Surgical Strategies in the Treatment of Complex Obstructive Sleep Apnoea in Children

doi:10.1053/prrv.2002.0179

Paediatric Respiratory Reviews

Volume 3, Issue 1, March 2002, Pages 25-35

https://doi.org/10.1053/prrv.2002.0179 Get rights and content

Abstract

Complex OSA in children is a challenging problem that requires careful team management. Evaluation includes history, physical examination and appropriate radiological and endoscopic studies. Twelve-channel polysomnography, with or without a pH probe, is mandatory in children with OSA to determine the severity and to document the efficacy of treatment. A variety of individual problems and nuances arise and will continue to do so. Clinical experience and a high degree of suspicion in the craniofacial population is necessary to rule out the existence of OSA in a given patient. Newer treatment modalities, such as distraction osteogenesis of the mandible and midface, have revolutionised treatment of OSA during childhood. Although still the gold standard of care, tracheostomy is not a benign procedure and the toll on both the patient and family can be devastating.

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Citation Excerpt :
It is used for children in whom a surgical intervention is not possible or desired or in whom surgery does not result in complete resolution of symptoms. It may be helpful for patients with neuromuscular diseases and children with anatomic abnormalities of the upper airway.41–45 If obesity appears to play a role, weight reduction should be encouraged.
The purpose of this article is to provide an understanding of the epidemiology, pathophysiology, risk factors, potentially serious complications, diagnostic modalities, and treatment options available for pediatric obstructive sleep apnea syndrome (OSAS).
The Ovid, MEDLINE, and PubMed databases from 1950 to the present were searched for relevant articles regarding pediatric OSAS.
Articles describing the prevalence, mechanisms, risk factors, complications, and most recent updates on assessment and management of pediatric sleep-disordered breathing (SDB) were used for this review.
The data suggest that SDB may be considered a disease continuum. It ranges in severity from mild obstruction of the upper airway, producing primary snoring, to increased upper airway resistance syndrome (UARS), to continuous episodes of complete upper airway obstruction or OSAS. The degree of sleep disruption, hypoxemia, hypercapnia, and upper airway airflow reduction are main factors in determining the severity of SDB. Mounting evidence implicates OSAS as a risk factor for decreased growth, impaired neurocognitive function, and cardiovascular morbidity. The first treatment of choice for OSAS in children remains tonsillectomy and adenoidectomy.
Sleep-disordered breathing is common in children and can cause minor as well as major disruption of sleep and health problems requiring intervention. Despite apparent symptoms and potentially severe consequences, SDB may be underdiagnosed and unrecognized. Therefore, a high index of suspicion and detailed clinical history and physical examination should be part of any clinical assessment of a child presenting with breathing difficulty during sleep.
Evolution of Sleep from Birth through Adolescence, and Sleep-Disordered Breathing in Children
2009, Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects: Third Edition
Obstructive sleep apnoea syndrome in children
2009, Acta Otorrinolaringologica Espanola
El síndrome de apnea obstructiva del sueño es una entidad bien conocida en adultos, pero hasta ahora ha sido menos estudiada en niños. Recientemente se ha producido un importante incremento en el reconocimiento de los trastornos del sueño en la etapa infantil. Nuestro objetivo es analizar los estudios científicos publicados en los últimos años. Hemos revisado artículos publicados acerca del síndrome de apnea obstructiva en edad pediátrica y hemos estudiado la sintomatología, el diagnóstico y las opciones de tratamiento. En conclusión, el curso natural y el pronóstico a largo plazo del síndrome de apnea obstructiva en la infancia no son bien conocidos, por lo que se necesitan más estudios en esta área.
Obstructive sleep apnoea syndrome is a well-known clinical entity in adults but until now it has been less well studied in children. In recent years there has been a dramatic increase in the recognition of sleep disorders in children. Our goal is to analyze scientific data published in the last few years. We reviewed published articles regarding paediatric obstructive sleep apnoea syndrome and extracted the clinical symptoms, diagnosis and treatment options. In conclusion, the natural course and long-term prognosis of childhood obstructive sleep apnoea syndrome are not well-known and further studies are needed in this area.

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^f1: Correspondence to: Steven R. Cohen MD, 8010 Frost St. Suite 412, San Diego, CA 92123, USA. Tel: 858-292-1075; E-mail: [email protected]

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Regular ArticleSurgical Strategies in the Treatment of Complex Obstructive Sleep Apnoea in Children

Abstract

J Oral Maxillofac Surg

Otolaryngol Head Neck Surg

Obstructive sleep apnoea syndrome and its treatment in children: areas of agreement and controversy

Pediatr Pulmonol

Cardiac failure with tonsil and adenoid hypertrophy

Arch Otolarygol

Inferior sagittal osteotomy of the mandible with hyoid myotomy suspension: a new procedure for sleep apnoea

Otolaryngol Head Neck Surg

Surgical therapy for severe refractory sleep apnoea in infants and children: application of the airway zone concept

Plast Reconstr Surg

Congenital bony syngnathia: a proposed classification

Cleft Palate Craniofac J

Lengthening the human mandible by gradual distraction

Plast Reconstr Surg

Mandibular distraction osteogenesis in the treatment of upper airway obstruction in children with craniofacial deformities

Plast Reconstr Surg

Regular Article
Surgical Strategies in the Treatment of Complex Obstructive Sleep Apnoea in Children