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Management of Pediatric Obstructive Sleep Apnea

  • Barry SteinbergEmail author
  • Rania A. Habib
  • Yirae Ort
Chapter

Abstract

This chapter explores the effects of obstructive sleep apnea in the pediatric population. The prevalence of pediatric obstructive sleep apnea is 2–5% and is most commonly diagnosed in preschool-aged children, and the incidence increases in children diagnosed with craniofacial abnormalities. Several anatomic factors contribute to the pathophysiology, but the most common in children is adenoid and tonsillar hypertrophy. A thorough physical examination along with polysomnography remains the mainstay of diagnosis. Adenotonsillectomy improves the symptoms of OSA with a 79–85% success rate, but there are several other treatment modalities. The general census among the specialists that treat pediatric OSA is that it is an underdiagnosed condition that causes significant morbidity and reduction in the quality of life when left untreated.

Keywords

Pediatric obstructive sleep apnea Polysomnography Craniofacial abnormalities Adenotonsillectomy 

References

  1. 1.
    Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med. 1996;153:866–78.  https://doi.org/10.1164/ajrccm.153.2.8564147.
  2. 2.
    A.S.D. Association. International classification of sleep disorders, revised: diagnostic and coding manual. Rochester, MN: American Sleep Disorders Association; 1997.Google Scholar
  3. 3.
    Farber JM. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2002;110:1255–7.CrossRefGoogle Scholar
  4. 4.
    Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G. Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med. 1999;159:1527–32.  https://doi.org/10.1164/ajrccm.159.5.9809079.CrossRefPubMedGoogle Scholar
  5. 5.
    Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Ward SD, Sheldon SH, Shiffman RN, Lehmann C, Spruyt K, American Academy of Pediatrics. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130:e714–55.  https://doi.org/10.1542/peds.2012-1672.CrossRefPubMedGoogle Scholar
  6. 6.
    Hultcrantz E, Lofstrand-Tidestrom B, Ahlquist-Rastad J. The epidemiology of sleep related breathing disorder in children. Int J Pediatr Otorhinolaryngol. 1995;32 Suppl:S63–6.  https://doi.org/10.1016/0165-5876(94)01144-M.
  7. 7.
    Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:242–52.  https://doi.org/10.1513/pats.200708-135MG.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Mitchell RB, Pereira KD, Friedman NR. Sleep-disordered breathing in children: survey of current practice. Laryngoscope. 2006;116(6):956–8.  https://doi.org/10.1097/01.MLG.0000216413.22408.FD.CrossRefPubMedGoogle Scholar
  9. 9.
    Jeans WD, Fernando DC, Maw AR, Leighton BC. A longitudinal study of the growth of the nasopharynx and its contents in normal children. Br J Radiol. 1981;54:117–21.  https://doi.org/10.1259/0007-1285-54-638-117.CrossRefPubMedGoogle Scholar
  10. 10.
    Goodwin JL, Babar SI, Kaemingk KL, Rosen GM, Morgan WJ, Sherrill DL, Quan SF, Tucson Children’s Assessment of Sleep Apnea Study. Symptoms related to sleep-disordered breathing in white and hispanic children: the Tucson Children’s Assessment of Sleep Apnea study. Chest. 2003;124:196–203.  https://doi.org/10.1378/chest.124.1.196.CrossRefPubMedGoogle Scholar
  11. 11.
    Garg RK, Afifi AM, Garland CB, Sanchez R, Mount DL. Pediatric obstructive sleep apnea: consensus, controversy, and craniofacial considerations. Plast Reconstr Surg. 2017;140:987–97.  https://doi.org/10.1097/PRS.0000000000003752.CrossRefPubMedGoogle Scholar
  12. 12.
    MacLean JE, Fitzsimons D, Fitzgerald DA, Waters KA. The spectrum of sleep-disordered breathing symptoms and respiratory events in infants with cleft lip and/or palate. Arch Dis Child. 2012;97:1058–63.  https://doi.org/10.1136/archdischild-2012-302104.CrossRefPubMedGoogle Scholar
  13. 13.
    Driessen C, Mathijssen IM, De Groot MR, Joosten KF. Does central sleep apnea occur in children with syndromic craniosynostosis? Respir Physiol Neurobiol. 2012;181:321–5.  https://doi.org/10.1016/j.resp.2012.03.017.CrossRefPubMedGoogle Scholar
  14. 14.
    Bannink N, Maliepaard M, Raat H, Joosten KF, Mathijssen IM. Obstructive sleep apnea-specific quality of life and behavioral problems in children with syndromic craniosynostosis. J Dev Behav Pediatr. 2011;32:233–8.  https://doi.org/10.1097/DBP.0b013e318206d5e3.CrossRefPubMedGoogle Scholar
  15. 15.
    Anderson IC, Sedaghat AR, McGinley BM, Redett RJ, Boss EF, Ishman SL. Prevalence and severity of obstructive sleep apnea and snoring in infants with Pierre Robin sequence. Cleft Palate Craniofac J. 2011;48:614–8.  https://doi.org/10.1597/10-100.CrossRefPubMedGoogle Scholar
  16. 16.
    MacLean JE, Hayward P, Fitzgerald DA, Waters K. Cleft lip and/or palate and breathing during sleep. Sleep Med Rev. 2009;13:345–54.  https://doi.org/10.1016/j.smrv.2009.03.001.CrossRefPubMedGoogle Scholar
  17. 17.
    DelRosso LM. Epidemiology and diagnosis of pediatric obstructive sleep apnea. Curr Probl Pediatr Adolesc Health Care. 2016;46:2–6.  https://doi.org/10.1016/j.cppeds.2015.10.009.CrossRefPubMedGoogle Scholar
  18. 18.
    Tang A, Benke JR, Cohen AP, Ishman SL. Influence of tonsillar size on OSA improvement in children undergoing adenotonsillectomy. Otolaryngol Head Neck Surg. 2015;153:281–5.  https://doi.org/10.1177/0194599815583459.CrossRefPubMedGoogle Scholar
  19. 19.
    Shen L, Zheng B, Lin Z, Xu Y, Yang Z. Tailoring therapy to improve the treatment of children with obstructive sleep apnea according to grade of adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. 2015;79:493–8.  https://doi.org/10.1016/j.ijporl.2015.01.005.CrossRefPubMedGoogle Scholar
  20. 20.
    Center for Disease Control, Childhood Obesity Data. (n.d.). https://www.cdc.gove/obesity/data/childhood.html.
  21. 21.
    Verhulst SL, Van Gaal L, De Backer W, Desager K. The prevalence, anatomical correlates and treatment of sleep-disordered breathing in obese children and adolescents. Sleep Med Rev. 2008;12:339–46.  https://doi.org/10.1016/j.smrv.2007.11.002.CrossRefPubMedGoogle Scholar
  22. 22.
    Blechner M, Williamson AA. Consequences of obstructive sleep apnea in children. Curr Probl Pediatr Adolesc Health Care. 2016;46:19–26.  https://doi.org/10.1016/j.cppeds.2015.10.007.CrossRefPubMedGoogle Scholar
  23. 23.
    Kohler MJ, Thormaehlen S, Kennedy JD, Pamula Y, van den Heuvel CJ, Lushington K, Martin AJ. Differences in the association between obesity and obstructive sleep apnea among children and adolescents. J Clin Sleep Med. 2009;5:506–11.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Armoni Domany K, Hossain MM, Nava-Guerra L, Khoo MC, McConnell K, Carroll JL, Xu Y, DiFrancesco M, Amin RS. Cardioventilatory control in preterm born children and the risk of obstructive sleep apnea. Am J Respir Crit Care Med. 2018;197(12):1596–603.  https://doi.org/10.1164/rccm.201708-1700OC.CrossRefPubMedGoogle Scholar
  25. 25.
    Boston M, Rutter MJ. Current airway management in craniofacial anomalies. Curr Opin Otolaryngol Head Neck Surg. 2003;11:428–32.CrossRefGoogle Scholar
  26. 26.
    Palaiologos G, Felig P. Effects of ketone bodies on amino acid metabolism in isolated rat diaphragm. Biochem J. 1976;154:709–16.CrossRefGoogle Scholar
  27. 27.
    Mass E, Brin I, Belostoky L, Maayan C, Gadoth N. A cephalometric evaluation of craniofacial morphology in familial dysautonomia. Cleft Palate Craniofac J. 1998;35:120–6.  https://doi.org/10.1597/1545-1569_1998_035_0120_ACEOCM_2.3.CO_2.CrossRefPubMedGoogle Scholar
  28. 28.
    Cielo CM, Marcus CL. Obstructive sleep apnoea in children with craniofacial syndromes. Paediatr Respir Rev. 2015;16:189–96.  https://doi.org/10.1016/j.prrv.2014.11.003.CrossRefPubMedGoogle Scholar
  29. 29.
    Steinberg B, Fraser B. The cranial base in obstructive sleep apnea. J Oral Maxillofac Surg. 1995;53:1150–4.  https://doi.org/10.1016/0278-2391(95)90621-5.CrossRefPubMedGoogle Scholar
  30. 30.
    Rosen D. Management of obstructive sleep apnea associated with down syndrome and other craniofacial dysmorphologies. Curr Opin Pulm Med. 2011;17:431–6.  https://doi.org/10.1097/MCP.0b013e32834ba9c0.CrossRefPubMedGoogle Scholar
  31. 31.
    Sedky K, Bennett DS, Pumariega A. Prader Willi syndrome and obstructive sleep apnea: co-occurrence in the pediatric population. J Clin Sleep Med. 2014;10:403–9.  https://doi.org/10.5664/jcsm.3616.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Allen J. Pulmonary complications of neuromuscular disease: a respiratory mechanics perspective. Paediatr Respir Rev. 2010;11:18–23.  https://doi.org/10.1016/j.prrv.2009.10.002.CrossRefPubMedGoogle Scholar
  33. 33.
    Eikermann M, Vogt FM, Herbstreit F, Vahid-Dastgerdi M, Zenge MO, Ochterbeck C, de Greiff A, Peters J. The predisposition to inspiratory upper airway collapse during partial neuromuscular blockade. Am J Respir Crit Care Med. 2007;175:9–15.  https://doi.org/10.1164/rccm.200512-1862OC.CrossRefPubMedGoogle Scholar
  34. 34.
    Gozal D. Obstructive sleep apnea in children: implications for the developing central nervous system. Semin Pediatr Neurol. 2008;15:100–6.  https://doi.org/10.1016/j.spen.2008.03.006.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Tan H-L, Gozal D, Kheirandish-Gozal L. Obstructive sleep apnea in children: a critical update. Nat Sci Sleep. 2013;5:109–23.  https://doi.org/10.2147/NSS.S51907.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Bourke R, Anderson V, Yang JS, Jackman AR, Killedar A, Nixon GM, Davey MJ, Walker AM, Trinder J, Horne RS. Cognitive and academic functions are impaired in children with all severities of sleep-disordered breathing. Sleep Med. 2011;12:489–96.  https://doi.org/10.1016/j.sleep.2010.11.010.CrossRefPubMedGoogle Scholar
  37. 37.
    Miano S, Paolino MC, Urbano A, Parisi P, Massolo AC, Castaldo R, Villa MP. Neurocognitive assessment and sleep analysis in children with sleep-disordered breathing. Clin Neurophysiol. 2011;122:311–9.  https://doi.org/10.1016/j.clinph.2010.06.019.CrossRefPubMedGoogle Scholar
  38. 38.
    Halbower AC, Degaonkar M, Barker PB, Earley CJ, Marcus CL, Smith PL, Prahme MC, Mahone EM. Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury. PLoS Med. 2006;3:e301.  https://doi.org/10.1371/journal.pmed.0030301.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Beebe DW, Gozal D. Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits. J Sleep Res. 2002;11:1–16.  https://doi.org/10.1046/j.1365-2869.2002.00289.x.CrossRefPubMedGoogle Scholar
  40. 40.
    O’Brien LM, Serpero LD, Tauman R, Gozal D. Plasma adhesion molecules in children with sleep-disordered breathing. Chest. 2006;129:947–53.  https://doi.org/10.1378/chest.129.4.947.CrossRefPubMedGoogle Scholar
  41. 41.
    Amin RS, Kimball TR, Kalra M, Jeffries JL, Carroll JL, Bean JA, Witt SA, Glascock BJ, Daniels SR. Left ventricular function in children with sleep-disordered breathing. Am J Cardiol. 2005;95:801–4.  https://doi.org/10.1016/j.amjcard.2004.11.044.CrossRefPubMedGoogle Scholar
  42. 42.
    Marcus CL, Greene MG, Carroll JL. Blood pressure in children with obstructive sleep apnea. Am J Respir Crit Care Med. 1998;157:1098–103.  https://doi.org/10.1164/ajrccm.157.4.9704080.CrossRefPubMedGoogle Scholar
  43. 43.
    Alexander RW. Inflammation and coronary artery disease. N Engl J Med. 1994;331:468–9.  https://doi.org/10.1056/NEJM199408183310709.CrossRefPubMedGoogle Scholar
  44. 44.
    Freezer NJ, Bucens IK, Robertson CF. Obstructive sleep apnoea presenting as failure to thrive in infancy. J Paediatr Child Health. 1995;31:172–5.CrossRefGoogle Scholar
  45. 45.
    Waters KA, Sitha S, O’brien LM, Bibby S, de Torres C, Vella S, de la Eva R. Follow-up on metabolic markers in children treated for obstructive sleep apnea. Am J Respir Crit Care Med. 2006;174:455–60.  https://doi.org/10.1164/rccm.200401-110OC.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Myers MG, Cowley MA, Munzberg H. Mechanisms of leptin action and leptin resistance. Annu Rev Physiol. 2008;70:537–56.  https://doi.org/10.1146/annurev.physiol.70.113006.100707.CrossRefPubMedGoogle Scholar
  47. 47.
    Polotsky VY, Smaldone MC, Scharf MT, Li J, Tankersley CG, Smith PL, Schwartz AR, O’Donnell CP. Impact of interrupted leptin pathways on ventilatory control. J Appl Physiol (Bethesda, Md 1985). 2004;96:991–8.  https://doi.org/10.1152/japplphysiol.00926.2003.CrossRefGoogle Scholar
  48. 48.
    Hayflick L. Current theories of biological aging. Fed Proc. 1975;34:9–13. http://www.ncbi.nlm.nih.gov/pubmed/1088947.PubMedGoogle Scholar
  49. 49.
    Brouilette R, Hanson D, David R, Klemka L, Szatkowski A, Fernbach S, Hunt C. A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr. 1984;105:10–4.CrossRefGoogle Scholar
  50. 50.
    Miles PG, Vig PS, Weyant RJ, Forrest TD, Rockette HE Jr. Craniofacial structure and obstructive sleep apnea syndrome—a qualitative analysis and meta-analysis of the literature. Am J Orthod Dentofac Orthop. 1996;109:163–72.  https://doi.org/10.1016/S0889-5406(96)70177-4.CrossRefGoogle Scholar
  51. 51.
    Accardo JA, Shults J, Leonard MB, Traylor J, Marcus CL. Differences in overnight polysomnography scores using the adult and pediatric criteria for respiratory events in adolescents. Sleep. 2010;33:1333–9.  https://doi.org/10.1093/sleep/33.10.1333.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, A.A. of S. Medicine. 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.  https://doi.org/10.5664/jcsm.2172.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Mitchell RB. Adenotonsillectomy for obstructive sleep apnea in children: outcome evaluated by pre- and postoperative polysomnography. Laryngoscope. 2007;117:1844–54.  https://doi.org/10.1097/MLG.0b013e318123ee56.CrossRefPubMedGoogle Scholar
  54. 54.
    Mitchell RB, Kelly J. Outcome of adenotonsillectomy for severe obstructive sleep apnea in children. Int J Pediatr Otorhinolaryngol. 2004;68:1375–9.  https://doi.org/10.1016/j.ijporl.2004.04.026.CrossRefPubMedGoogle Scholar
  55. 55.
    Lipton AJ, Gozal D. Treatment of obstructive sleep apnea in children: do we really know how? Sleep Med Rev. 2003;7:61–80.  https://doi.org/10.1053/smrv.2001.0256.CrossRefPubMedGoogle Scholar
  56. 56.
    Lin AC, Koltai PJ. Persistent pediatric obstructive sleep apnea and lingual tonsillectomy. Otolaryngol Head Neck Surg. 2009;141:81–5.  https://doi.org/10.1016/j.otohns.2009.03.011.CrossRefPubMedGoogle Scholar
  57. 57.
    Anand H, Roberts PJ, Badman G, Dixon AJ, Collins JF. Novel kainic acid analogues. Effects on cyclic GMP content of adult rat cerebellar slices. Biochem Pharmacol. 1986;35:409–15.  https://doi.org/10.1016/0006-2952(86)90213-3.CrossRefPubMedGoogle Scholar
  58. 58.
    O’Donnell AR, Bjornson CL, Bohn SG, Kirk VG. Compliance rates in children using noninvasive continuous positive airway pressure. Sleep. 2006;29:651–8.PubMedGoogle Scholar
  59. 59.
    Goldbart AD, Veling MC, Goldman JL, Li RC, Brittian KR, Gozal D. Glucocorticoid receptor subunit expression in adenotonsillar tissue of children with obstructive sleep apnea. Pediatr Res. 2005;57:232–6.  https://doi.org/10.1203/01.PDR.0000150722.34561.E6.CrossRefPubMedGoogle Scholar
  60. 60.
    Brouillette RT, Manoukian JJ, Ducharme FM, Oudjhane K, Earle LG, Ladan S, Morielli A. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr. 2001;138:838–44.  https://doi.org/10.1067/mpd.2001.114474.CrossRefPubMedGoogle Scholar
  61. 61.
    Tahiri Y, Viezel-Mathieu A, Aldekhayel S, Lee J, Gilardino M. The effectiveness of mandibular distraction in improving airway obstruction in the pediatric population. Plast Reconstr Surg. 2014;133:352e–9e.  https://doi.org/10.1097/01.prs.0000438049.29258.a8.CrossRefPubMedGoogle Scholar
  62. 62.
    Figueroa AA, Glupker TJ, Fitz MG, BeGole EA. Mandible, tongue, and airway in Pierre Robin sequence: a longitudinal cephalometric study. Cleft Palate Craniofac J. 1991;28:425–34.  https://doi.org/10.1597/1545-1569(1991)028_0425:MTAAIP_2.3.CO_2.CrossRefPubMedGoogle Scholar
  63. 63.
    Bouchard C, Troulis MJ, Kaban LB. Management of obstructive sleep apnea: role of distraction osteogenesis. Oral Maxillofac Surg Clin North Am. 2009;21:459–75.  https://doi.org/10.1016/j.coms.2009.07.001.CrossRefPubMedGoogle Scholar
  64. 64.
    Carr MM, Poje CP, Kingston L, Keilma D, Heard C. Complications in pediatric tracheostomies. Laryngoscope. 2001;111:1925–8.CrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial SurgeryCollege of Medicine, University of Florida—JacksonvilleJacksonvilleUSA
  2. 2.Wolfsons Children’s HospitalJacksonvilleUSA
  3. 3.Department of Oral and Maxillofacial SurgerySchool of Dentistry, Louisiana State UniversityNew OrleansUSA
  4. 4.Facial Cosmetic SurgeryBellevueUSA

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