OSA in underweight children. We recommend polysomnography for the diagnosis of OSA in symptomatic underweight children with large tonsils, especially when they have a history of allergies.

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Age‐Related Clinical and Polysomnographic Features of Severe Obstructive Sleep Apnea in Infants

Schild,

Zalzal,

Newman

et al. 2024

The Laryngoscope

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ObjectiveTo use clinical and polysomnographic (PSG) parameters to define the features of severe OSA in infants including PSG parameters, risk factors, and interventions.MethodsRetrospective comparison of PSG features in 207 infants (<12 months) referred for sleep‐disordered breathing. Stepwise multivariate logistic regression was used to define risk factors for severe OSA including sleep stage‐specific PSG parameters. Oxygenation was assessed as % of time with SpO2 < 90% nadir with apneic events and frequency of SpO2 desaturations (>3%) calculated as stage‐specific O2 desaturation indexes.ResultsWe found that 43% of the infants had an OAHI ≥10/h (90/207) with 152 analyzed due to lack of follow‐up. Age is the strongest predictor for severe OSA with infants at or less than 3 months of age with 6.22 higher risk of severe OSA (95% CI, 3.16–12.27). Age‐stratified analyses showed that infants ≤3 months had significantly higher total and OSA sleep stage‐specific apnea hypopnea (OAHI) indexes (REM and NREM), hypopnea indexes (HI), obstructive apnea indexes (OI), arousal indexes, and more severe hypoxemia, both sustained and intermittent. The top risk factor in infants ≤3 months was craniofacial abnormality, which occurred in 57.9% of cases. No intervention was the most common management for each group (61.1% in ≤3 months and 56.6% in 4–12 months). The most common procedures in infants ≤3 months were mandibular distraction osteogenesis (MDO) and supraglottoplasty (SGP) while adenoidectomy was the most common in the 4‐ to 12‐ month group.ConclusionDiagnosis ≤3 months is the strongest predictor for severe OSA, demonstrated across PSG parameters. No surgical intervention is the most common management.Level of Evidence3 Laryngoscope, 2024

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Obstructive Sleep Apnea in Children Under 3 Years of Age

Cited by 15 publications

References 21 publications

Role of upper airway evaluation in the multidisciplinary management of obstructive sleep apnea in children below two years of age

Role of upper airway evaluation in the multidisciplinary management of obstructive sleep apnea in children below two years of age

Obstructive Sleep Apnea in Underweight Children

Age‐Related Clinical and Polysomnographic Features of Severe Obstructive Sleep Apnea in Infants

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