ABSTRACT
@#A 22-month-old male diagnosed with achondroplasia was referred for difficulty in sleeping and was diagnosed to have severe obstructive sleep apnea (OSA) on polysomnography (PSG) (AHI 50.1). This patient had macrocephaly, midface hypoplasia, flat nasal bridge, relative macroglossia and enlarged palatine and adenoid tonsils. The patient underwent bilateral tonsillectomy with adenoidectomy without complication. Six months post-op, repeat polysomnography revealed a still severe (AHI 15.7) OSA with preferential recovery of REM and N3 sleep. Further outpatient follow-up and management is warranted. OSA despite being common in this subset of patients remains overlooked and not prioritized because of the multitude of coexisting concerns. Management of OSA in children with achondroplasia shows improved sleep structure and is helpful for further growth and development.
Subject(s)
Achondroplasia , TonsillectomyABSTRACT
@#A 22-month-old male diagnosed with achondroplasia was referred for difficulty in sleeping and was diagnosed to have severe obstructive sleep apnea (OSA) on polysomnography (PSG) (AHI 50.1). This patient had macrocephaly, midface hypoplasia, flat nasal bridge, relative macroglossia and enlarged palatine and adenoid tonsils. The patient underwent bilateral tonsillectomy with adenoidectomy without complication. Six months post-op, repeat polysomnography revealed a still severe (AHI 15.7) OSA with preferential recovery of REM and N3 sleep. Further outpatient follow-up and management is warranted. OSA despite being common in this subset of patients remains overlooked and not prioritized because of the multitude of coexisting concerns. Management of OSA in children with achondroplasia shows improved sleep structure and is helpful for further growth and development.
Subject(s)
TonsillectomyABSTRACT
El síndrome de apnea/hipopnea obstructiva (SAHOS) se caracteriza por un aumento de la resistencia de la vía aérea superior asociado a una estrechez y colapso intermitente de la faringe produciendo roncopatía y periodos de apneas e hipopneas (1,2,3). Es una patología frecuente que puede ocasionar complicaciones importantes si no se diagnostica y trata adecuadamente. La clínica en niños es distinta que en adultos, ya que la somnolencia se manifiesta de forma paradójica, con alteraciones de la conducta y emocionales. Si no se trata puede ocasionar morbilidad importante que afecta a los sistemas nerviosos central, cardiovascular y endocrino. La identificación de factores de riesgo permite un diagnóstico y un tratamiento precoz. La Polisomnografía nocturna (PSG), es el método diagnóstico de elección. Registros más simplificados son útiles solo cuando los resultados son positivos. El tratamiento más frecuente es la adenoamigdalectomía, con ella se obtiene un porcentaje elevado de curación. En otros pacientes va a depender de la causa o factores predisponentes como puede ser la baja de peso en los niños obesos. En algunos casos van a requerir de CPAP/BiPAP-nasal, dispositivos intraorales, distracción maxilomandibular o tratamiento tópico antiinflamatorio. Palabras Clave: apnea del sueño infantil, ronquidos, trastornos respiratorios, polisomnografía, SAHOS.
Abstract. Obstructive sleep apnea/hypopnea syndrome (OSAS) is characterized by an increased resistance in the upper airway, associated with a narrow and intermittent collapse of the pharynx causing snoring and periods of apneas and hypopneas (1,2,3). It is a highly prevalent pathology that can cause major complications when it is not diagnosed and treated properly. The presentation is different in children than in adults, since sleepiness can be manifested in a paradoxical way, with behavioral and emotional symptoms. If left untreated, it can cause significant morbidity affecting the cardiovascular, endocrine and central nervous systems. The identification of risk factors allows making a diagnosis and establishing treatment earlier. Nocturnal polysomnography (PSG) is the diagnostic method of choice. Simpler recordings are useful only when the results are positive. The most common treatment is tonsillectomy, which is a highly successful treatment. In other patients, the treatment will depend on the cause or risk factors, such as weight loss in obese children. In some cases, children might require the use of a nasal CPAP/BiPAP, intraoral devices, maxillomandibular advancement or anti-inflammatory topical treatment.Key Words: pediatric sleep apnea, snoring, respiratory disorders, polysomnography, OSAS.
ABSTRACT
The present study aimed to investigate the efficacy of adenotonsillectomy (AT) for children with obstructive sleep apnea syndrome (OSAS) and the improvement of their cognitive function.Studies on cognitive performance of OSAS children treated with or without AT were identified by searching the Pubmed,EMBASE and Cochrane library.A meta-analysis was conducted to analyze the literature.The random-effects model was used to evaluate 11 eligible studies using an inverse-variance method.The neuropsychological test results of 4 cognitive domains (general intelligence,memory,attention-executive function and verbal ability) were obtained and analyzed.By comparison of cognitive function between OSAS children and healthy controls,the effect sizes of each domain were achieved as follows:general intelligence,-0.5 (P＜0.0001);memory,-0.18 (P=0.02);attention-executive function,-0.21 (P=0.002);and verbal ability,-0.48 (P=0.0006).The effect sizes of general intelligence,memory,attention-executive function,and verbal ability after AT compared to baseline level were-0.37 (P=0.008),-0.36 (P=0.0005),-0.02 (P=0.88),and-0.45 (P=0.009),respectively.Comparing the cognitive ability between OSAS children after AT and healthy controls showed that the effect sizes were-0.54 (P=0.0009),-0.24 (P=0.12),-0.17 (P=0.35),and-0.45 (P=0.009) in general intelligence,memory,attention-executive function,and verbal ability,respectively.Our results confirmed that OSAS children performed worse than healthy children in terms of the 4 cognitive domains investigated.After 6-12 months of observation,significant improvement in attention-executive function and verbal ability were found in OSAS children treated with AT compared to their baseline level;restoration of attention-executive function and memory were observed in OSAS children after AT in comparison to healthy controls.Further rigorous randomized controlled trials should be conducted to obtain definitive conclusions.
ABSTRACT
INTRODUCTION: In this study, we compared sleep structure, EEG characteristic of pediatric obstructive sleep apnea (OSA) and normal controls which were matched in sex and age. METHODS: Fifteen children (male:female=4:11) who complained snoring and were suspected to have sleep apnea and their age and sex matched normal controls (male:female=5:10) have been done nocturnal polysomnography (NPSG). Sleep parameters, sleep apnea variables and relative spectral components of EEG from NPSG have been compared between both groups. RESULTS: Pediatric OSA group were distinguished from normal controls in terms of apnea index, respiratory disturbance index and nadir of oxyhemoglobulin desaturation. Pediatric OSA group showed increased percent of sleep stage 1, decreased rapid eye movement sleep percent and increased delta power in O1 EEG channel. However other sleep parameters and spectral powers were not different between two groups. CONCLUSION: In pediatric OSA group, sleep structure parameter disruption may be not prominent as the previous studies for adult OSA group because of including mild OSA data in diagnostic criteria. In addition, EEG changes might not be distinct due to low arousal index compared to adult OSA patients. We can observe general characteristics and particularity of pediatric OSA through this study.