Predictors of a Normal Sleep Study in Healthy Children with Sleep Disordered Breathing Symptoms

Abraham, Elizabeth J.; Bains, Ashank; Rubin, Batsheva R.; Cohen, Michael B.; Levi, Jessica R.

doi:10.1177/0003489421990156

Cited by 7 publications

(6 citation statements)

References 31 publications

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“…In a study at Boston Medical Center, 45% of patients with snoring and apneic symptoms undergoing elective PSG had no evidence of OSA with the criteria of AHI < 2 despite having symptoms and exam consistent with oSDB. 8 This suggests that the clinical picture alone or a lower threshold AHI score may lead to unnecessary overtreatment of OSA. Thus, some providers and studies use a threshold AHI score <1.5 or <2 as normal instead of AHI < 1 as proposed by the AASM and AAO-HNSF.…”

Section: Discussionmentioning

confidence: 99%

“…Utilizing a lower threshold AHI score risks overdiagnosis and overtreatment of OSA. In a study at Boston Medical Center, 45% of patients with snoring and apneic symptoms undergoing elective PSG had no evidence of OSA with the criteria of AHI < 2 despite having symptoms and exam consistent with oSDB 8 . This suggests that the clinical picture alone or a lower threshold AHI score may lead to unnecessary overtreatment of OSA.…”

Section: Discussionmentioning

confidence: 99%

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A commentary on broader use of preoperative polysomnography in pediatric patients with obstructive sleep apnea

Garg,

Silber,

Levi

2023

Otolaryngol.--head neck surg.

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Obstructive sleep apnea (OSA), characterized by repeated episodes of prolonged airway obstruction during sleep, is a common condition in pediatric patients ages 2 to 6. Polysomnography (PSG) testing can be used to assess the severity of OSA or obstructive sleep‐disordered breathing prior to adenotonsillectomy. The article “Characteristics and Frequency of Children With Severe Obstructive Sleep Apnea Undergoing Elective Polysomnography” by Bains et al. notes the variability in guidelines regarding indication for PSG amongst professional societies, making it difficult for physicians to determine which patients require PSG. The purpose of this commentary is to emphasize and elaborate on the potential benefit for preoperative PSG in all patients considering adenotonsillectomy as presented by the aforementioned article. With broader use of preoperative PSG, providers would have a more accurate assessment of OSA severity and to aid in surgical decision‐making and postoperative planning.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A commentary on broader use of preoperative polysomnography in pediatric patients with obstructive sleep apnea

Garg,

Silber,

Levi

2023

Otolaryngol.--head neck surg.

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“…A recent study in healthy children suspected of OSA reported that 18% of children undergo surgery without objective sleep evaluation and that of the children evaluated with PSG-studies (based on parent's concern and preference for their child to have objective sleep-evaluation before surgery) only about 55% had OSA and hence might benefit from surgery [49]. This is of concern as surgery includes some immediate risk for the child and may cause complications [19] and removing this lymphoid tissue may increase longerterm respiratory, allergic, and infectious sequelae [20].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Children Likely to Have Spontaneous Resolution of Obstructive Sleep Apnea: Results from the Childhood Adenotonsillectomy Trial (CHAT)

Magnusdottir¹,

Hilmisson²,

Raymann³

et al. 2021

Children

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Objective: To evaluate if cardiopulmonary coupling (CPC) calculated sleep quality (SQI) may have a role in identifying children that may benefit from other intervention than early adenotonsillectomy (eAT) in management of obstructive sleep apnea (OSA). Methods: A secondary analysis of electrocardiogram-signals (ECG) and oxygen saturation-data (SpO2) collected during polysomnography-studies in the prospective multicenter Childhood Adenotonsillectomy Trial (CHAT) to calculate CPC-SQI and apnea hypopnea index (AHI) was executed. In the CHAT, children 5–9 years with OSA without prolonged oxyhemoglobin desaturations were randomly assigned to adenotonsillectomy (eAT) or watchful waiting with supportive care (WWSC). The primary outcomes were to document change in attention and executive function evaluated with the Developmental Neuropsychological Assessment (NEPSY). In our analysis, children in the WWSC-group with spontaneous resolution of OSA (AHIObstructive < 1.0) and high-sleep quality (SQI ≥ 75) after 7-months were compared with children that showed residual OSA. Results: Of the 227 children randomized to WWSC, 203 children had available data at both baseline and 7-month follow-up. The group that showed resolution of OSA at month 7 (n = 43, 21%) were significantly more likely to have high baseline SQI 79.96 [CI95% 75.05, 84.86] vs. 72.44 [CI95% 69.50, 75.39], p = 0.005, mild OSA AHIObstructive 4.01 [CI95% 2.34, 5.68] vs. 6.52 [CI95% 5.47, 7.57], p= 0.005, higher NEPSY-attention-executive function score 106.22 [CI95% 101.67, 110.77] vs. 101.14 [CI95% 98.58, 103.72], p = 0.038 and better quality of life according to parents 83.74 [CI95% 78.95, 88.54] vs. 77.51 [74.49, 80.53], p = 0.015. The groups did not differ when clinically evaluated by Mallampati score, Friedman palate position or sleep related questionnaires. Conclusions: Children that showed resolution of OSA were more likely to have high-SQI and mild OSA, be healthy-weight and have better attention and executive function and quality of life at baseline. As this simple method to evaluate sleep quality and OSA is based on analyzing signals that are simple to collect, the method is practical for sleep-testing, over multiple nights and on multiple occasions. This method may assist physicians and parents to determine the most appropriate therapy for their child as some children may benefit from WWSC rather than interventions. If the parameters can be used to plan care a priori, this would provide a fundamental shift in how childhood OSA is diagnosed and managed.

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“…Ethnicity is a well ascribed major risk factor for childhood obesity, 29 and impacts pediatric OSA prevalence 4,30–33 . Notwithstanding few studies have addressed the influence of Hispanic ethnicity on OSA 34 .…”

Section: Introductionmentioning

confidence: 99%

Association of body anthropometry and obstructive sleep apnea in children: Variations observed in Hispanic children

Bhattacharjee

Sun

Malhotra

et al. 2022

Obesity Science & Practice

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Objectives: Obesity is a risk factor for obstructive sleep apnea (OSA) in children.Childhood obesity rates vary amongst different ethnic groups. Here the interaction of Hispanic ethnicity and obesity on OSA risk was evaluated. Methods:Retrospective cross-sectional analysis of consecutive children undergoing polysomnography and anthropometry using bioelectrical impedance from 2017 to 2020. Demographics obtained from the medical chart. Children who had also undergone cardiometabolic testing were identified and the relationship of cardiometabolic markers with OSA and anthropometry was assessed.Results: Data from 1217 children revealed Hispanic children were more likely to have moderate-severe OSA (36.0%) compared to Non-Hispanic children (26.5%), p < 0.001. Hispanic children had greater Body mass index (BMI), BMI percentile and percent body fat, p < 0.0001. In children that underwent cardiometabolic testing, Hispanic children had significantly greater serum alanine aminotransferase levels (ALT) levels. Following adjustment of age and sex, Hispanic ethnicity was not found to moderate the association of anthropometry with OSA, anthropometry with cardiometabolic markers, and OSA with cardiometabolic markers. Conclusions:OSA was more likely in Hispanic children; this relationship was likely driven by obesity status rather than ethnicity. Among children undergoing cardiometabolic testing, Hispanic children were observed to have greater ALT concentrations however ethnicity did not impact the association of anthropometry and ALT or other cardiometabolic markers.

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Predictors of a Normal Sleep Study in Healthy Children with Sleep Disordered Breathing Symptoms

Cited by 7 publications

References 31 publications

A commentary on broader use of preoperative polysomnography in pediatric patients with obstructive sleep apnea

A commentary on broader use of preoperative polysomnography in pediatric patients with obstructive sleep apnea

Characteristics of Children Likely to Have Spontaneous Resolution of Obstructive Sleep Apnea: Results from the Childhood Adenotonsillectomy Trial (CHAT)

Association of body anthropometry and obstructive sleep apnea in children: Variations observed in Hispanic children

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