Pediatric obstructive sleep apnea (OSAS) is an example of sleep disordered breathing which refers to a clinical spectrum of repetitive episodes of complete or partial obstruction of the airway during sleep. The prevalence is likely ~2% of the pediatric population. In contrast to adults where redundant soft tissue from obesity is the cause, in children it’s caused by adenotonsillar hypertrophy. As a result, adenotonsillectomy has been found to be curative in 75-100% of patients in different studies. Home nasal CPAP has also been used, but mostly as a bridge to surgical intervention. OSA is unlikely in the absence of snoring, and it may present in a number of other ways including daytime somnolence, learning/behavioral problems (ADHD), cardiovascular morbidity (cor pulmonale), failure to thrive and even death. Polysomnography is the gold standard for diagnosis. Other testing modalities including night audio/videotaping, pulse oximetry and abbreviated (Nap) polysomnography have not proven as sensitive.
Risk factors in the general population for the disease include a positive family history, African American race (4-6x more likely than Caucasians), as well as a history of sinus problems or persistent wheeze. The growing obesity epidemic in children is contributing as well with those children 4.5 x more likely to be diagnosed, and there was a 3-5 times higher prevalence in former pre-term infants in a community based study of 8-11 year olds.
Up to 27% of children undergoing adenotonsillectomy for OSAS have postoperative respiratory complications. Risk factors for postoperative complications include age younger than 3 years, severe OSAS on PSG, Failure to thrive, obesity, prematurity, recent URI, craniofacial abnormalities, Down Syndrome, and neuromuscular disorders with overnight observation and in some instances overnight intubation recommended. Examples of craniofacial abnormalities include mandibular hypoplasia (Pierre Robin sequence) and patients with high arched or cleft palates. These patients often require advanced procedures such as mandibular distraction or tracheostomy to improve symptoms after traditional surgical and nonsurgical interventions fail.
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