Pediatric Obstructive Sleep Apnea: Where Do We Stand?

Huang, Yu‐Shu; Guilleminault, Christian

doi:10.1159/000470885

Cited by 50 publications

(38 citation statements)

References 30 publications

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“…AR and AH cause the obstruction and the increase in airflow resistance in the upper airway (Ballikaya et al, 2018 ). AH condition, in particular, is involved in the development of obstructive sleep apnea (OSA) (Huang and Guilleminault, 2017 ), leading to poor quality of life. When both coexist, the clinical symptoms are similar but obstructive complications and snoring could prevail (Cao and Xu, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

16S Metagenomics Reveals Dysbiosis of Nasal Core Microbiota in Children With Chronic Nasal Inflammation: Role of Adenoid Hypertrophy and Allergic Rhinitis

Migliori

Zicari

Aleandri

et al. 2020

Front. Cell. Infect. Microbiol.

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Allergic rhinitis (AR) and adenoid hypertrophy (AH) are, in children, the main cause of partial or complete upper airway obstruction and reduction in airflow. However, limited data exist about the impact of the increased resistance to airflow, on the nasal microbial composition of children with AR end AH. Allergic rhinitis (AR) as well as adenoid hypertrophy (AH), represent extremely common pathologies in this population. Their known inflammatory obstruction is amplified when both pathologies coexist. In our study, the microbiota of anterior nares of 75 pediatric subjects with AR, AH or both conditions, was explored by 16S rRNA-based metagenomic approach. Our data show for the first time, that in children, the inflammatory state is associated to similar changes in the microbiota composition of AR and AH subjects respect to the healthy condition. Together with such alterations, we observed a reduced variability in the between-subject biodiversity on the other hand, these same alterations resulted amplified by the nasal obstruction that could constitute a secondary risk factor for dysbiosis. Significant differences in the relative abundance of specific microbial groups were found between diseased phenotypes and the controls. Most of these taxa belonged to a stable and quantitatively dominating component of the nasal microbiota and showed marked potentials in discriminating the controls from diseased subjects. A pauperization of the nasal microbial network was observed in diseased status in respect to the number of involved taxa and connectivity. Finally, while stable co-occurrence relationships were observed within both control- and diseases-associated microbial groups, only negative correlations were present between them, suggesting that microbial subgroups potentially act as maintainer of the eubiosis state in the nasal ecosystem. In the nasal ecosystem, inflammation-associated shifts seem to impact the more intimate component of the microbiota rather than representing the mere loss of microbial diversity. The discriminatory potential showed by differentially abundant taxa provide a starting point for future research with the potential to improve patient outcomes. Overall, our results underline the association of AH and AR with the impairment of the microbial interplay leading to unbalanced ecosystems.

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Section: Introductionmentioning

confidence: 99%

16S Metagenomics Reveals Dysbiosis of Nasal Core Microbiota in Children With Chronic Nasal Inflammation: Role of Adenoid Hypertrophy and Allergic Rhinitis

Migliori

Zicari

Aleandri

et al. 2020

Front. Cell. Infect. Microbiol.

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“…This suggests that sex hormones contribute less to childhood OSAS than to adult OSAS, which predominantly affects men [ 7 ]. An increasing rate of childhood obesity helps to explain the persistence of OSAS after adenotonsillectomy (AT) [ 8 , 9 , 10 ], and improvement after weight loss [ 11 ], though obesity is a more influential risk factor in adults. Another predisposing factor is adenotonsillar hypertrophy (AH), which is more frequent in preschoolers (3 to 5 years) [ 3 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Home Respiratory Polygraphy is Useful in the Diagnosis of Childhood Obstructive Sleep Apnea Syndrome

Chiner

Cánovas

Molina

et al. 2020

JCM

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The utility of home respiratory polygraphy (HRP) was assessed as an alternative to polysomnography (PSG) in the diagnosis of childhood obstructive sleep apnea syndrome (OSAS). PSG was indicated only in patients with concomitant disease or where HRP results were questionable. The follow-up period was 1 year. We recorded clinical and anthropometric data, physical examination findings, respiratory variables, severity level and choice of therapy. We assessed 121 children, 70 boys and 51 girls, with mean age 7 ± 4 years, mean body mass index (BMI) 19 ± 5 kg/m2, and mean BMI percentile 62 ± 38%. We included 104 HRP and 24 PSG recordings. Of the latter, 7 were preceded by HRP (false negatives) and 17 were indicated as the first-choice method owing to concomitant disease. Of the initial HRP recordings, 93% were technically valid. All technically valid HRPs and 96% of PSGs resulted in a diagnosis of OSAS (apnea-hypopnea index 9.5 ± 9.1/h). Thirty-three percent of cases were moderate and 22% severe. Apnea-hypopnea index showed no correlation with BMI or BMI percentile. Adenotonsillectomy was indicated in 93 patients (77%), conservative treatment in 17 (14%), and conservative treatment combined with CPAP/BiPAP in 11 (9%). There were no significant differences between children diagnosed by HRP and by PSG in terms of treatment choice. The prevalence of OSAS in our sample was 96.7%. In conclusion, when the probability of OSAS is high, HRP is usually sufficient for diagnosing the syndrome and establishing therapy in children. PSG is advisable in complex or questionable cases.

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“…113 v) Other surgical options in treating OSA (although rarely needed in children) as nasal turbinate reduction, tongue reduction, tongue suspension procedure, and tracheostomy are options in some difficult cases. 114,115 In conclusion, early diagnosis and treatment of pediatric OSAS is encouraged and may improve a child's long-term cognitive and social potential and school performance. Increasing prevalence of OSA type II parallels the increasing prevalence obesity and is a nightmare for sleep physicians, who expect more residual OSA and a shift in the consequences to metabolic and cardiac consequences.…”

Section: Managementmentioning

confidence: 99%

Diagnosis and management of childhood sleep-disordered breathing

Al-Shamrani

Alharbi‎

2020

SMJ

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Sleep-disordered breathing (SDB) includes disorders of breathing that affect airway patency, which impair children's sleep and lead to negative consequences. Obstructive sleep apnea, hypoventilation and upper airway resistance syndrome are common causes of morbidity and mortality in childhood. These clinical practice guidelines, intended for use by pediatricians and primary care clinicians, provide a clear recommendation for the diagnosis and management of sleep-disordered breathing, focusing on the most serious disorder, obstructive sleep apnea syndrome (OSAS). These clinical guidelines formulate clear recommendations to identify patients with suspected OSAS. Further, the manuscript will highlight the potential consequences of SBD in children, and how to overcome such difficulties, what could be the therapeutic options, a 12 recommendations and what are the future direction for pediatric sleep medicine.

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Pediatric Obstructive Sleep Apnea: Where Do We Stand?

Cited by 50 publications

References 30 publications

16S Metagenomics Reveals Dysbiosis of Nasal Core Microbiota in Children With Chronic Nasal Inflammation: Role of Adenoid Hypertrophy and Allergic Rhinitis

16S Metagenomics Reveals Dysbiosis of Nasal Core Microbiota in Children With Chronic Nasal Inflammation: Role of Adenoid Hypertrophy and Allergic Rhinitis

Home Respiratory Polygraphy is Useful in the Diagnosis of Childhood Obstructive Sleep Apnea Syndrome

Diagnosis and management of childhood sleep-disordered breathing

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