Does your child snore? Does your child show other signs of disturbed sleep : long pauses in breathing, much tossing and turning in the bed, chronic mouth breathing during sleepnight sweats owing to increased effort to breathe? All these, and especially the snoringare possible signs of sleep apneawhich is commoner among children than is generally recognized.

Studies have suggested that as many as 25 percent of children diagnosed with attention-deficit hyperactivity disorder may actually have symptoms of obstructive sleep apnea and that much of their learning difficulty and behavior problems can be the consequence of chronic fragmented sleep. Bed-wetting, sleep-walking, retarded growth, other hormonal and metabolic problems, even failure to thrive can be related to sleep apnea.

Several recent studies show a strong association between pediatric sleep disorders and childhood obesity. Judith Owens, M. If you suspect your child may have OSAyou may wish to seek out a pediatrician who specializes in sleep disorders. The association has assembled a partial list of sleep medicine professional who indicate they specialize in treating pediatric sleep disorders.

Click here for a directory of specialists. As in adults, polysomnography is the only tool for definitive diagnosis and assessment of the severity of pediatric obstructive sleep apnea.

It needs to be conducted during an overnight stay in a sleep lab, with the test conducted by technologists experienced in working with children and the data interpreted by a sleep medicine physician with pediatric experience. At present there is too little data as to the feasibility and validity of pediatric home studies to list them as a reliable alternative.

Unlike adults, normal children rarely experience obstructive apnea events. Consequently, most pediatric sleep specialists regard an apnea index AI of more than 1 or an apnea hypopnea index AHI of 1. An apnea index includes only respiratory events with an absence of airflow and does not include hypopneas, or respiratory events with reduced air flow. In the case of an AHI of 5 to10 mild to moderate OSA or more than 10 in a child who is 12 or younger, which indicates moderate to severe pediatric OSAthe decision to treat is usually straightforward.

How to proceed is less clear in children with AHIs between 1 and 5. Several recent studies have found behavioral problems in children who snore that parallel problems found in children with OSA.

Pediatric Sleep Disordered Breathing and Maxillofacial Development with Soroush Zaghi

An assessment of risk factors and possible developments yet to come by an experienced health care practitioner in each individual case will help determine the relative cost-benefit of treatment. Surgical removal of the adenoids and tonsils is the most common treatment for pediatric OSA.Nocturnal enuresis, diaphoresis, cyanosis, mouth breathing, nasal obstruction during wakefulness, adenoidal facies, and hyponasal speech may also be present. Primary snoring is often the presenting symptom reported by parents, and should warrant careful screening for OSAS.

Primary snoring is defined as snoring without obstructive apnea, frequent arousals from sleep or abnormalities in gaseous exchange. Thus, clinicians must be able to distinguish between primary snoring and OSAS. PSG is designed to capture multiple sensory channels including blood pressure, brain waves, breathing patterns and heartbeat as an individual sleeps. It can also record eye and leg movements and muscle tension which can be useful in diagnosing parasomnias. A PSG performed at a facility will record a minimum of 12 channels which involves at least 22 wire attachments to the individual.

Sensors that send electrical signals to a computer are placed on the head, face, chest and legs. This test is attended by a technologist and the results are evaluated by a qualified physician. A PSG may be performed in conjunction with a positive airway pressure PAP machine to determine the titration of oxygen flow.

Positive airway pressure PAP titration study is used to set the right level of PAP which can be administered as continuous positive airway pressure CPAP or bilevel positive airway pressure BPAP once individual tolerance and optimal levels are determined by a sleep technologist.

pediatric ahi osa

PAP titration may be performed in conjunction with a PSG as part of a split night study if the diagnosis of moderate or severe OSA can be made within the first two hours of recorded sleep and at least three hours of PAP titration, including the ability of PAP to eliminate respiratory events during both rapid eye movement REM sleep and non-REM sleep, is demonstrated. If this is not possible, a second night in the sleep center may be necessary for the CPAP titration study.

However, based on normative data, an obstructive apnea index of 1 is frequently chosen as the threshold of normality. Other normative values reported in the literature for children aged 1 to 15 years include: central apnea index 0. PM devices measure fewer parameters than a laboratory based sleep study and are therefore not recommended for assessment of sleep disorder in the pediatric population.

An example of an actigraph device is the Actiwatch. Prescreening devices or procedures purportedly predict pretest probability of obstructive sleep apnea OSA prior to performing a sleep study. Examples of prescreening techniques include, but may not be limited to, acoustic pharyngometry and SleepStrip.

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According to the American Academy of Pediatrics guideline on the diagnosis and management of childhood OSAScomplex high-risk patients should be referred to a specialist with expertise in sleep disorders.

Treatment of OSAS in children depends on the severity of symptoms and the underlying anatomic and physiologic abnormalities. Tonsillectomy is the surgical removal of the tonsils, which are a collection of lymphoid tissue covered by mucous membranes located on either side of the throat. An adenoidectomy is the surgical removal of the adenoid glands.

The adenoids are masses of lymphoid tissue located at the back of the nose in the upper part of the throat. Other causes of pediatric OSAS include obesity, craniofacial anomalies, and neuromuscular disorders.

Obese children may have less satisfactory results with adenotonsillectomy, but it is generally considered the first-line therapy for these patients as well. Tracheostomy is a surgical procedure in which an opening is created through the neck into the windpipe trachea and a tube placed through this opening to provide an airway.

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Uvulopalatopharyngoplasty UPPP is the surgical revision of the posterior soft palate and adjacent tissue to relieve partial obstruction of the nasopharyngeal airway that causes OSA. The success of pharmacological treatment of OSAS in children has not been evaluated in controlled clinical trials Erler and Paditz, In a meta-analysis of mandibular distraction osteogenesis, Ow and Cheung concluded that mandibular distraction osteogenesis is effective in treating craniofacial deformities, but further clinical trials are needed to evaluate the long-term stability and to compare the treatment with conventional treatment methods, especially in cases of OSA or class II mandibular hypoplasia.

The apnea-hypopnea index AHI improved from Lowest oxygen saturation improved from These findings need to be validated by studies with larger sample sizes and long-term follow-up. Pre-operative and post-operative polysomnographic data were evaluated for each patient. Success of surgery was determined using the criteria of a post-operative AHI of 5 or fewer events per hour, without evidence of hypoxemia oxygen saturation as measured by pulse oximetryand without prolonged hypercarbia end-tidal carbon dioxide.

Overall, the mean AHI improved from The authors concluded that pediatric OSA refractory to adenotonsillectomy that is due to retroglossal and base-of-tongue collapse remains difficult to treat. However, most patients in this analysis benefited from combined genioglossus advancement and radiofrequency ablation. A total of 10 infants median age of 9. Breathing pattern and respiratory effort were measured by esophageal and trans-diaphragmatic pressure monitoring during spontaneous breathing, with or without CPAP and BiPAP ventilation.There are conflicting guidelines on the potential benefit of sleep studies polysomnography on children who are suspected of having obstructive sleep apnea.

Often doctors suggest adenotonsillectomy removal of both the adenoids and tonsils without recommending a sleep study first. But when researchers performed a retrospective study on patients aged two to 18 who underwent diagnostic polysomnography for sleep-disordered breathing between andtheir results found that many actually had normal sleep studies defined as an apnea-hypopnea index of less than 2.

Maybe Not]. They also found Caucasian children, children older than 4 years old, children without respiratory symptoms other than snoring, and children with smaller tonsils, were more likely to have normal sleep studies. Your email address will not be published. Save my name, email, and website in this browser for the next time I comment. View All Events. Maybe Not] They also found Caucasian children, children older than 4 years old, children without respiratory symptoms other than snoring, and children with smaller tonsils, were more likely to have normal sleep studies.

Related Posts. Leave a reply Cancel reply Your email address will not be published. Follow Us. April 30 - May 2. June 10 - June Background: Assessments of pediatric obstructive sleep apnea OSA are underutilized across Canada due to a lack of resources.

Prompt diagnosis and treatment of OSA are crucial for children, as untreated OSA is linked to behavioral deficits, growth failure, and negative cardiovascular consequences. We aim to assess the performance of a portable pediatric OSA screening tool at different AHI cut-offs using overnight smartphone-based pulse oximetry. Material and methods: Following ethics approval and informed consent, children referred to British Columbia Children's Hospital for overnight PSG were recruited for two studies including and 75 children, respectively.

An additional smartphone-based pulse oximeter sensor was used in both studies to record overnight pulse oximetry [SpO 2 and photoplethysmogram PPG ] alongside the PSG. Features characterizing SpO 2 dynamics and heart rate variability from pulse peak intervals of the PPG signal were derived from pulse oximetry recordings. The "Gray Zone" approach was also implemented for different tolerance values to allow for more precise detection of children with inconclusive classification results.

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Results: The optimal diagnostic tolerance values defining the "Gray Zone" borders 15, 10, and 5, respectively were selected to develop the final models to screen for children at AHI cut-offs of 1, 5, and Further validation with larger and more heterogeneous datasets is required before introducing in clinical practice.

Keywords: Mobile health solutions; Oxygen saturation dynamics; Pediatric sleep apnea; Pulse oximetry; Pulse rate variability; Signal analysis. Abstract Background: Assessments of pediatric obstructive sleep apnea OSA are underutilized across Canada due to a lack of resources.Objective: Pediatric obstructive sleep apnea OSA is a prevalent but under-diagnosed disease.

pediatric ahi osa

Although several screening questionnaires are available for pediatric OSA, they are either complicated to use or not sensitive enough, and therefore OSA is seldom screened in primary care settings. Here, we validated a previously developed short 6-item hierarchically-based screening questionnaire tool for pediatric OSA.

Methods: Parents of 85 children referred for a sleep study at a pediatric community-based sleep clinic completed the questionnaire and their children underwent an overnight PSG. Receiver operator curve analyses and other predictive scales were assessed. Results: The 6-item questionnaire exhibited favorable sensitivity and fair specificity for diagnosis of OSA, which varied depending on the apnea-hypopnea index used for OSA definition.

Conclusions: A 6-item questionnaire is a sensitive and easy-to-use screening tool for pediatric OSA in a pediatric sleep clinic setting. All rights reserved.

Abstract Objective: Pediatric obstructive sleep apnea OSA is a prevalent but under-diagnosed disease.

Many Children Don’t Have Sleep Apnea After All

Publication types Comparative Study Validation Study.Patient Information Handout. Obstructive sleep-disordered breathing is common in children. From 3 percent to 12 percent of children snore, while obstructive sleep apnea syndrome affects 1 percent to 10 percent of children. The majority of these children have mild symptoms, and many outgrow the condition. Consequences of untreated obstructive sleep apnea include failure to thrive, enuresis, attention-deficit disorder, behavior problems, poor academic performance, and cardiopulmonary disease.

The most common etiology of obstructive sleep apnea is adenotonsillar hypertrophy. Clinical diagnosis of obstructive sleep apnea is reliable; however, the gold standard evaluation is overnight polysomnography.

Treatment includes the use of continuous positive airway pressure and weight loss in obese children. These alternatives are tolerated poorly in children and rarely are considered primary therapy. Adenotonsillectomy is curative in most patients.

Children with craniofacial syndromes, neuromuscular diseases, medical comorbidities, or severe obstructive sleep apnea, and those younger than three years are at increased risk of developing postoperative complications and should be monitored overnight in the hospital. Snoring, mouth breathing, and obstructive sleep apnea OSA often prompt parents to seek medical attention for their children. The estimated prevalence of snoring in children is 3 to 12 percent, while OSA affects 1 to 10 percent.

OSA often results from adenotonsillar hypertrophy, neuromuscular disease, and craniofacial abnormalities. Sleep-disordered breathing refers to a pathophysiologic continuum that includes snoring, upper airway resistance syndrome, obstructive hypopnea syndrome, and OSA. Affected children have symptoms of OSA but lack the accompanying polysomnographic findings.

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While many children demonstrate intermittent snoring and mouth breathing, true OSA results in detrimental clinical sequelae such as failure to thrive, behavior problems, enuresis, and corp ulmonale. Sleep-disordered breathing in children is a timely public health concern, given the increasing rates of obesity and hyperactivity in this population. As demonstrated in one study, 5 a large percentage of children with hyperactivity or inattentive behaviors had underlying sleep-disordered breathing.

These children would be cared for more effectively with appropriate recognition and treatment of sleep-disordered breathing than with the use of stimulant medications.In the adult population, tonsillectomy is the appropriate first line treatment in select patients EpsteinEvidence Based Clinical Guideline. After thorough examination, if the primary site of obstruction is hypertrophied tonsils, tonsillectomy has been shown to be a very effective treatment regardless of the severity of the OSA VerseLevel 3.

While most of the articles supporting adult tonsillectomy for OSA are small, the results of these 7 articles strongly support this treatment. In Versemany of the studies prior to are reviewed. Surgical treatment of pediatric sleep disordered breathing with tonsillectomy and adenoidectomy is the recommended first line treatment. In snoring pediatric patients with symptoms of sleep disordered breathing in whom AHI is not normalized postoperatively, or in whom AHI was not elevated preoperatively, significant improvement are seen in all QOL measures, neurocognitive functioning and behavior Chervin ,Level 2 evidence.

SDB encompasses a spectrum of obstructive disorders that increases in severity from primary snoring to obstructive sleep apnea OSA. Daytime symptoms associated with SDB may include excessive sleepiness, inattention, poor concentration, and hyperactivity Marcus Children have been shown to have significant improvement in these symptoms with tonsillectomy and adenoidectomy Chervin Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library.

In no sense do they represent a standard of care.

pediatric ahi osa

The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. Position statements are not intended to and should not be treated as legal, medical, or business advice. Get Involved. Search form. Position Statement Reimbursement.

This is more content. References: Epstein, Lawrence J. Chair ; Kristo, David; Strollo, Jr. Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. PediatricsClinical practice guideline: Polysomnography for sleep-disordered breathing prior to tonsillectomy in children.

Obstructive Sleep Apnea: Diagnosis

Otolaryngol Head Neck Surg. Epub Jun Diagnosis and management of childhood obstructive sleep apnea syndrome. Epub Aug More Resources About: Sleep Medicine.