Sleep endoscopy as a diagnostic tool in pediatric obstructive sleep apnea

Truong, Mai Thy; Woo, Victoria G.; Koltai, Peter J.

doi:10.1016/j.ijporl.2012.02.028

Cited by 103 publications

(138 citation statements)

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“…those with mandibular hypoplasia and mucopolysaccharidoses), but its disadvantage is radiation exposure (class IV) [66,67]. There is limited evidence for the clinical value of functional respiratory imaging (a CT scan with three-dimensional reconstruction of the pharynx and computational fluid dynamics modelling of inspiratory flow) and acoustic pharyngometry (class IV) [68][69][70]. Literature review a) One class I and several class III and IV studies support the association between a history of prematurity and obstructive SDB [71][72][73].…”

Section: Literature Reviewmentioning

confidence: 99%

“…f ) Adenoid regrowth has been demonstrated in 12.2% of non-obese children with OSAS at 1.5 years post-adenotonsillectomy using nasopharyngoscopy (class IV) [255]. Drug-induced sleep endoscopy in children with persistent SDB may demonstrate laryngomalacia, adenoidal tissue regrowth, tongue base obstruction and pharyngeal collapse (class III and IV) [69,[263][264][265]. MRI of the upper airway may reveal residual adenoid tissue in obese children with persistent OSAS following adenotonsillectomy (class IV) [266].…”

Section: Literature Reviewmentioning

confidence: 99%

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Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

et al. 2015

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This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h, those with an AHI of 1-5 episodes·h −1 and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7). @ERSpublications Management of obstructive sleep disordered breathing in childhood should follow a stepwise approach

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Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

et al. 2015

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“…En la endoscopía de sueño, la HAL producen un patrón de colapso de la vía aérea en relación a la base de lengua. Esto también puede visualizarse en niños con mandíbula retraída, aun con AL de tamaño modesto, y en aquellos con hipotonía secundaria a un trastorno del neurodesarrollo 25 .…”

Section: Tabla 1 Escala De Clasificación De Hipertrofia De Amígdala unclassified

“…En la especuloscopía nasal deben buscarse dirigidamente signos de rinitis, hipertrofia de cornetes y desviación septal. Además del examen físico otorrinolaringológico, resulta relevante el peso del paciente 25 . Sin embargo, la evaluación clínica mediante anamnesis y examen físico, ha demostrado limitada exactitud para el diagnóstico de AOS pediátrico, en particular, para excluirlo 26 .…”

Section: Evaluación Diagnósticaunclassified

Hipertrofia de amígdala lingual y apnea obstructiva del sueño en población pediátrica: Una asociación a considerar

2017

Rev. Otorrinolaringol. Cir. Cabeza Cuello

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“…This is often accomplished through examination of the patterns of dynamic airway collapse during sedation-induced sleep. 5,6 Examination often reveals obstruction and upper combination of these anatomic and dynamic findings factors. 5,7,8 Because different sedatives and anesthetic agents may affect respiratory and upper airway control differently, upper airway evaluation during drug-induced sleep may overestimate the contribution of hypopharyngeal hypotonia to the presence of OSA.…”

Section: Introductionmentioning

confidence: 99%

Upper Airway Reflexes are Preserved During Dexmedetomidine Sedation in Children With Down Syndrome and Obstructive Sleep Apnea

Mahmoud

Ishman

McConnell

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: The assessment of pharyngeal collapsibility is difficult to perform in children under normal sleep. An alternative is to perform the assessment under an anesthetic, such as dexmedetomidine (DEX), that induces non-rapid eye movement (NREM) sleep. The objectives of this study were to compare critical closing airway pressure (Pcrit) obtained during natural sleep to that obtained under DEX in patients with Down syndrome (DS) and persistent obstructive sleep apnea (OSA) and determine whether Pcrit measured under sedation predicts the severity of OSA. Methods: The passive and active Pcrit, which represent airway passive mechanical properties and active dynamic responses to airway obstruction, respectively, were measured. Upper airway reflex activity was estimated by calculating the difference between active and passive Pcrit. Subjects underwent overnight polysomnography during which Pcrit was measured during normal sleep. Pcrit was also measured during DEX sedation at a dose of 2 µg/kg/h. Results: The study included 50 patients with median age of 11.4 years (interquartile range: 7.0-13.9) and median body mass index of 23.0 kg/m 2 (interquartile range: 18.4-29.1), 66% male and 80% Caucasian. Passive Pcrit was significantly higher than active Pcrit when measured during normal sleep and DEX-induced sleep. There was a positive association between apnea-hypopnea index and passive Pcrit (Spearman r = 0.53, P = .0001) and active Pcrit (r = 0.55, P = .0002) under DEX-induced sleep. There were no significant differences between the Pcrit measurements during natural sleep and during DEX sedation. I NTRO DUCTI O NObstructive sleep apnea (OSA) is increasingly recognized as a common disorder in children. It is characterized by recurrent partial or total collapse of the upper airway 1 and is associated with cognitive, metabolic, and cardiovascular morbidity. Children with OSA respond well to adenotonsillectomy (T&A) as a first-line treatment. However, a large percentage of children have recurrence of OSA several months after T&A. In one study, 27% of lean children and 79% of obese children without genetic syndromes had recurrences of OSA 1 year after T&A.3 In children with genetic syndromes and craniofacial abnormalities, OSA either persists or recurs in a much larger percentage of children.4 A significant proportion of children with Down syndrome (DS) may have persistent or recurrent OSA after T&A. Prior to repeat interventions, clinicians must identify the level(s) of residual obstruction. This is often accomplished through examination of the patterns of dynamic airway collapse during sedation-induced sleep. properties that parallel the physiologic changes seen during nonrapid eye movement sleep through action on alpha 2-adrenergic receptors. These properties make dexmedetomidine an attractive drug for sedating children who need dynamic upper airway evaluation. Study Impact: The responses to airway obstruction and the association between airway collapsibility and obstructive sleep apnea severity during dexmedet...

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Sleep endoscopy as a diagnostic tool in pediatric obstructive sleep apnea

Cited by 103 publications

References 12 publications

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Hipertrofia de amígdala lingual y apnea obstructiva del sueño en población pediátrica: Una asociación a considerar

Upper Airway Reflexes are Preserved During Dexmedetomidine Sedation in Children With Down Syndrome and Obstructive Sleep Apnea

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