Pediatric Obstructive Sleep Apnea

Schwengel, Deborah A.; Dalesio, Nicholas M.; Stierer, Tracey L.

doi:10.1016/j.anclin.2013.10.012

Cited by 101 publications

(62 citation statements)

References 121 publications

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“…16 Snoring is a common sign; as many as 40% of snoring children who are referred for evaluation by an otolaryngologist or sleep specialist prove to have OSA, and the absence of snoring makes a diagnosis of OSA much less likely. 12,14,17 An illustrative case report exemplifies many of the features of OSA. A woman in her mid-50s was admitted to a hospital for workup of abdominal pain.…”

Section: Clinical Featuresmentioning

confidence: 99%

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Obstructive Sleep Apnea: Preoperative Screening and Postoperative Care

Wolfe

Pomerantz

Miller

et al. 2016

The Journal of the American Board of Family Medicine

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The incidence of obstructive sleep apnea (OSA) has reached epidemic proportions, and it is an often unrecognized cause of perioperative morbidity and mortality. Profound hypoxic injury from apnea during the postoperative period is often misdiagnosed as cardiac arrest due to other causes. Almost a quarter of patients entering a hospital for elective surgery have OSA, and >80% of these cases are undiagnosed at the time of surgery. The perioperative period puts patients at high risk of apneic episodes because of drug effects from sedatives, narcotics, and general anesthesia, as well as from the effects of postoperative rapid eye movement sleep changes and postoperative positioning in the hospital bed.

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Section: Clinical Featuresmentioning

confidence: 99%

“…12,13 OSA is also associated with obesity and chronic upper airway inflammatory disorders, including sinusitis, allergic rhinitis, and asthma. 14 Children are less likely to report daytime drowsiness. In children OSA often presents as learning difficulties, behavioral problems, and hyperactivity.…”

Section: Clinical Featuresmentioning

confidence: 99%

Obstructive Sleep Apnea: Preoperative Screening and Postoperative Care

Wolfe

Pomerantz

Miller

et al. 2016

The Journal of the American Board of Family Medicine

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“…In the general population, shifts in the risk factors for OSA occur from childhood through adolescence [21]. While in childhood small airway size and enlarged lymphoid tissue increase the risk, in adolescence obesity and male sex are associated with OSA [26]. However, in our study population, children and adolescents were thin with a mean BMI z -score of –0.55, which is considered a low normal nutritional status, and predominantly female (67%), which is consistent with proportions reported by other EDS studies [4].…”

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnoea in Children and Adolescents with Ehlers-Danlos Syndrome

et al. 2018

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Background: In Ehlers-Danlos syndrome (EDS), a group of monogenic disorders affecting connective tissues, obstructive sleep apnoea (OSA) is highly prevalent in adults. The prevalence of OSA in children with EDS is unknown. Objectives: This prospective cross-sectional study aimed at determining the prevalence of OSA in paediatric EDS patients. Methods: Children with EDS (n = 24) were recruited from the Children’s Hospital Zurich and matched to healthy controls. Participants completed home respiratory polygraphy and questionnaires (Sleep-Related Breathing Disorder Scale [SRBD], Epworth Sleepiness Scale [ESS], and Child Health Questionnaire [CHQ]). The American Academy of Sleep Medicine criteria were applied for OSA diagnosis (obstructive apnoea-hypopnoea index [oAHI] ≥1/h). Conditional logistic regression was used to compare the prevalence of OSA and to adjust for possible confounding. Results: OSA was found in 42% of paediatric EDS patients and in 13% of matched controls (OR = 4.5, 95% CI = 0.97–20.83, p = 0.054). The median oAHI was higher in EDS patients than in controls (0.77/h, IQR = 0.19–1.76, vs. 0.24/h, IQR = 0.0–0.60, p < 0.001 adjusted for age, sex, and BMI z-score). EDS patients had lower scores in most CHQ scales and higher SRBD and ESS scores than controls (0.26, IQR = 0.1–0.35, vs. 0.07, IQR = 0–0.19, p = 0.004); 7 ± 4 vs. 5 ± 4, p = 0.033, respectively). Conclusion: OSA is a previously underestimated EDS-related complication increasing disease burden.

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“…Other treatments include weight loss, intranasal corticosteroids, and continuous positive airway pressure, 13 which has been found to limit craniofacial development. 6 Oral appliances (OAs) such as maxillary expanders and mandibular orthopedic appliances have also been suggested to improve SDB outcomes. 12 Treatments for adult SDB include both surgical and nonsurgical interventions.…”

Section: Review Articlesmentioning

confidence: 99%

“…3,4 Multiple factors had been identified in the etiology of SDB/ OSA. These included structural constrictions of the soft tissue space surrounding the oropharynx and nasopharynx and its lumen (i.e., hypertrophied tonsils and/or adenoids), 1 constrictions surrounding the nasal cavity, 5 neuromuscular abnormalities of the upper airway, 1 hyperdivergent craniofacial growth patterns, 6 genetic markers (i.e., tumor necrosis factor-alpha), 7 early life programming 8 (i.e., exposure to secondhand cigarette smoking and poor nutrition), and prenatal factors such as hormonal and physiological changes during gestation, 9 in addition to other factors.…”

Section: Introductionmentioning

confidence: 99%

Quality Assessment of Systematic Reviews on the Efficacy of Oral Appliance Therapy for Adult and Pediatric Sleep-Disordered Breathing

Al-Jewair

Gaffar

Flores-Mir

2016

Journal of Clinical Sleep Medicine

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Study Objectives: To assess the methodological quality of published systematic reviews (SRs) and meta-analyses (MAs) about the efficacy of oral appliances (OA) in the management of adult and pediatric sleep-disordered breathing (SDB). Methods: SRs/MAs that evaluated the efficacy of OA therapy on the treatment of SDB in human subjects of all age groups were sought. Multiple electronic databases were searched for articles published in any language from the database's inception until January 2016. Two reviewers independently selected and then assessed the methodological quality of the studies using the Assessment of Multiple Systematic Reviews (AMSTAR) measurement tool. Results: Thirteen reviews on adult SDB were included (2 SRs and 11 SRs with MAs). Of those, seven were medium quality and six were high quality. Only four reviews were included on pediatric SDB (3 SRs and 1 SR with MA). Three of these were of high quality and one was medium quality. The identified limitations in the included reviews were failing to reference the excluded studies or describe reasons for exclusion, lack of applying valid criteria to assess the quality of included studies, lack of publication bias assessment, and absence of conflicts of interest reporting. Conclusions: Overall, SRs/MAs on OA therapy for adult and pediatric SDB were conducted with acceptable methodological quality. High AMSTAR scores should not be extrapolated as a proxy of the methodological quality of the included evidence. There is a need for more primary studies and then that information can be used to be synthesized through SRs on pediatric SDB. Keywords: mandibular advancement device, sleep apnea syndrome, systematic review, treatment efficacy Citation: Al-Jewair TS, Gaffar BO, Flores-Mir C. Quality assessment of systematic reviews on the efficacy of oral appliance therapy for adult and pediatric sleep-disordered breathing. J Clin Sleep Med 2016;12(8):1175-1183. I NTRO DUCTI O NLoud snoring and obstructive sleep apnea (OSA) are common sleep-disordered breathing (SDB) conditions that can affect growing and nongrowing individuals. OSA is characterized by repetitive partial (hypopnea) or complete (apnea) upper airway obstructions lasting at least 10 sec and by snoring during sleep.1 The prevalence in adults ranges from 9% to 24% for OSA and from 2% to 4% for OSA when daytime symptoms are considered.2 SDB/OSA occurs in 1.2% to 5.8% of children and adolescents. 3,4 Multiple factors had been identified in the etiology of SDB/ OSA. These included structural constrictions of the soft tissue space surrounding the oropharynx and nasopharynx and its lumen (i.e., hypertrophied tonsils and/or adenoids), 1 constrictions surrounding the nasal cavity, 5 neuromuscular abnormalities of the upper airway, 1 hyperdivergent craniofacial growth patterns, 6 genetic markers (i.e., tumor necrosis factor-alpha), 7 early life programming 8 (i.e., exposure to secondhand cigarette smoking and poor nutrition), and prenatal factors such as hormonal and physiological changes during gestation, 9 i...

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Pediatric Obstructive Sleep Apnea

Cited by 101 publications

References 121 publications

Obstructive Sleep Apnea: Preoperative Screening and Postoperative Care

Obstructive Sleep Apnea: Preoperative Screening and Postoperative Care

Obstructive Sleep Apnoea in Children and Adolescents with Ehlers-Danlos Syndrome

Quality Assessment of Systematic Reviews on the Efficacy of Oral Appliance Therapy for Adult and Pediatric Sleep-Disordered Breathing

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