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Diagnostic Approaches to Childhood Obstructive Sleep Apnea Hypopnea Syndrome

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Abstract

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common sleep disorder in adults that is increasingly recognized in children, affecting 1 to 3% of children. Children experience a spectrum of severity related to the degree of upper airway obstruction, the duration of the disease, and the presence or absence of hypoxemic episodes. Failure to diagnose and treat OSAHS can result in serious, but generally reversible consequences for the child including impaired growth, neurocognitive and behavioral dysfunction, and cardiorespiratory failure. Even mild OSAHS appears linked to reversible health consequences. Adenotonsillar hypertrophy is the major predisposing factor for OSAHS in childhood. However, enlarged tonsils and adenoids can be a normal finding in young children and are not diagnostic for OSAHS. The identification of children with OSAHS is often difficult because affected children may have no signs or symptoms when awake. Furthermore, clinical assessment cannot reliably distinguish between simple snoring and OSAHS. Adenotonsillectomy is the most common therapy for OSAHS in children, but surprisingly, only a small percentage of children undergo any diagnostic testing prior to surgery. Thus, the challenge is to develop new diagnostic strategies that effectively screen, identify, and treat children most likely to benefit from specific treatment.

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References

  1. Teculescu DB, Caillier I, Perrin P, Rebstock E, Rauch A. Snoring in French preschool children. Pediatr Pulmonol 1992;13:239–244

    Google Scholar 

  2. Gislason T, Benediktsdottir B. Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. An epidemiologic study of lower limit of prevalence. Chest 1995;107:963–966

    Google Scholar 

  3. Redline S, Tishler PV, Schluchter M, et al.Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. American Journal of Respiratory & Critical Care Medicine 1999;159:1527–1532

    Google Scholar 

  4. Jeans WD, Fernando DC, Maw AR, Leighton BC. A longitudinal study of the growth of the nasopharynx and its contents in normal children. British Journal of Radiology 1981;54:117–121

    Google Scholar 

  5. Linder-Aronson S, Leighton, BC. A longitudinal study of the development of the posterior nasopharyngeal wall between 3 and 16 years of age. European Journal of Orthodontics 1983;5:47–58

    Google Scholar 

  6. Brouilette RT, Fernbach S, Hunt, CE. Obstructive sleep apnea in infants and children. J Pediatr 1982;100:31–40

    Google Scholar 

  7. Lind M, Lundell B. Tonsillar hyperplasia in children: a cause of obstructive sleep apneas, CO2 retention, and retarded growth. Arch Otolaryngol 1982;108:650–654

    Google Scholar 

  8. Guilleminault C, Winkle R, Korobkin R, Simmons B. Children and nocturnal snoring: evaluation of the effects of sleep related respiratory resistive load and daytime functioning. Eur J Pediatr 1982;139:165–171

    Google Scholar 

  9. Stradling JR, Thomas G, Warley AR, Williams, P, Freeland A. Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children. Lancet 1990;335:249–253

    Google Scholar 

  10. Williams EF, Woo P, Miller R, Kellman, RM. The effects of adenotonsillectomy on growth in young children. Otolaryngol Head Neck Surg 1991;104:509–516

    Google Scholar 

  11. Marcus CL, Carroll JL, Koerner, CB, et al. Determinants of growth in children with the obstructive sleep apnea syndrome. J Pediatr 1994;125:556–562

    Google Scholar 

  12. Ali NJ, Pitson D, Stradling, JR. Sleep disordered breathing: effects of adenotonsillectomy on behaviour and psychological functioning. European Journal of Pediatrics 1996;155:56–62

    Google Scholar 

  13. Gozal D. Sleep-disordered breathing and school performance in children. Pediatrics 1998;102:616–620

    Google Scholar 

  14. Suen JS, Arnold JE, Brooks LJ. Adenotonsillectomy for treatment of obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg 1995;121:525–530

    Google Scholar 

  15. Kirk V, Kahn A, Brouillette R. Diagnostic approach to obstructive sleep apnea in children. Sleep Medicine Reviews 1998;2:255–269

    Google Scholar 

  16. Pokras R, Kozak L, McCarthy E. Ambulatory and inpatient procedures in the United States, 1994. National Center for Health Statistics. Vital Health Stat 1997; 13

  17. Rosenfeld R, Green R. Tonsillectomy and adenoidectomy: changing trends. Ann Otol Rhino Laryngol 1990;90:187–191

    Google Scholar 

  18. Waters KA, Everett FM, Bruderer JW, Sullivan CE. Obstructive sleep apnea: the use of nasal CPAP in 80 children. Am J Respir Crit Care Med 1995;152:780–785

    Google Scholar 

  19. Marcus CL, Ward SL, Mallory, GB, et al. Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea. J Pediatr 1995;127:88–94

    Google Scholar 

  20. Guilleminault C, Eldridge, FL, Simmons FB. Sleep apnea in eight patients. Pediatrics 1976;58:28–31

    Google Scholar 

  21. Frank Y, Kravath, RE, Pollak CP, Weitzman ED. Obstructive sleep apnea and its therapy: Clinical and polysomnographic manifestations. Pediatrics 1983;71:737–742

    Google Scholar 

  22. Swift AC. Upper airway obstruction, sleep disturbance and adenotonsillectomy in children. J Laryngol Otol 1988;102:419–422

    Google Scholar 

  23. Brouillette R, Hanson D, David R, et al. A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr 1984;105:10–14

    Google Scholar 

  24. Goldstein NA, Sculerati N, Walsleben JA, Bhatia N, Friedman, DM, Rapoport DM. Clinical diagnosis of pediatric obstructive sleep apnea validated by polysomnography. Otolaryngol Head Neck Surg 1994;111:611–617

    Google Scholar 

  25. Carroll JL, McColley SA, Marcus CL, Curtis S, Loughlin, GM. Inability of clinical history to distinguish primary snoring from obstructive sleep apnea syndrome in children. Chest 1995;108:610–618

    Google Scholar 

  26. Sanchez-Armengol A, Capote-Gil F, Cano-Gomez S, Ayerbe-Garcia R, Delgado-Moreno F, Castillo-Gomez J. Polysomnographic studies in children with adenotonsillar hypertrophy and suspected obstructive sleep apnea. Pediatr Pulmonol 1996;22:101–105

    Google Scholar 

  27. Nieminen P, Tolonen U, Lopponen H, et al. Snoring children: factors predicting sleep apnea. Acta Otolaryngol Suppl (Stockh) 1997;529:190–194

    Google Scholar 

  28. Wang RC, Elkins TP, Keech D, Wauquier A, Hubbard D. Accuracy of clinical evaluation in pediatric obstructive sleep apnea. Otolaryngol Head Neck Surg 1998;118:69–73

    Google Scholar 

  29. Greene MG, Carroll JL. Consequences of sleep-disordered breathing in childhood. Curr Opin Pulm Med 1997;3:456–463

    Google Scholar 

  30. Anonymous. Standards and indications for cardiopulmonary sleep studies in children. American Thoracic Society. Am J Respir Crit Care Med 1996;153:866–878

  31. Marcus C, Keens T, Davidson Ward S. Comparison of nap and overnight polysomnography in children. Pediatr Pulmonol 1992;13:16–21

    Google Scholar 

  32. Pack AI. Simplifying the diagnosis of obstructive sleep apnea [editorial; comment] [see comments]. Annals of Internal Medicine 1993;119:528–529

    Google Scholar 

  33. Anonymous. American Thoracic Society. Indications and Standards for Cardiopulmonary Sleep Studies. Am Rev Resp Dis 1989;139:559–568

    Google Scholar 

  34. Ferber R, Millman R, Coppola M, et al. Portable recording in the assessment of obstructive sleep apnea. ASDA standards of practice [see comments]. Sleep 1994;17:378–92

    Google Scholar 

  35. Anonymous. Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. Standards of Practice Committee of the American Sleep Disorders Association [see comments]. Sleep 1994;17:372–377

  36. Brouillette RT, Jacob SV, Morielli A, et al. There’s no place like home: evaluation of obstructive sleep apnea in the child’s home. Pediatr Pulmonol 1995;11(Suppl 0):86–88

    Google Scholar 

  37. Brouillette RT, Jacob SV, Waters, KA, et al. Cardiorespiratory sleep studies for children can often be performed in the home. Sleep 1996;19(Suppl 0):278–280

    Google Scholar 

  38. Marcus CL, Omlin KJ, Basinki, DJ, et al. Normal polysomnographic values for children and adolescents. Am Rev Respir Dis 1992;146:1235–1239

    Google Scholar 

  39. Rosen CL, D’Andrea L, Haddad, GG. Adult criteria for obstructive sleep apnea do not identify children with serious obstruction. Am Rev Respir Dis 1992;146:1231–1234

    Google Scholar 

  40. Carroll JL, Loughlin GM. Diagnostic criteria for obstructive sleep apnea syndrome in children. Ped Pulmonol 1992;14:71–74

    Google Scholar 

  41. Gaultier C. Sleep-related breathing disorders. 6. Obstructive sleep apnoea syndrome in infants and children: established facts and unsettled issues. Thorax 1995;50:1204–1210

    Google Scholar 

  42. Ward SL, Marcus CL. Obstructive sleep apnea in infants and young children. J Clin Neurophysiol 1996;13:198–207

    Google Scholar 

  43. Carroll JL. Sleep-related upper-airway obstruction in children and adolescents. Child Adolesc Psych Clin North Am 1996;5:617–647

    Google Scholar 

  44. Ross S, Allen I, Harrison K, et al. Systematic Review of the Literature Regarding the Diagnosis of Sleep Apnea. Evidence Report/Technology Assessment No. 1. (Prepared by MetaWorks Inc. under Contract No. 290–97–0016.). Rockville, MD: Agency for Health Care Policy and Research; 1999

  45. Van Someren, VH, Hibbert J, Stothers, JK, Kyme MC, Morrison GA. Identification of hypoxaemia in children having tonsillectomy and adenoidectomy. Clinical Otolaryngology & Allied Sciences 1990;15:263–271

    Google Scholar 

  46. Vavrina J. Computer assisted pulse oximetry for detecting children with obstructive sleep apnea syndrome. International Journal of Pediatric Otorhinolaryngology 1995;33:239–248

    Google Scholar 

  47. Brouillette RT, Morielli A, Leimanis A, et al. Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Pediatrics 2000;105:405–412

    Google Scholar 

  48. Potsic WP. Comparison of polysomnography and sonography for assessing regularity of respiration during sleep in adenotonsillar hypertrophy. Laryngoscope 1987;97:1430–1437

    Google Scholar 

  49. Sivan Y, Kornecki A, Schonfeld T. Screening obstructive sleep apnoea syndrome by home videotape recording in children. Eur Respir J 1996;9:2127–2131

    Google Scholar 

  50. Jacob SV, Morielli A, Mograss, MA, et al. Home testing for pediatric obstructive sleep apnea syndrome secondary to adenotonsillar hypertrophy. Pediatr Pxulmonol 1995;20:241–252

    Google Scholar 

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Authors and Affiliations

  1. Divisions of Epidemiology, Neurology, Pulmonology, Department of Pediatrics, Case Western Reserve University—University Hospitals Health System, Rainbow Babies and Children’s Hospital, Cleveland, Ohio

    Carol Rosen M.D.

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  1. Carol Rosen M.D.
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Correspondence to Carol Rosen M.D..

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Rosen, C. Diagnostic Approaches to Childhood Obstructive Sleep Apnea Hypopnea Syndrome. Sleep Breath 4, 177–181 (2000). https://doi.org/10.1007/s11325-000-0177-8

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