Pediatric Obstructive Sleep Apnea in High-Risk Populations: Clinical Implications

ElMallah, Mai K.; Bailey, Evan; Trivedi, Michelle; Kremer, Ted; Rhein, Lawrence

doi:10.3928/19382359-20170815-01

Cited by 22 publications

(24 citation statements)

References 27 publications

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“…2,3 Certain populations have been established as high risk for development of pediatric OSA such as those with Down syndrome, craniofacial disorders, and neuromuscular disorders. 4 Though the exact role it plays is not well understood, premature birth, defined as gestational age (GA) <37 weeks, has been suggested as a risk factor for pediatric OSA 5,6 with one recent study reporting that 9.6% of their sample of 197 ex-preterm children ages 5 to 12 had OSA revealed through polysomnography. 7 The rate of preterm birth in the United States has been steadily rising with some studies putting it as high as 12.8% in recent decades.…”

Section: Introductionmentioning

confidence: 99%

Prematurity: A Prognostic Factor for Increased Severity of Pediatric Obstructive Sleep Apnea

et al. 2021

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Objective/Hypothesis: Studies have suggested preterm birth, defined as gestational age (GA) <37 weeks, is a risk factor for obstructive sleep apnea (OSA) in later childhood. However, little is known about the characteristics, severity, and degree of intervention of childhood OSA in former preterm infants compared to term infants. This study compares polysomnographic characteristics and surgical interventions in former preterm and term infants presenting with sleep disordered breathing.Study Design: Retrospective cohort study from 2015 to 2019 at a single tertiary referral center. Methods: Electronic Medical Records of pediatric patients ages 0 to 18 presenting with sleep disordered breathing were reviewed for gestational age, polysomnographic findings, clinical characteristics, and OSA surgical interventions. Association between gestational age, polysomnographic characteristics, and surgical interventions for OSA were reported.Results: A total of 615 patient records were analyzed. Adjusting for covariates, prematurity was associated with a 2.97× higher likelihood of development of severe OSA (aOR (95%CI): 2.97 (1.40-6.32)), increased apneic-hypoxic index (AHI) (mean (SD): 6.5 (9.8) vs. 4.6 (6.4), P < .05), increased end tidal CO 2 (50.5 (5.11) vs. 48.5 (5.8), P < .05), decreased REM latency (116 (64.7) vs. 132.4 (69.9), P < .05), and increased number of surgeries for OSA (0.65 (.95) vs. 0.45 (0.69), P < .05) compared to children born at term. Children born with GA < 32 weeks presented at a significantly later age with sleep disordered breathing (7.04 (.80) vs. 5.1 (0.15), P < .05) than children born at term.Conclusions: Prematurity was associated with increased likelihood of severe OSA, increased AHI, as well as increased number of surgical interventions for OSA compared to children born at term. These results suggest an association with preterm birth and increased severity of childhood OSA.

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Section: Introductionmentioning

confidence: 99%

Prematurity: A Prognostic Factor for Increased Severity of Pediatric Obstructive Sleep Apnea

et al. 2021

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“…Prior studies demonstrate that surgeons do not properly screen for OSA in the general VPD population (Bennett et al, 2017). The negative consequences of OSA in children cannot be overemphasized and include neurocognitive impairment and dysfunction of the cardiovascular and pulmonary systems (Biggs et al, 2014; Walter et al, 2015; Ehsan et al, 2017; Mallah et al, 2017; Paul & Pinto, 2017; Trivedi et al, 2017). We believe this study highlights the need to evaluate for OSA by PSG both pre- and post-VPD surgery in 22q11.2DS patients.…”

Section: Discussionmentioning

confidence: 99%

Defining Risk of Postoperative Obstructive Sleep Apnea in Patients With 22q11.2DS Undergoing Pharyngeal Flap Surgery for Velopharyngeal Dysfunction Using Polysomnographic Evaluation

Lee

Chang

Solot

et al. 2020

The Cleft Palate Craniofacial Journal

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Objective: To determine pre- and postoperative prevalence of obstructive sleep apnea (OSA) in patients with 22q11.2 deletion syndrome (DS) undergoing wide posterior pharyngeal flap (PPF) surgery for velopharyngeal dysfunction (VPD). Design: Retrospective study using pre- and postoperative polysomnography (PSG) to determine prevalence of OSA. Medical records were reviewed for patients’ medical comorbidities. Parents were surveyed about snoring. Setting: Academic tertiary care pediatric hospital. Patients: Forty patients with laboratory confirmed 22q11.2DS followed over a 6-year period. Interventions: Pre- and postoperative PSG, speech evaluation, and parent surveys. Main Outcome Measure: Severity and prevalence of OSA, defined by obstructive apnea hypopnea index (OAHI), before and after PPF surgery to determine whether PPF is associated with increased risk of OSA. Results: Mean OAHI did not change significantly after PPF surgery (1.1/h vs 2.1/h, P = .330). Prevalence of clinically significant OSA (OAHI ≥ 5) was identical pre- and postoperatively (2 of 40), with both cases having severe-range OSA requiring positive airway pressure therapy. All other patients had mild-range OSA. Nasal resonance was graded as severe preoperatively in 85% of patients. None were graded as severe postoperatively. No single patient factor or parent-reported concern predicted risk of OSA (OAHI ≥ 1.5). Conclusions: Patients with 22q11.2DS are medically complex and are at increased risk of OSA at baseline. Wide PPF surgery for severe VPD does not significantly increase risk of OSA. Careful perioperative planning is essential to optimize both speech and sleep outcomes.

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“…All people with DMD will eventually develop SDB attributable to progressive decline in neuromuscular function. 62 Complex abnormalities such as achondroplasia and epilepsy have also been associated with OSA. People with achondroplasia have a reported prevalence of OSA of 20% to 32% that is thought to be at least partially related to the presence of midface hypoplasia.…”

Section: Diagnostic Evaluation Of Sdb and Osa Syndromementioning

confidence: 99%

Sleep‐Disordered Breathing and Cardiovascular Disease in Children and Adolescents

Smith¹,

Isaiah²,

Melendres³

et al. 2021

JAHA

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Obstructive sleep apnea (OSA) is a known risk factor for cardiovascular disease in adults. It is associated with incident systemic hypertension, arrhythmia, stroke, coronary artery disease, and heart failure. OSA is common in children and adolescents, but there has been less focus on OSA as a primary risk factor for cardiovascular disease in children and adolescents. This scientific statement summarizes what is known regarding the impact of sleep‐disordered breathing and, in particular, OSA on the cardiovascular health of children and adolescents. This statement highlights what is known regarding the impact of OSA on the risk for hypertension, arrhythmia, abnormal ventricular morphology, impaired ventricular contractility, and elevated right heart pressure among children and adolescents. This scientific statement also summarizes current best practices for the diagnosis and evaluation of cardiovascular disease–related complications of OSA in children and adolescents with sleep apnea and highlights potential future research in the area of sleep‐disordered breathing and cardiovascular health during childhood and adolescence.

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Pediatric Obstructive Sleep Apnea in High-Risk Populations: Clinical Implications

Cited by 22 publications

References 27 publications

Prematurity: A Prognostic Factor for Increased Severity of Pediatric Obstructive Sleep Apnea

Prematurity: A Prognostic Factor for Increased Severity of Pediatric Obstructive Sleep Apnea

Defining Risk of Postoperative Obstructive Sleep Apnea in Patients With 22q11.2DS Undergoing Pharyngeal Flap Surgery for Velopharyngeal Dysfunction Using Polysomnographic Evaluation

Sleep‐Disordered Breathing and Cardiovascular Disease in Children and Adolescents

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