scholarly journals ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children

2017 ◽  
Vol 50 (6) ◽  
pp. 1700985 ◽  
Author(s):  
Athanasios G. Kaditis ◽  
Maria Luz Alonso Alvarez ◽  
An Boudewyns ◽  
Francois Abel ◽  
Emmanouel I. Alexopoulos ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Sleep Disordered Breathing ◽  
Objective Assessment ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Sleep Study ◽  
Mandibular Hypoplasia ◽  
Obstructive Sleep ◽  
Obstructive Sleep Disordered Breathing ◽  
Disordered Breathing

The present statement was produced by a European Respiratory Society Task Force to summarise the evidence and current practice on the diagnosis and management of obstructive sleep disordered breathing (SDB) in children aged 1–23 months. A systematic literature search was completed and 159 articles were summarised to answer clinically relevant questions. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are identified. Morbidity (pulmonary hypertension, growth delay, behavioural problems) and coexisting conditions (feeding difficulties, recurrent otitis media) may be present. SDB severity is measured objectively, preferably by polysomnography, or alternatively polygraphy or nocturnal oximetry. Children with apparent upper airway obstruction during wakefulness, those with abnormal sleep study in combination with SDB symptoms (e.g.snoring) and/or conditions predisposing to SDB (e.g.mandibular hypoplasia) as well as children with SDB and complex conditions (e.g.Down syndrome, Prader–Willi syndrome) will benefit from treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions (e.g.supraglottoplasty for laryngomalacia or nasopharyngeal airway for mandibular hypoplasia). Hence, obstructive SDB in children aged 1–23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities that contribute to upper airway obstruction during sleep.

569 Correlation between age and initial findings of sleep disordered breathing in children with achondroplasia

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A224-A225
Author(s):  
Fayruz Araji ◽  
Cephas Mujuruki ◽  
Brian Ku ◽  
Elisa Basora-Rovira ◽  
Anna Wani
Keyword(s):  
Sleep Apnea ◽  
Primary Care Physicians ◽  
Sleep Disordered Breathing ◽  
Upper Airway ◽  
Sleep Study ◽  
Surgical Interventions ◽  
Screening Guidelines ◽  
Obstructive Sleep ◽  
Children’S Sleep ◽  
Disordered Breathing

Abstract Introduction Achondroplasia (ACH) occurs approximately 1 in 20,000–30,000 live births. They are prone to sleep disordered breathing specifically due to the upper airway stenosis, enlarged head circumference, combined with hypotonia and limited chest wall size associated with scoliosis at times. The co-occurrence of sleep apnea is well established and can aide in the decision for surgical intervention, however it is unclear at what age children should be evaluated for sleep apnea. Screening is often delayed as during the daytime there is no obvious gas exchange abnormalities. Due to the rareness of this disease, large studies are not available, limiting the data for discussion and analysis to develop guidelines on ideal screening age for sleep disordered breathing in children with ACH. Methods The primary aim of this study is to ascertain the presence of sleep disorder breathing and demographics of children with ACH at time of first polysomnogram (PSG) completed at one of the largest pediatric sleep lab in the country. The secondary aim of the study is to identify whether subsequent polysomnograms were completed if surgical interventions occurred and how the studies differed over time with and without intervention. Retrospective review of the PSGs from patients with ACH, completed from 2017–2019 at the Children’s Sleep Disorders Center in Dallas, TX. Clinical data, demographics, PSG findings and occurrence of interventions were collected. Results Twenty-seven patients with the diagnosis of ACH met criteria. The average age at the time of their first diagnostic PSG was at 31.6 months of age (2.7 years), of those patients 85% had obstructive sleep apnea (OSA),51% had hypoxemia and 18% had hypercapnia by their first diagnostic sleep study. Of those with OSA, 50% were severe. Majority were females, 55%. Most of our patients were Hispanic (14%), Caucasian (9%), Asian (2%), Other (2%), Black (0%). Each patient had an average of 1.9 PSGs completed. Conclusion Our findings can help create a foundation for discussion of screening guidelines. These guidelines will serve to guide primary care physicians to direct these patients to an early diagnosis and treatment of sleep disordered breathing. Support (if any):

scholarly journals 1244 A Curious Case of ASV Failure

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A474-A474
Author(s):  
Nishant Chaudhary ◽  
Mirna Ayache ◽  
John Carter
Keyword(s):  
Sleep Apnea ◽  
Airway Obstruction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Central Sleep Apnea ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Neck Extension ◽  
Sleep Study ◽  
Obstructive Sleep

Abstract Introduction Positive airway pressure-induced upper airway obstruction has been reported with the treatment of obstructive sleep apnea (OSA) using continuous positive airway pressure (CPAP) along with an oronasal interface. Here we describe a case of persistent treatment emergent central sleep apnea (TECSA) inadequately treated with adaptive servo ventilation (ASV), with an airflow pattern suggestive of ASV-induced upper airway obstruction. Report of Case A 32-year-old male, with severe OSA (apnea hypopnea index: 52.4) and no other significant past medical history, was treated with CPAP and required higher pressures during titration sleep studies to alleviate obstructive events, despite a Mallampati Class II airway and a normal body mass index. Drug-Induced Sleep Endoscopy (DISE) showed a complete velopharynx and oropharynx anterior posterior (AP) collapse, long soft palate, which improved with neck extension. CPAP therapy, however, did not result in any symptomatic benefit and compliance reports revealed high residual AHI and persistent TECSA. He underwent an ASV titration sleep study up to a final setting of expiratory positive airway pressure 9 cm H2O, pressure support 6-15 cm H2O (auto-rate), with a full-face mask due to high oral leak associated with the nasal interface. The ASV device detected central apneas and provided mandatory breaths, but did not capture the thorax or abdomen, despite normal mask pressure tracings. Several such apneas occurred, with significant oxyhemoglobin desaturation. Conclusion We postulate that the ASV failure to correct central sleep apnea as evidenced by the absence of thoracoabdominal inspiratory effort, occurred due to ASV-induced upper airway obstruction. Further treatment options for this ASV phenomenon are to pursue an ASV-assisted DISE and determine the effectiveness of adjunctive therapy including neck extension, nasal mask with a mouth closing device and a mandibular assist device.

Neuropsychological Consequences of Sleep-Disordered Breathing

2010 ◽  
Author(s):  
Jennifer Janusz ◽  
Ann Halbower
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Sleep Disordered Breathing ◽  
Upper Airway ◽  
Sleep Fragmentation ◽  
Primary Snoring ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Disordered Breathing

Pediatric sleep disorders have been gaining awareness among practitioners due to their potential for cognitive, behavioral, and somatic effects (Gozal 2008; Moore et al. 2006). Sleep-disordered breathing (SDB) is commonly seen in children and encompasses a range of disorders, in primary snoring to obstructive sleep apnea (Marcus 2000). Sleep-disordered breathing is characterized by partial or complete upper airway obstruction during sleep due to collapse or narrowing of the pharynx. This can result in sleep fragmentation due to brief arousals during the night, as well as disruption or cessation of airflow (Blunden and Beebe 2006; Halbower and Mahone 2006). This chapter describes the neuropsychological and behavioral consequences of SDB, comorbid disorders, and effects of treatment. Sleep-disordered breathing is considered a spectrum of airflow limitation, from mild to severe. For instance, primary snoring (PS), defined as snoring without oxygen desaturation or sleep arousals, is at the mild end of the spectrum. Upper airway resistance syndrome (UARS), in the middle of the spectrum, is characterized by increased negative intrathoracic pressure with sleep arousals and sleep fragmentation but no oxygen desaturations (Bao and Guilleminault 2004; Garetz 2008; Lumeng and Chervin 2008). In obstructive sleep apnea (OSA), at the severe end of the spectrum, there are repeated episodes of blockage of the airway with changes in oxygenation. Obstructive sleep apnea results from a combination of factors, including anatomical obstruction from adenoids, tonsils, or a narrow pharynx, and decreased neuromuscular tone required to maintain airway patency (Arens and Marcus 2004). An overnight polysomnogram (PSG) completed in a sleep laboratory and measuring sleep–wake states, respiration, movement, blood levels of oxygen and carbon dioxide, and cardiac activity, is considered the “gold standard” for the diagnosis of OSA (American Academy of Pediatrics 2002). The PSG is used to diagnose respiratory events, cardiac changes, and arousals from different sleep states. Respiratory events include obstructive apneas and hypopneas. Obstructive apnea events are episodes of complete airway obstruction, while hypopneas are partial obstructions or airflow limitations (Garetz 2008; Redline et al. 2007).

Cephalometric Assessment of the Posterior Airway Space in Patients with Cleft Palate after Palatoplasty

2003 ◽  
Vol 40 (5) ◽  
pp. 498-503 ◽  
Author(s):  
Edmund Rose ◽  
Ulrike Thissen ◽  
Jörg-Elard Otten ◽  
Irmtrud Jonas
Keyword(s):  
Cleft Palate ◽  
Sleep Disordered Breathing ◽  
Upper Airway ◽  
University Hospital ◽  
Control Group ◽  
Facial Growth ◽  
Surgical Closure ◽  
Obstructive Sleep ◽  
Obstructive Sleep Disordered Breathing ◽  
Disordered Breathing

Objective Upper airway obstruction and mouth breathing influence facial growth and development, which may result in breathing disorders while asleep. The purpose of the present investigation was to analyze cephalometric alterations between patients with cleft palate and a noncleft control group in an obstructive sleep disordered breathing-specific tracing. Setting The study was conducted in the cleft palate clinic of a university hospital. Participants Fifty-three subjects with a mean age of 12.3 ± 3.7 years (range 6.3 to 17.2 years). The cohort included 33 subjects (13 females, 20 males; mean age 12.1 ± 3.8 years, mean body mass index 17.5 ± 2.9 kg/m2) with surgical closure of a unilateral or bilateral cleft palate and a matched control of noncleft participants. None of the subjects suffered from sleep disordered breathing syndrome. Results Compared with the controls, patients with cleft palate had a significant narrow anterior-posterior dimension of the pharynx at the level of the maxillary plane and the narrowest width, a more downward hyoid position, and a longer uvula. Conclusions Patients with cleft palate appear to present pharyngeal and craniofacial distinctive features that characterize patients with obstructive sleep disordered breathing and differ from those of a noncleft control.

Upper Airway Epithelial Structural Changes in Obstructive Sleep-disordered Breathing

2002 ◽  
Vol 166 (4) ◽  
pp. 501-509 ◽  
Author(s):  
Friedrich P. Paulsen ◽  
Philipp Steven ◽  
Michael Tsokos ◽  
Karl Jungmann ◽  
Andreas Müller ◽  
...  
Keyword(s):  
Sleep Disordered Breathing ◽  
Structural Changes ◽  
Upper Airway ◽  
Airway Epithelial ◽  
Obstructive Sleep ◽  
Obstructive Sleep Disordered Breathing ◽  
Disordered Breathing

scholarly journals Sleep Disordered Breathing May Signal Laryngomalacia

2017 ◽  
Vol 11 (1) ◽  
pp. 68-74
Author(s):  
Christine M. Clark ◽  
Dale S. DiSalvo ◽  
Jansie Prozesky ◽  
Michele M. Carr
Keyword(s):  
Postoperative Complications ◽  
Airway Obstruction ◽  
Sleep Disordered Breathing ◽  
Upper Airway ◽  
Retrospective Chart Review ◽  
Symptomatic Improvement ◽  
Anesthetic Techniques ◽  
Tonsillar Hypertrophy ◽  
Obstructive Sleep ◽  
Disordered Breathing

Background: Pediatric anesthesiologists are often confronted with children with sleep-disordered breathing (SDB) presenting for tonsillectomy and/or anesthesia. The typical patient has symptoms of obstructive sleep apnea (OSA) with enlarged tonsils; however, a subset of patients may have underlying laryngomalacia (LM) without tonsillar hypertrophy. Both OSA and LM significantly increase the risk of intra- and postoperative airway obstruction and sensitivity to narcotics. The prevalence of LM may be underestimated, because direct laryngoscopy (DL) is not routinely performed in the diagnostic evaluation of patients with SDB who lack tonsillar hypertrophy. Aim: To identify the prevalence and DL findings in pediatric patients with SDB without tonsillar hypertrophy. Methods: Retrospective chart review of 108 patients with SDB who underwent general anesthesia for adenotonsillectomy (TA) or adenoidectomy with concomitant DL. The following data were collected: demographic information, medical comorbidities, polysomnography results, anesthetic techniques, and postoperative complications. Results: 94.5% of children had DL findings consistent with LM, including a retropositioned epiglottis and short aryepiglottic folds. Postglottic edema was observed in 42.2%, and these patients were significantly more likely to have a diagnosis of gastroesophageal reflux (P=0.023). 57.8% had vocal cord edema. 75.3% of children who received routine postoperative follow-up care experienced complete symptom resolution. Postoperative complications following discharge from hospital occurred in 12.4% of patients, and 15.7% underwent supraglottoplasty for continued SDB symptoms after TA or adenoidectomy. Conclusion: A substantial proportion of patients with SDB who lacked tonsillar hypertrophy had findings consistent with LM, suggesting that the larynx may be the primary site of upper airway obstruction in these patients. This has significant implications in terms of perioperative management. The majority of patients with SDB had symptomatic improvement following TA or adenoidectomy; however, a subset required further surgical intervention with supraglottoplasty.

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