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Understanding Obstructive Sleep Apnea Syndrome in Children

  • Pediatric Anesthesia (J Lerman, Section Editor)
  • Published:
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Abstract

Obstructive sleep apnea syndrome (OSAS) is relevant to pediatric anesthesia and is often encountered in adenotonsillectomy (A&T), the most common pediatric surgery and first-line treatment for OSAS. End-organ effects of OSAS are widespread and include pulmonary and cardiovascular complications, neurocognitive and behavioral disruption, and metabolic and inflammatory derangements. Co-existing obesity and asthma are commonly encountered. OSAS increases risk for postoperative respiratory complications causing death or anoxic brain injury. While preoperative OSAS diagnosis is preferred, anesthesia and surgery societies have not adopted emerging diagnostic technologies. Guidelines for identifying which children may undergo ambulatory versus in-patient surgery, anesthetic technique, and postoperative monitoring are lacking. Risk factors for respiratory complications post A&T include patients <3 years, suspected/diagnosed severe OSAS, and co-morbidities. Perioperative use of NSAIDs in children undergoing A&T remains controversial. Dexamethasone and alpha-2 agonists are preferred in children with OSAS undergoing A&T surgery, whereas neostigmine should be avoided. The ideal opioid for use in these children is unknown. However, prescribing postoperative codeine presents serious risk of perioperative cardiac arrest, particularly in those with severe OSAS complicated by obesity. Opioid metabolic pathway overlap with codeine is a concern. Consensus guidelines are required in pediatric anesthesia to improve outcomes in OSAS.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Jennum P, Ibsen R, Kjellberg J. Morbidity and mortality in children with obstructive sleep apnoea: a controlled national study. Thorax. 2013;10:949–54.

    Google Scholar 

  2. Cullen KA, Hall MJ, Golosinskly A. Ambulatory surgery in the United States, 2006. Natl Health Stat report. 2009;11:1–28.

    Google Scholar 

  3. Brown KA, Brouillette RT. The elephant in the room: lethal apnea at home after adenotonsillectomy. Anesth Analg. 2014;118:1157–9.

    PubMed  Google Scholar 

  4. Coté CJ, Posner KL, Domino KB. Death or neurologic injury after tonsillectomy in children with a focus on obstructive sleep apnea: houston, we have a problem! Anesth Analg. 2014;118:1276–83.

    PubMed  Google Scholar 

  5. Goldman JL, Baugh RF, Davies L, et al. Mortality and major morbidity after tonsillectomy: etiologic factors and strategies for prevention. Laryngoscope. 2013;123:2544–53.

    PubMed  Google Scholar 

  6. •• Brown KA. Outcome, risk, and error and the child with obstructive sleep apnea. Paediatr Anaesth. 2011; 21:771–80. Excellent review article to put the problem of managing children with OSAS in proper context.

  7. Morris LG, Lieberman SM, Reitzen SD, et al. Characteristics and outcomes of malpractice claims after tonsillectomy. Otolaryngol Head Neck Surg. 2008;138:315–20.

    PubMed  Google Scholar 

  8. Subramanyam R, Chidambaran V, Ding L, Myer CM 3rd, Sadhasivam S. Anesthesia- and opioids-related malpractice claims following tonsillectomy in USA: LexisNexis claims database 1984-2012. Paediatr Anaesth. 2014;24:412–20.

    PubMed  Google Scholar 

  9. Tolisano AM, Bager JM. Sleep surgery and medical malpractice. Laryngoscope. 2014;124:E250–4.

    PubMed  Google Scholar 

  10. Rabbitts JA, Groenewald CB, Moriarty JP, Flick R. Epidemiology of ambulatory anesthesia for children in the United States: 2006 and 1996. Anesth Analg. 2010;111:1011–5.

    PubMed  Google Scholar 

  11. Mahant S, Keren R, Localio R, et al. Pediatric Research in Inpatient Settings (PRIS) Network. Variation in quality of tonsillectomy perioperative care and revisit rates in children’s hospitals. Pediatrics. 2014;133:280–8.

    PubMed  Google Scholar 

  12. Goyal SS, Shah R, Roberson DW, Schwartz ML. Variation in post-adenotonsillectomy admission practices in 24 pediatric hospitals. Laryngoscope. 2013;123:2560–6.

    PubMed  Google Scholar 

  13. Katz ES, D’Ambrosio CM. Pediatric obstructive sleep apnea syndrome. Clin Chest Med. 2010;31:221–34.

    PubMed  Google Scholar 

  14. •• Stewart DW, Ragg PG, Sheppard S, Chalkiadis GA. The severity and duration of postoperative pain and analgesia requirements in children after tonsillectomy, orchidopexy, or inguinal hernia repair. Paediatr Anaesth. 2012; 22:136–43. Good description of post A&T pain compared to other commonly performed pediatric surgeries.

  15. Raeder J. Ambulatory anesthesia aspects for tonsillectomy and abrasion in children. Curr Opin Anaesthesiol. 2011;24:620–6.

    PubMed  Google Scholar 

  16. Patino M, McAuliffe J, Francis L, Mohamed M. Obstructive sleep apnea syndrome: anesthetic concerns. Int Anesthesiol Clin. 2012;50:41–53.

    PubMed  Google Scholar 

  17. •• Patino M, Sadhasivam S, Mahmoud M. Obstructive sleep apnoea in children: perioperative considerations. Br J Anaesth. 2013; 111(Suppl 1):i83–95. Good overview of the pharmacogenetics and implications of CYP2D6 dependent opioids.

    PubMed  Google Scholar 

  18. Hanna AH, Mason LJ. Challenges in paediatric ambulatory anesthesia. Curr Opin Anaesthesiol. 2012;25:315–20.

    PubMed  CAS  Google Scholar 

  19. •• Schwengel DA, Dalesio NM, Stierer TL. Pediatric obstructive sleep apnea. Anesthesiol Clin. 2014;32:237–61. Excellent detailed overview of the topic.

  20. Schwengel DA, Sterni LM, Tunkel DE, Heitmiller ES. Perioperative management of children with obstructive sleep apnea. Anesth Analg. 2009;109:60–75.

    PubMed  Google Scholar 

  21. Nespoli L, Caprioglio A, Brunetti L, Nosetti L. Obstructive sleep apnea syndrome in childhood. Early Hum Dev. 2013;89(Suppl 3):S33–7.

    PubMed  Google Scholar 

  22. Primhak R, Kingshott R. Sleep physiology and sleep-disordered breathing: the essentials. Arch Dis Child. 2012;97:54–8.

    PubMed  Google Scholar 

  23. •• Witmans M, Young R. Update on pediatric sleep-disordered breathing. Pediatr Clin North Am. 2011;58:571–89. Excellent overview of OSAS diagnosis and treatment and attempts to address discordance between guideline recommendations and actual practice.

  24. •• Tauman R, Gozal D. Obstructive sleep apnea in children. Exp Rev Respir Med. 2011;5:425–40. Excellent overview of the pathophysiology of pediatric OSA.

  25. Owens JA. Update in pediatric sleep medicine. Curr Opin Pulm Med. 2011;17:425–30.

    PubMed  Google Scholar 

  26. •• Alexander NS, Schroeder JW Jr. Pediatric obstructive sleep apnea syndrome. Pediatr Clin North Am. 2013;60:827–40. Excellent overview and comments on significance of various guidelines.

  27. •• Ishman SL. Evidence-based practice. Pediatric obstructive sleep apnea. Otolaryngol Clin N Am. 2012; 45:1055–69. Provides a good overview from a surgical perspective and comments on the strength of evidence for various interventions.

  28. •• Lerman JL. A disquisition on sleep-disordered breathing in children. Paediatr Anaesth. 2009; 19(Suppl. 1):100–8. A clinically practical overview of OSAS as it relates to the practicing pediatric anesthesiologist.

  29. Marcus CL, Brooks LJ, Draper KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130:576–84.

    PubMed  Google Scholar 

  30. •• Marcus CL, Brooks LJ, Draper KA et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Technical report. Pediatrics. 2012;130:e714–55. An updated version of the 2002 guidelines, it is practical and an excellent resource for most related topics including those relevant to pediatric anesthesia.

  31. Roland PS, Rosenfeld RM, Brooks LJ, et al. Clinical practice guideline: Polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg. 2011;145(1 Suppl):S1–15.

    PubMed  Google Scholar 

  32. Aurora RN, Zak RS, Karippot A, et al. Practice parameters for the respiratory indications for polysomnography in children. Sleep. 2011;34:379–88.

    PubMed  PubMed Central  Google Scholar 

  33. Nixon GM, Brouillette RT. Paediatric obstructive sleep apnoea. Thorax. 2005;60:511–6.

    PubMed  PubMed Central  CAS  Google Scholar 

  34. Nakayama M, Koike S, Kuriyama S, et al. Seasonal variation in a clinical referral pediatric cohort at risk for obstructive sleep apnea. Int J Pediatr Otorhinolaryngol. 2013;77:266–9.

    PubMed  Google Scholar 

  35. Gottlieb DJ, Vezina RM, Chase C, et al. Symptoms of sleep-disordered breathing in 5-year-old children are associated with sleepiness and problem behaviors. Pediatrics. 2003;112:870–7.

    PubMed  Google Scholar 

  36. Jackman AR, Biggs SN, Walter LM, et al. Sleep disordered breathing in early childhood: quality of life for children and families. Sleep. 2013;36:1639–46.

    PubMed  PubMed Central  Google Scholar 

  37. Nisbet LC, Yiallourou SR, Walter LM, Horne RS. Blood pressure regulation, autonomic control and sleep disordered breathing in children. Sleep Med Rev. 2014;18:179–89.

    PubMed  Google Scholar 

  38. Gibson SE, Myer CM 3rd, Strife JL, O’Connor DM. Sleep fluoroscopy for localization of upper airway obstruction in children. Ann Otol Rhinol Laryngol. 1996;105:678–83.

    PubMed  CAS  Google Scholar 

  39. Katz S, Murto K, Barrowman N, et al. Neck circumference percentile: A screening tool for pediatric obstructive sleep apnea. Pediatr Pulmonol. 2015;50:196–201.

    PubMed  Google Scholar 

  40. •• Hoffstein V, Zamel N, Phillipson EA. Lung volume dependence of pharyngeal cross-sectional area in patients with obstructive sleep apnea. Am Rev Respir Dis. 1984;130:175–8. Salient article demonstrating decreased lung volume resulted in reduced cross-sectional area of pharyngeal airway. This led to the concept of tracheal tethering of the airway.

    CAS  Google Scholar 

  41. Malakasioti G, Gourgoulianis K, Chrousos G, Kaditis A. Interactions of obstructive sleep-disordered breathing with recurrent wheezing or asthma and their effects on sleep quality. Pediatr Pulmonol. 2011;46:1047–54.

    PubMed  Google Scholar 

  42. •• Ross K. Sleep-disordered breathing and childhood asthma: clinical implications. Curr Opin Pulm Med. 2013;19:79–83. Good review of the link between asthma and OSAS.

  43. Alkhalil M, Schulman E, Getsy J. Obstructive sleep apnea syndrome and asthma: what are the links? J Clin Sleep Med. 2009;15(5):71–8.

    Google Scholar 

  44. Gutierrez MJ, Zhu J, Rodriguez-Martinez CE, Nino CL, Nino G. Nocturnal phenotypical features of obstructive sleep apnea (OSA) in asthmatic children. Pediatr Pulmonol. 2013;48:592–600.

    PubMed  Google Scholar 

  45. •• Bhattacharjee R, Choi BH, Gozal D, Mokhlesi B. Association of adenotonsillectomy with asthma outcomes in children: a longitudinal database analysis. PLoS Med. 2014;11:e1001753. Administrative data base research linking adenotonsillectomy to therapeutic effect for asthma.

  46. Corbo GM, Fuciarelli F, Foresi A, De Benedetto F. Snoring in children: association with respiratory symptoms and passive smoking. BMJ. 1989;299:1491–4.

    PubMed  PubMed Central  CAS  Google Scholar 

  47. Montgomery-Downs HE, O’Brien LM, Holbrook CR, Gozal D. Snoring and sleep-disordered breathing in young children: subjective and objective correlates. Sleep. 2004;27:87–94.

    PubMed  Google Scholar 

  48. Weinstock TG, Rosen CL, Marcus CL, et al. Predictors of obstructive sleep apnea severity in adenotonsillectomy candidates. Sleep. 2014;37:261–9.

    PubMed  PubMed Central  Google Scholar 

  49. Anderson ME Jr, Buchwald ZS, Ko J, Aurora R, Sanford T. Patients with pediatric obstructive sleep apnea show altered T-cell populations with a dominant TH17 profile. Otolaryngol Head Neck Surg. 2014;150:880–6.

    PubMed  Google Scholar 

  50. Malakasioti G, Gourgoulianis K, Chrousos G, Kaditis A. Interactions of obstructive sleep-disordered breathing with recurrent wheezing or asthma and their effects on sleep quality. Pediatr Pulmonol. 2011;46:1047–54.

    PubMed  Google Scholar 

  51. Snow A, Dayyat E, Montgomery-Downs HE, Kheirandish-Gozal L, Gozal D. Pediatric obstructive sleep apnea: a potential late consequence of respiratory syncitial virus bronchiolitis. Pediatr Pulmonol. 2009;44:1186–91.

    PubMed  Google Scholar 

  52. •• Guilleminault C, Akhtar F. Sleep Med Rev. 2015; doi: https://doi.org/10.1016/j.smrv.2014.11.008. An interesting review that provides a contrarian view to the tonsils being the source of the problem. Rather they suggest that tonsillar hypertrophy is a sign of a more extensive problem related to dysfunctional craniofacial development.

    PubMed  Google Scholar 

  53. Miller AJ, Vargervik K, Chierici G. Experimentally induced neuromuscular changes during and after nasal airway obstruction. Am J Orthod. 1984;85:385–92.

    PubMed  CAS  Google Scholar 

  54. Huang YS, Guilleminault C. Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences. Front Neurol. 2013;3:184.

    PubMed  PubMed Central  Google Scholar 

  55. Brouillette RT, Horwood L, Constantin E, Brown K, Ross NA. Childhood sleep apnea and neighborhood disadvantage. J Pediatr. 2011;158(789–795):e1.

    Google Scholar 

  56. •• Kheirandish-Gozal L, Gozal D. Genotype-phenotype interactions in pediatric obstructive sleep apnea. Respir Physiol Neurobiol. 2013;189:338–43. Excellent review regarding the variability in the OSAS phenotype.

  57. Tan HL, Kheirandish-Gozal L, Gozal D. The promise of translational and personalised approaches for paediatric obstructive sleep apnoea: an ‘Omics’ perspective. Thorax. 2014;69:474–80.

    PubMed  Google Scholar 

  58. •• Isono S. Obesity and obstructive sleep apnoea: mechanisms for increased collapsibility of the passive pharyngeal airway. Respirology. 2012;17:32–42. Excellent simplified description of the pathophysiology describing upper airway collapse.

  59. Arens R, McDonough JM, Costarino AT, et al. Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2001;164:698–703.

    PubMed  CAS  Google Scholar 

  60. Eastwood PR, Szollosi I, Platt PR, Hillman DR. Collapsibility of the upper airway during anesthesia with isoflurane. Anesthesiology. 2002;97:786–93.

    PubMed  CAS  Google Scholar 

  61. Eastwood PR, Platt PR, Shepherd K, Maddison K, Hillman DR. Collapsibility of the upper airway at different concentrations of propofol anesthesia. Anesthesiology. 2005;103:470–7.

    PubMed  CAS  Google Scholar 

  62. Montravers P, Dureuil B, Desmonts JM. Effects of i.v. midazolam on upper airway resistance. Br J Anaesth. 1992;68:27–31.

    PubMed  CAS  Google Scholar 

  63. Eastwood PR, Szollosi I, Platt PR, Hillman DR. Comparison of upper airway collapse during general anaesthesia and sleep. Lancet. 2002;359:1207–9.

    PubMed  Google Scholar 

  64. Eckert DJ, Malhotra A. Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:144–53.

    PubMed  PubMed Central  Google Scholar 

  65. •• Deacon NL, Catcheside PG. The role of high loop gain induced by intermittent hypoxia in the pathophysiology of obstructive sleep apnoea. Sleep Med Rev. 2014; doi:https://doi.org/10.1016/j.smrv.2014.10.003. Article reviews the literature regarding the concept of ventilatory instability in patients with OSAS i.e. sustained increase in ventilatory neural output which outlasts the original hypoxemic/hypercarbic stimulus.

    PubMed  Google Scholar 

  66. Fregosi RF, Quan SF, Jackson AC, et al. Ventilatory drive and the apnea-hypopnea index in six-to-twelve year old children. BMC Pulm Med. 2004;4:4.

    PubMed  PubMed Central  Google Scholar 

  67. Huang J, Pinto SJ, Yuan H, et al. Upper airway collapsibility and genioglossus activity in adolescents during sleep. Sleep. 2012;35:1345–52.

    PubMed  PubMed Central  Google Scholar 

  68. Muzumdar H, Arens R. Physiological effects of obstructive sleep apnea syndrome in childhood. Respir Physiol Neurobiol. 2013;188:370–82.

    PubMed  PubMed Central  Google Scholar 

  69. Nisbet LC, Yiallourou SR, Biggs SN, et al. Preschool children with obstructive sleep apnea: the beginnings of elevated blood pressure? Sleep. 2013;36:1219–26.

    PubMed  PubMed Central  Google Scholar 

  70. •• Marcus CL, Moore RH, Rosen CL, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med. 2013;368:2366–76. The first prospective randomized controlled trial to compare A&T to watchful waiting. Primary outcome was change in neurocognitive status.

  71. Tarasiuk A, Simon T, Tal A, Reuveni H. Adenotonsillectomy in children with obstructive sleep apnea syndrome reduces health care utilization. Pediatrics. 2004;113:351–6.

    PubMed  Google Scholar 

  72. Grigg-Damberger M, Ralls F. Cognitive dysfunction and obstructive sleep apnea: from cradle to tomb. Curr Opin Pulm Med. 2012;18:580–7.

    PubMed  Google Scholar 

  73. Hill CM, Hogan AM, Onugha N, et al. Increased cerebral blood flow velocity in children with mild sleep-disordered breathing: a possible association with abnormal neuropsychological function. Pediatrics. 2006;118:e1100–8.

    PubMed  Google Scholar 

  74. Gozal D, Crabtree VM, Sans Capdevila O, Witcher LA, Kheirandish-Gozal L. C-reactive protein, obstructive sleep apnea, and cognitive dysfunction in school-aged children. Am J Respir Crit Care Med. 2007;176:188–93.

    PubMed  PubMed Central  CAS  Google Scholar 

  75. Jackman AR, Biggs SN, Walter LM, et al. Sleep-disordered breathing in preschool children is associated with behavioral, but not cognitive, impairments. Sleep Med. 2012;13:621–31.

    PubMed  Google Scholar 

  76. Brown KA, Laferrière A, Moss IR. Recurrent hypoxemia in young children with obstructive sleep apnea is associated with reduced opioid requirement for analgesia. Anesthesiology. 2004;100:806–10; discussion 5A.

    PubMed  CAS  Google Scholar 

  77. Raghavendran S, Bagry H, Detheux G, Zhang X, Brouillette RT, Brown KA. An anesthetic management protocol to decrease respiratory complications after adenotonsillectomy in children with severe sleep apnea. Anesth Analg. 2010;110:1093–101.

    PubMed  Google Scholar 

  78. Finck AD, Berkowitz BA, Hempstead J, Ngai SH. Pharmacokinetics of morphine: effects of hypercarbia on serum and brain morphine concentrations in the dog. Anesthesiology. 1977;47:407–10.

    PubMed  CAS  Google Scholar 

  79. Laferrière A, Liu JK, Moss IR. Neurokinin-1 versus mu-opioid receptor binding in rat nucleus tractus solitarius after single and recurrent intermittent hypoxia. Brain Res Bull. 2003;59:307–13.

    PubMed  Google Scholar 

  80. Wang DS, Zurek AA, Lecker I, et al. Memory deficits induced by inflammation are regulated by α5-subunit-containing GABAA receptors. Cell Rep. 2012;2:488–96.

    PubMed  PubMed Central  Google Scholar 

  81. Zurek AA, Bridgwater EM, Orser BA. Inhibition of α5 γ-aminobutyric acid type A receptors restores recognition memory after general anesthesia. Anesth Analg. 2012;114:845–55.

    PubMed  CAS  Google Scholar 

  82. Kheirandish-Gozal L, Etzioni T, Bhattacharjee R, et al. Obstructive sleep apnea in children is associated with severity-dependent deterioration in overnight endothelial function. Sleep Med. 2013;14:526–31.

    PubMed  Google Scholar 

  83. Kaditis AG, Alexopoulos EI, Damani E, et al. Urine levels of catecholamines in Greek children with obstructive sleep-disordered breathing. Pediatr Pulmonol. 2009;44:38–45.

    PubMed  Google Scholar 

  84. Gozal D, Hakim F, Kheirandish-Gozal L. Chemoreceptors, baroreceptors, and autonomic deregulation in children with obstructive sleep apnea. Respir Physiol Neurobiol. 2013;185:177–85.

    PubMed  CAS  Google Scholar 

  85. •• Gozal D, Kheirandish-Gozal L, Bhattacharjee R, Kim J. C-reactive protein and obstructive sleep apnea syndrome in children. Front Biosci. 2012;4:2410–22. A good review of inflammation associated with pediatric OSAS.

  86. Kaditis AG, Alexopoulos EI, Hatzi F, et al. Overnight change in brain natriuretic peptide levels in children with sleep-disordered breathing. Chest. 2006;130:1377–84.

    PubMed  CAS  Google Scholar 

  87. Ingram DG, Matthews CK. Effect of adenotonsillectomy on c-reactive protein levels in children with obstructive sleep apnea: a meta-analysis. Sleep Med. 2013;14:172–6.

    PubMed  Google Scholar 

  88. Bhattacharjee R, Gozal D. Cardiovascular disease and sleep disordered breathing: are children vulnerable? Sleep. 2009;32:1251–2.

    PubMed  PubMed Central  Google Scholar 

  89. Chatsuriyawong S, Gozal D, Kheirandish-Gozal L, et al. Genetic variance in nitric oxide synthase and endothelin genes among children with and without endothelial dysfunction. J Transl Med. 2013;11:227.

    PubMed  PubMed Central  Google Scholar 

  90. •• Vlahandonis A, Walter LM, Horne RS. Does treatment of SDB in children improve cardiovascular outcome? Sleep Med Rev. 2013;17:75–85. A review of cardiovascular outcomes in children treated for SDB and provides recommendations for management.

  91. Kelly A, Dougherty S, Cucchiara A, Marcus CL, Brooks LJ. Catecholamines, adiponectin, and insulin resistance as measured by HOMA in children with obstructive sleep apnea. Sleep. 2010;33:1185–91.

    PubMed  PubMed Central  Google Scholar 

  92. Certal V, Catumbela E, Winck JC, Azevedo I, Teixeira-Pinto A, Costa-Pereira A. Clinical assessment of pediatric obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope. 2012;122(9):2105–14.

    PubMed  Google Scholar 

  93. •• Laupacis A, Sekar N, Stiell IG. Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA. 1997;277:488–94. An excellent review of methodological standards to develop clinical prediction rules.

  94. •• Spruyt K, Gozal D. Development of pediatric sleep questionnaires as diagnostic or epidemiological tools: a brief review of dos and don’ts. Sleep Med Rev. 2011;15:7–17. An excellent review of methodological standards to develop clinical prediction rules specifically for OSAS in children.

  95. Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108:812–21.

    PubMed  Google Scholar 

  96. Kadmon G, Chung SA, Shapiro CM. I’M SLEEPY: a short pediatric sleep apnea questionnaire. Int J Pediatr Otorhinolaryngol. 2014;78:2116–20.

    PubMed  Google Scholar 

  97. Spruyt K, Gozal D. Screening of pediatric sleep-disordered breathing: a proposed unbiased discriminative set of questions using clinical severity scales. Chest. 2012;142:1508–15.

    PubMed  PubMed Central  Google Scholar 

  98. Kadmon G, Shapiro CM, Chung SA, Gozal D. Validation of a pediatric obstructive sleep apnea screening tool. Int J Pediatr Otorhinolaryngol. 2013;77:1461–4.

    PubMed  Google Scholar 

  99. Xu Z, Cheuk DK, Lee SL. Clinical evaluation in predicting childhood obstructive sleep apnea. Chest. 2006;130:1765–71.

    PubMed  Google Scholar 

  100. Church GD. The role of polysomnography in diagnosing and treating obstructive sleep apnea in pediatric patients. Curr Probl Pediatr Adolesc Health Care. 2012;42:2–25.

    PubMed  Google Scholar 

  101. •• Friedman NR. Pediatric sleep studies: when and how often are they necessary? Curr Opin Otolaryngol Head Neck Surg. 2013;21(6):557–66. An excellent review of the various guidelines and their indications for PSG.

  102. Wise MS, Nichols CD, Grigg-Damberger MM, et al. Executive summary of respiratory indications for polysomnography in children: an evidence-based review. Sleep. 2011;34:389–398AW.

    PubMed  PubMed Central  Google Scholar 

  103. •• American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2014;120:268–86. An update from 2006, it is the only anesthesia society sponsored guideline to address the perioperative management of children with OSAS.

  104. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the american academy of sleep medicine. J Clin Sleep Med. 2012;8:597–619.

    PubMed  PubMed Central  Google Scholar 

  105. Mitchell RB, Pereira KD, Friedman NR. Sleep-disordered breathing in children: survey of current practice. Laryngoscope. 2006;116:956–8.

    PubMed  Google Scholar 

  106. Kahlke PE, Witmans MB, Alabdoulsalam T, Young R, MacLean JE, Mandhane PJ. Full-night versus 4 h evening polysomnography in children less than 2 years of age. Sleep Med. 2013;14:177–82.

    PubMed  Google Scholar 

  107. Brockmann PE, Perez JL, Moya A. Feasibility of unattended home polysomnography in children with sleep-disordered breathing. Int J Pediatr Otorhinolaryngol. 2013;77:1960–4.

    PubMed  Google Scholar 

  108. Marcus CL, Traylor J, Biggs SN, et al. Feasibility of comprehensive, unattended ambulatory polysomnography in school-aged children. J Clin Sleep Med. 2014;10:913–8.

    PubMed  PubMed Central  Google Scholar 

  109. •• Brockmann PE, Schaefer C, Poets A, Poets CF, Urschitz MS. Diagnosis of obstructive sleep apnea in children: a systematic review. Sleep Med Rev. 2013;17(5):331–40. An excellent review identifying promising diagnostic tools for pediatric OSAS including urinary biomarkers, acoustic pharyngometry and nasal manometry.

  110. Nath A, Emani J, Suskind DL, Baroody FM. Predictors of persistent sleep apnea after surgery in children younger than 3 years. JAMA Otolaryngol Head Neck Surg. 2013;139:1002–8.

    PubMed  Google Scholar 

  111. Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med. 2010;182(5):676–83.

    PubMed  Google Scholar 

  112. Brouillette RT, Morielli A, Leimanis A, Waters KA, Luciano R, Ducharme FM. Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Pediatrics. 2000;105:405–12.

    PubMed  CAS  Google Scholar 

  113. Nixon GM, Kermack AS, Davis GM, Manoukian JJ, Brown KA, Brouillette RT. Planning adenotonsillectomy in children with obstructive sleep apnea: the role of overnight oximetry. Pediatrics. 2004;113(1 Pt 1):e19–25.

    PubMed  Google Scholar 

  114. Chang L, Wu J, Cao L. Combination of symptoms and oxygen desaturation index in predicting childhood obstructive sleep apnea. Int J Pediatr Otorhinolaryngol. 2013;77:365–71.

    PubMed  Google Scholar 

  115. Pavone M, Cutrera R, Verrillo E, Salerno T, Soldini S, Brouillette RT. Night-to-night consistency of at-home nocturnal pulse oximetry testing for obstructive sleep apnea in children. Pediatr Pulmonol. 2013;48:754–60.

    PubMed  Google Scholar 

  116. Horwood L, Brouillette RT, McGregor CD, Manoukian JJ, Constantin E. Testing for pediatric obstructive sleep apnea when health care resources are rationed. JAMA Otolaryngol Head Neck Surg. 2014;140:616–23.

    PubMed  Google Scholar 

  117. Lee TT, Lefebvre CE, Gans NE, Daniel SJ. Quantifying respiratory complications post-adenotonsillectomy in patients with normal or inconclusive overnight oximetry. J Otolaryngol Head Neck Surg. 2013;42:50.

    PubMed  PubMed Central  Google Scholar 

  118. Gozal D. Serum, urine, and breath-related biomarkers in the diagnosis of obstructive sleep apnea in children: is it for real? Curr Opin Pulm Med. 2012;18:561–7.

    PubMed  CAS  Google Scholar 

  119. Becker L, Kheirandish-Gozal L, Peris E, et al. Contexualised urinary biomarker analysis facilitates diagnosis of paediatric obstructive sleep apnoea. Sleep Med. 2014;15:541–9.

    PubMed  PubMed Central  Google Scholar 

  120. Biggs SN, Vlahandonis A, Anderson V, et al. Long-term changes in neurocognition and behavior following treatment of sleep disordered breathing in school-aged children. Sleep. 2014;37:77–84.

    PubMed  PubMed Central  Google Scholar 

  121. Katz ES, Moore RH, Rosen CL, et al. Growth after adenotonsillectomy for obstructive sleep apnea: an RCT. Pediatrics. 2014;134:282–9.

    PubMed  PubMed Central  Google Scholar 

  122. Acevedo JL, Shah RK, Brietzke SE. Systematic review of complications of tonsillotomy versus tonsillectomy. Otolaryngol Head Neck Surg. 2012;146:871–9.

    PubMed  Google Scholar 

  123. Alexiou VG, Salazar-Salvia MS, Jervis PN, Falagas ME. Modern technology-assisted vs conventional tonsillectomy: a meta-analysis of randomized controlled trials. Arch Otolaryngol Head Neck Surg. 2011;137:558–70.

    PubMed  Google Scholar 

  124. Leonardis RL, Robison JG, Otteson TD. Evaluating the management of obstructive sleep apnea in neonates and infants. JAMA Otolaryngol Head Neck Surg. 2013;139:139–46.

    PubMed  Google Scholar 

  125. DiFeo N, Meltzer LJ, Beck SE, et al. Predictors of positive airway pressure therapy adherence in children: a prospective study. J Clin Sleep Med. 2012;8:279–86.

    PubMed  PubMed Central  Google Scholar 

  126. Tapia IE, Marcus CL. Newer treatment modalities for pediatric obstructive sleep apnea. Paediatr Respir Rev. 2013;14:199–203.

    PubMed  Google Scholar 

  127. •• Tan HL, Gozal D, Kheirandish-Gozal L. Obstructive sleep apnea in children: a critical update. Nat Sci Sleep. 2013;5:109–23. Excellent review article incorporating pathophysiology of OSA and proposed future therapeutic algorithms.

  128. Baugh RF, Archer SM, Mitchell RB, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg. 2011;144(1 Suppl):S1–30.

    PubMed  Google Scholar 

  129. Raman VT, Jatana KR, Elmaraghy CA, Tobias JD. Guidelines to decrease unanticipated hospital admission following adenotonsillectomy in the pediatric population. Int J Pediatr Otorhinolaryngol. 2014;78(1):19–22.

    PubMed  Google Scholar 

  130. Tait AR, Voepel-Lewis T, Christensen R, O’Brien LM. The STBUR questionnaire for predicting perioperative respiratory adverse events in children at risk for sleep-disordered breathing. Paediatr Anaesth. 2013;23:510–6.

    PubMed  PubMed Central  Google Scholar 

  131. •• Kain ZN, Caldwell-Andrews AA, Mayes LC, et al. Family-centered preparation for surgery improves perioperative outcomes in children: a randomized controlled trial. Anesthesiology. 2007;106:65–74. Well executed trial showing the benefits of family centered care improving postoperative outcomes including pain.

    PubMed  Google Scholar 

  132. Francis A, Eltaki K, Bash T, et al. The safety of preoperative sedation in children with sleep-disordered breathing. Int J Pediatr Otorhino. 2006;70:1517–21.

    Google Scholar 

  133. Reimer EJ, Dunn GS, Montgomery CJ, Sanderson PM, Scheepers LD, Merrick PM. The effectiveness of clonidine as an analgesic in paediatric adenotonsillectomy. Can J Anaesth. 1998;45:1162–7.

    PubMed  CAS  Google Scholar 

  134. Murto K, Lamontagne C, McFaul C, et al. Celecoxib pharmacogenetics and pediatric adenotonsillectomy: a blinded randomized controlled study. Can J Anesth 2015 (in press).

  135. Valois-Gómez T, Oofuvong M, Auer G, Coffin D, Loetwiriyakul W, Correa JA. Incidence of difficult bag-mask ventilation in children: a prospective observational study. Paediatr Anaesth. 2013;23:920–6.

    PubMed  Google Scholar 

  136. •• Tait AR. Anesthetic management of the child with an upper respiratory tract infection. Curr Opin Anaesthesiol. 2005;18:603–7. Excellent review of the perioperative implications of an upper respiratory tract infection.

    PubMed  Google Scholar 

  137. Burke CN, Voepel-Lewis T, Wagner D, Lau I, Baldock A, Malviya S, Nafiu O. A retrospective description of anesthetic medication dosing in overweight and obese children. Paediatr Anaesth. 2014;24:857–62.

    PubMed  Google Scholar 

  138. Dart RC, Rumack BH. Intravenous acetaminophen in the United States: iatrogenic dosing errors. Pediatrics. 2012;129:349–53.

    PubMed  Google Scholar 

  139. Plante J, Turgeon AF, Zarychanski R, et al. Effect of systemic steroids on post-tonsillectomy bleeding and reinterventions: systematic review and meta-analysis of randomised controlled trials. BMJ. 2012;345:e5389.

    PubMed  PubMed Central  Google Scholar 

  140. •• Carr AS, Courtman S, Holtby H, et al. The Association of Paediatric Anaesthetists of Great Britain and Ireland. Guidelines on the prevention of post-operative vomiting in children. Spring 2009; 1–35. An excellent resource for evidence based anti-emetic administration guidelines in children.

  141. Wilson K, Lakheeram I, Morielli A, Brouillette R, Brown K. Can assessment for obstructive sleep apnea help predict postadenotonsillectomy respiratory complications? Anesthesiology. 2002;96:313–22.

    PubMed  Google Scholar 

  142. Waters KA, McBrien F, Stewart P, Hinder M, Wharton S. Effects of OSA, inhalational anesthesia, and fentanyl on the airway and ventilation of children. J Appl Physiol. 2002;92:1987–94.

    PubMed  CAS  Google Scholar 

  143. •• Mason KP, Lerman J. Review article: Dexmedetomidine in children: current knowledge and future applications. Anesth Analg. 2011; 113:1129–42. An excellent review article.

  144. Dahmani S, Stany I, Brasher C, et al. Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth. 2010;104:216–23.

    PubMed  CAS  Google Scholar 

  145. Olutoye OA, Glover CD, Diefenderfer JW, et al. The effect of intraoperative dexmedetomidine on postoperative analgesia and sedation in pediatric patients undergoing tonsillectomy and adenoidectomy. Anesth Analg. 2010;111:490–5.

    PubMed  CAS  Google Scholar 

  146. Dahmani S, Michelet D, Abback PS, et al. Ketamine for perioperative pain management in children: a meta-analysis of published studies. Paediatr Anaesth. 2011;21:636–52.

    PubMed  Google Scholar 

  147. Herbstreit F, Zigrahn D, Ochterbeck C, Peters J, Eikermann M. Neostigmine/glycopyrrolate administered after recovery from neuromuscular block increases upper airway collapsibility by decreasing genioglossus muscle activity in response to negative pharyngeal pressure. Anesthesiology. 2010;113:1280–8.

    PubMed  CAS  Google Scholar 

  148. Fagerlund MJ, Kåhlin J, Ebberyd A, Schulte G, Mkrtchian S, Eriksson LI. The human carotid body: expression of oxygen sensing and signaling genes of relevance for anesthesia. Anesthesiology. 2010;113:1270–9.

    PubMed  Google Scholar 

  149. Jonsson M, Wyon N, Lindahl SG, Fredholm BB, Eriksson LI. Neuromuscular blocking agents block carotid body neuronal nicotinic acetylcholine receptors. Eur J Pharmacol. 2004;497:173–80.

    PubMed  CAS  Google Scholar 

  150. Grainger J, Saravanappa N. Local anaesthetic for post-tonsillectomy pain: a systematic review and meta-analysis. Clin Otolaryngol. 2008;33(5):411–9.

    PubMed  CAS  Google Scholar 

  151. Romero-Brufau S, Huddleston JM, Naessens JM, et al. Widely used track and trigger scores: are they ready for automation in practice? Resuscitation. 2014;85(4):549–52.

    PubMed  Google Scholar 

  152. Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med. 2014;371:1803–12.

    PubMed  CAS  Google Scholar 

  153. •• Racoosin JA, Roberson DW, Pacanowski MA, Nielsen DR. New evidence about an old drug–risk with codeine after adenotonsillectomy. N Engl J Med. 2013;368:2155–7. An excellent article reviewing the history behind codeine becoming contraindicated for A&T in the US.

  154. Yellon RF, Kenna MA, Cladis FP, Mcghee W, Davis PJ. What is the best non-codeine postadenotonsillectomy pain management for children? Laryngoscope. 2014;124:1737–8.

    PubMed  Google Scholar 

  155. Kelly LE, Sommer DD, Ramakrishna J, et al. Morphine or Ibuprofen for post-tonsillectomy analgesia: a randomized trial. Pediatrics. 2015;135:307–13.

    PubMed  Google Scholar 

  156. Butler SF, McNaughton EC, Black RA. Tapentadol abuse potential: a postmarketing evaluation using a sample of individuals evaluated for substance abuse treatment. Pain Med. 2015;16:119–30.

    PubMed  Google Scholar 

  157. Tzschentke TM, Christoph T, Kögel BY. The mu-opioid receptor agonist/noradrenaline reuptake inhibition (MOR-NRI) concept in analgesia: the case of tapentadol. CNS Drugs. 2014;28:319–29.

    PubMed  CAS  Google Scholar 

  158. Hannam J, Anderson BJ. Explaining the acetaminophen-ibuprofen analgesic interaction using a response surface model. Paediatr Anaesth. 2011;21:1234.

    PubMed  Google Scholar 

  159. Wong I, St John-Green C, Walker SM. Opioid-sparing effects of perioperative paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) in children. Paediatr Anaesth. 2013;23:475–95.

    PubMed  PubMed Central  Google Scholar 

  160. Pierce CA, Voss B. Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review. Ann Pharmacother. 2010;44:489–506.

    PubMed  CAS  Google Scholar 

  161. •• Lewis SR, Nicholson A, Cardwell ME, Siviter G, Smith AF. Nonsteroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy. Cochrane Database Syst Rev. 2013;7:CD003591. The most quoted review related to this topic. They conclude that higher numbers of patients are required to confidently state that NSAIDs do not cause post A&T bleeding.

  162. •• Riggin L, Ramakrishna J, Sommer DD, Koren G. A 2013 updated systematic review & meta-analysis of 36 randomized controlled trials; no apparent effects of non steroidal anti-inflammatory agents on the risk of bleeding after tonsillectomy. Clin Otolaryngol. 2013;38(2):115–29. An often quoted article claiming NSAIDs are safe to administer post A&T. Concerns about confounders influencing the results are mentioned in the text.

  163. Zhang C, Hu J, Liu X, Yan J. Effects of intravenous dexmedetomidine on emergence agitation in children under sevoflurane anesthesia: a meta-analysis of randomized controlled trials. PLoS ONE. 2014;9:e99718.

    PubMed  PubMed Central  Google Scholar 

  164. •• Provincial Council for Maternal & Child Health & Ministry of Health and Long-term Care. Quality-Based Procedures Clinical Handbook for Paediatric Tonsillectomy with and without Adenoidectomy. December 2013 http://www.health.gov.on.ca/en/pro/programs/ecfa/docs/qbp_tonsil.pdf. An Ontario Provincial working group’s recent attempt to standardize the perioperative managemet of children undergoing A&T.

  165. Sawnani H, Thampratankul L, Szczesniak RD, Fenchel MC, Simakajornboon N. Sleep disordered breathing in young boys with duchenne muscular dystrophy. J Pediatr. 2015;166(640–645):e1.

    Google Scholar 

  166. Raynes-Greenow CH, Hadfield RM, Cistulli PA, Bowen J, Allen H, Roberts CL. Sleep apnea in early childhood associated with preterm birth but not small for gestational age: a population-based record linkage study. Sleep. 2012;35:1475–80.

    PubMed  PubMed Central  Google Scholar 

  167. Calhoun SL, Vgontzas AN, Mayes SD, et al. Prenatal and perinatal complications: is it the link between race and SES and childhood sleep disordered breathing? J Clin Sleep Med. 2010;6:264–9.

    PubMed  PubMed Central  Google Scholar 

  168. Lundkvist K, Sundquist K, Li X, Friberg D. Familial risk of sleep-disordered breathing. Sleep Med. 2012;13:668–73.

    PubMed  Google Scholar 

  169. Kimple AJ, Ishman SL. Allergy and sleep-disordered breathing. Curr Opin Otolaryngol Head Neck Surg. 2013;21:277–81.

    PubMed  Google Scholar 

  170. Yoon SY, Jain U, Shapiro C. Sleep in attention-deficit/hyperactivity disorder in children and adults: past, present, and future. Sleep Med Rev. 2012;16:371–88.

    PubMed  Google Scholar 

  171. Deal CL, Tony M, Höybye C, et al. GrowthHormone Research Society workshop summary: consensus guidelines for recombinant human growth hormone therapy in Prader-Willi syndrome. J Clin Endocrinol Metab. 2013;98:E1072–87.

    PubMed  PubMed Central  CAS  Google Scholar 

  172. Churchill SS, Kieckhefer GM, Landis CA, Ward TM. Sleep measurement and monitoring in children with Down syndrome: a review of the literature, 1960–2010. Sleep Med Rev. 2012;16:477–88.

    PubMed  PubMed Central  Google Scholar 

  173. Jain SV, Horn PS, Simakajornboon N, Glauser TA. Obstructive sleep apnea and primary snoring in children with epilepsy. J Child Neurol. 2013;28:77–82.

    PubMed  Google Scholar 

  174. Yilmaz E, Sedky K, Bennett DS. The relationship between depressive symptoms and obstructive sleep apnea in pediatric populations: a meta-analysis. J Clin Sleep Med. 2013;9:1213–20.

    PubMed  PubMed Central  Google Scholar 

  175. Rosen CL, Debaun MR, Strunk RC, et al. Obstructive sleep apnea and sickle cell anemia. Pediatrics. 2014;134:273–81.

    PubMed  PubMed Central  Google Scholar 

  176. Nevin MA. Pediatric obesity, metabolic syndrome, and obstructive sleep apnea syndrome. Pediatr Ann. 2013;42:205–10.

    PubMed  Google Scholar 

  177. Katyal V, Pamula Y, Martin AJ, et al. Craniofacial and upper airway morphology in pediatric sleep-disordered breathing: Systematic review and meta-analysis. Am J Orthod Dentofacial Orthop. 2013;143(20–30):e3.

    Google Scholar 

  178. Katz ES, D’Ambrosio CM. Pediatric obstructive sleep apnea syndrome. Clin Chest Med. 2010;31:221–34.

    PubMed  Google Scholar 

  179. Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. American Academy of Pediatrics. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2002;109:704–12.

    Google Scholar 

  180. Kaditis A, Kheirandish-Gozal L, Gozal D. Algorithm for the diagnosis and treatment of pediatric OSA: a proposal of two pediatric sleep centers. Sleep Med. 2012;13:217–27.

    PubMed  Google Scholar 

  181. Manuel A, Witmans M, El-Hakim H. Children with a history of prematurity presenting with snoring and sleep-disordered breathing: a cross-sectional study. Laryngoscope. 2013;123:2030–4.

    PubMed  Google Scholar 

  182. Gleich SJ, Olson MD, Sprung J, et al. Perioperative outcomes of severely obese children undergoing tonsillectomy. Paediatr Anaesth. 2012;22:1171–8.

    PubMed  PubMed Central  Google Scholar 

  183. Horwood L, Nguyen LH, Brown K, Paci P, Constantin E. African American ethnicity as a risk factor for respiratory complications following adenotonsillectomy. JAMA Otolaryngol Head Neck Surg. 2013;139:147–52.

    PubMed  Google Scholar 

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  1. Department of Anesthesiology, Children’s Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Rd., Ottawa, ON, K1H8L1, Canada

    Kimmo Murto

  2. Children’s Hospital of Eastern Ontario (CHEO) Research Institute (RI), Ottawa, ON, Canada

    Kimmo Murto

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Murto, K. Understanding Obstructive Sleep Apnea Syndrome in Children. Curr Anesthesiol Rep 5, 125–139 (2015). https://doi.org/10.1007/s40140-015-0109-6

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