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Medline ® Abstracts for References 8,86,87

of 'Evaluation of suspected obstructive sleep apnea in children'

Diagnosis and management of childhood obstructive sleep apnea syndrome.
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
Pediatrics. 2012;130(3):e714.
OBJECTIVE: This technical report describes the procedures involved in developing recommendations on the management of childhood obstructive sleep apnea syndrome (OSAS).
METHODS: The literature from 1999 through 2011 was evaluated.
RESULTS AND CONCLUSIONS: A total of 3166 titles were reviewed, of which 350 provided relevant data. Most articles were level II through IV. The prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor. OSAS was associated with cardiovascular, growth, and neurobehavioral abnormalities and possibly inflammation. Most diagnostic screening tests had low sensitivity and specificity. Treatment of OSAS resulted in improvements in behavior and attention and likely improvement in cognitive abilities. Primary treatment is adenotonsillectomy (AT). Data were insufficient to recommend specific surgical techniques; however, children undergoing partial tonsillectomy should be monitored for possible recurrence of OSAS. Although OSAS improved postoperatively, the proportion of patients who had residual OSAS ranged from 13% to 29% in low-risk populations to 73% when obese children were included and stricter polysomnographic criteria were used. Nevertheless, OSAS may improve after AT even in obese children, thus supporting surgery as a reasonable initial treatment. A significant number of obese patients required intubation or continuous positive airway pressure (CPAP) postoperatively, which reinforces the need for inpatient observation. CPAP was effective in the treatment of OSAS, but adherence is a major barrier. For this reason, CPAP is not recommended as first-line therapy for OSAS when AT is an option. Intranasal steroids may ameliorate mild OSAS, but follow-up is needed. Data were insufficient to recommend rapid maxillary expansion.
Respiratory monitoring by means of an unattended device in children with suspected uncomplicated obstructive sleep apnea: a validation study.
Zucconi M, Calori G, Castronovo V, Ferini-Strambi L
Chest. 2003 Aug;124(2):602-7.
STUDY OBJECTIVE: To compare an unattended device for cardiorespiratory monitoring (POLY-MESAM; MAP; Martinsried, Germany) [P-M]with classic nocturnal polysomnography (PSG) for diagnosis of obstructive sleep apnea (OSA) in children.
DESIGN: Clinical setting.
PATIENTS: Twelve children (age range, 3 to 6 years) with highly suspected uncomplicated OSA who underwent PSG and P-M on 2 consecutive laboratory nights in a balanced manner.
MEASUREMENTS: Respiratory indexes were compared for P-M (automated analysis), hand-scored revised P-M (P-Mrev), and PSG. Analysis of contingency for cutoff levels of respiratory disturbance index (RDI) of 5 and 10 and level of agreement between P-M, P-Mrev, and PSG by the concordance method were evaluated.
RESULTS: Nine of twelve children (75%) had a PSGRDI>5, while 41.7% had an RDI>10, indicating moderate-to-severe OSA. P-M sensitivity (78%) increased with the increase of the RDI cutoff, and P-Mrev sensitivity reached 100% at the cutoff of 10. The specificity was low for RDI>5 and increased only modestly at RDI>10 (P-Mrev, 57%). Seven of 12 children (increasing to 9 children with P-Mrev) and 9 of 12 children (increasing to 11 children with P-Mrev) were correctly classified by the P-M unit when cutoffs of 5 and 10 were considered, respectively. As far as the agreement level is concerned, P-M underestimated the incidence of obstructive hypopnea and overestimated the number of central apnea cases. P-Mrev improved the latter measure.
CONCLUSION: Based on these data, the P-M device cannot be advocated for common use in a clinical setting, but it may have a role in urgent screening for highly suspected moderate-to-severe OSA.
Sleep Disorders Center, Department of Neurology, and Statistic Unit, IRCCS H San Raffaele, Milan, Italy. zucconi.marco@hsr.it
Evaluation of a new device for home cardiorespiratory recording in children.
Poels PJ, Schilder AG, van den Berg S, Hoes AW, Joosten KF
Arch Otolaryngol Head Neck Surg. 2003 Dec;129(12):1281-4.
OBJECTIVE: To evaluate the feasibility of using a new home cardiorespiratory recording device (HCRD) in children.
DESIGN: Cross-sectional study.
PATIENTS: Consecutive children scheduled for adenotonsillectomy to treat habitual snoring and/or apneas at otorhinolaryngology clinics in 2 academic and 7 general hospitals.
INTERVENTION: Single-night unattended home cardiorespiratory recording prior to adenotonsillectomy using the HCRD.
MAIN OUTCOME MEASURES: Number of technically acceptable recordings and successful recordings with artifact-free signals (respiration, saturation, and nasal flow) present for sufficient duration to allow scoring of the polysomnogram and to make a diagnosis.
RESULTS: Of 53 eligible children, 24 participated in the study. The main reason for nonparticipation was refusal of caregivers (n = 16). Mean (SD) age of participants was 4.2 (1.6) years; median Brouillette obstructive sleep apnea score was 2.54. Technically acceptable recordings were obtained in 18 children (75%). Only 7 recordings (29%) were classified as successful. The poorest signal quality was obtained from the nasal cannula.
CONCLUSION: Based on strict scoring criteria in this study, the results of single-night unattended recordings at home with the HCRD fell short of expectations.
Julius Center for Health Sciences and General Practice, the Department of Otorhinolaryngology, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB Utrecht, the Netherlands.