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Paediatric obstructive sleep apnoea: can our identification of surgical candidates be evidence-based?

Published online by Cambridge University Press:  14 February 2018

L Pabla ,
J Duffin ,
L Flood  and
K Blackmore
L Pabla*
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
J Duffin
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
L Flood
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
K Blackmore
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
*
Address for correspondence: Miss Lakhbinder Pabla, ENT Department, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK E-mail: Lakh.pabla.bal@gmail.com
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Abstract

Background:

Paediatric obstructive sleep apnoea is a common clinical condition managed by most ENT clinicians. However, despite the plethora of publications on the subject, there is wide variability, in the literature and in practice, on key aspects such as diagnostic criteria, the impact of co-morbidities and the indications for surgical correction.

Methods:

A systematic review is presented, addressing four key questions from the available literature: (1) what is the evidence base for any definition of paediatric obstructive sleep apnoea?; (2) does it cause serious systemic illness?; (3) what co-morbidities influence the severity of paediatric obstructive sleep apnoea?; and (4) is there a medical answer?

Results and conclusion:

There is a considerable lack of evidence regarding most of these fundamental questions. Notably, screening measures show low specificity and can be insensitive to mild obstructive sleep apnoea. There is a surprising lack of clarity in the definition (let alone estimate of severity) of sleep-disordered breathing, relying on what may be arbitrary test thresholds. Areas of potential research might include investigation of the mechanisms through which obstructive sleep apnoea causes co-morbidities, whether neurocognitive, behavioural, metabolic or cardiovascular, and the role of non-surgical management.

Keywords

ChildTonsillectomySleep Apnea, ObstructiveComorbidityPolysomnography

Information

Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 4 , April 2018 , pp. 284 - 292
Copyright
Copyright © JLO (1984) Limited 2018 

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References

1Marcus, CL, Chapman, D, Ward, SD, McColley, SA, Herrerias, CT, Stillwell, PC et al. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109:704–12Google Scholar
2Venekamp, RP, Chandrasekharan, D, Abel, F, Blackshaw, H, Kreis, IA, Evans, HE et al. Research into childhood obstructive sleep-disordered breathing: a systematic review. Chest 2017;152:51–7CrossRefGoogle ScholarPubMed
3Brietzke, SE, Katz, ES, Roberson, DW. Can history and physical examination reliably diagnose pediatric obstructive sleep apnea/hypopnea syndrome? A systematic review of the literature. Otolaryngol Head Neck Surg 2004;131:827–32Google Scholar
4Goldbart, AD, Tal, A. Inflammation and sleep disordered breathing in children: a state-of-the-art review. Pediatr Pulmonol 2008;43:1151–60CrossRefGoogle ScholarPubMed
5Ow, AT, Cheung, LK. Meta-analysis of mandibular distraction osteogenesis: clinical applications and functional outcomes. Plast Reconstr Surg 2008;121:54–69eGoogle Scholar
6Praud, JP, Dorion, D. Obstructive sleep disordered breathing in children: beyond adenotonsillectomy. Pediatr Pulmonol 2008;43:837–43Google Scholar
7Owens, JA. Neurocognitive and behavioral impact of sleep disordered breathing in children. Pediatr Pulmonol 2009;44:417–22CrossRefGoogle ScholarPubMed
8Nolan, J, Brietzke, SE. Systematic review of pediatric tonsil size and polysomnogram-measured obstructive sleep apnea severity. Otolaryngol Head Neck Surg 2011;144:844–50Google Scholar
9Bhattacharjee, R, Kim, J, Kheirandish-Gozal, L, Gozal, D. Obesity and obstructive sleep apnea syndrome in children: a tale of inflammatory cascades. Pediatr Pulmonol 2011;46:313–23CrossRefGoogle ScholarPubMed
10Kuhle, S, Urschitz, MS. Anti-inflammatory medications for obstructive sleep apnea in children. Cochrane Database Syst Rev 2011;(1):CD007074CrossRefGoogle ScholarPubMed
11Church, GD. The role of polysomnography in diagnosing and treating obstructive sleep apnea in pediatric patients. Curr Probl Pediatr Adolesc Health Care 2012;42:2–25CrossRefGoogle ScholarPubMed
12Certal, V, Catumbela, E, Winck, JC, Azevedo, I, Teixeira-Pinto, A, Costa-Pereira, A. Clinical assessment of pediatric obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 2012;122:2105–14CrossRefGoogle ScholarPubMed
13Gozal, D, Kheirandish-Gozal, L, Bhattacharjee, R, Kim, J. C-reactive protein and obstructive sleep apnea syndrome in children. Front Biosc (Elite Ed) 2012;4:2410–22Google Scholar
14Brockmann, PE, Schaefer, C, Poets, A, Poets, CF, Urschitz, MS. Diagnosis of obstructive sleep apnea in children: a systematic review. Sleep Med Rev 2013;17:331–40CrossRefGoogle ScholarPubMed
15Brockmann, PE, Bertrand, P, Castro-Rodriguez, JA. Influence of asthma on sleep disordered breathing in children: a systematic review. Sleep Med Rev 2014;18:393–7CrossRefGoogle ScholarPubMed
16Certal, V, Camacho, M, Winck, JC, Capasso, R, Azevedo, I, Costa-Pereira, A. Unattended sleep studies in pediatric OSA: a systematic review and meta-analysis. Laryngoscope 2015;125:255–62Google Scholar
17Caron, CJ, Pluijmers, BI, Joosten, KF, Mathijssen, IM, van der Schroeff, MP, Dunaway, DJ et al. Obstructive sleep apnoea in craniofacial microsomia: a systematic review. Int J Oral Maxillofac Surg 2015;44:592–8Google Scholar
18Kaditis, A, Kheirandish-Gozal, L, Gozal, D. Pediatric OSAS: oximetry can provide answers when polysomnography is not available. Sleep Med Rev 2016;27:96–105Google Scholar
19Gileles-Hillel, A, Kheirandish-Gozal, L, Gozal, D. Biological plausibility linking sleep apnoea and metabolic dysfunction. Nat Rev Endocrinol 2016;12:290–8CrossRefGoogle ScholarPubMed
20Anderson, IG, Holm, JC, Homoe, P. Obstructive sleep apnoea in obese children and adolescents, treatment methods and outcome of treatment - a systematic review. Int J Pediatr Otorhinolaryngol 2016;87:190–7Google Scholar
21Kohli, N, DeCarlo, D, Goldstein, NA, Silverman, J. Asthma outcomes after adenotonsillectomy: a systematic review. Int J Pediatr Otorhinolaryngol 2016;90:107–12CrossRefGoogle ScholarPubMed
22Sanchez, T, Castro-Rodriguez, JA, Brockmann, PE. Sleep-disordered breathing in children with asthma: a systematic review on the impact of treatment. J Asthma Allergy 2016;9:83–91Google ScholarPubMed
23Huynh, NT, Desplats, E, Almeida, FR. Orthodontics treatments for managing obstructive sleep apnea syndrome in children: a systematic review and meta-analysis. Sleep Med Rev 2016;25:84–94Google Scholar
24Brouillette, RT, Manoukian, JJ, Ducharme, M, Oudjbane, K, Earle, LG, Laden, S et al. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr 2001;138:838–44Google Scholar
25Marcus, CL, Rosen, G, Davidson Ward, SL, Halbower, AC, Sterni, L, Lutz, J et al. Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatrics 2006;117:442–51Google Scholar
26Kheirandish-Gozal, L, Gozal, D. Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics 2008;122:149–55CrossRefGoogle ScholarPubMed
27Goldbart, AD, Greenberg-Dotan, S, Tal, A. Montelukast for children with obstructive sleep apnea: a double-blind, placebo-controlled study. Pediatrics 2012;130:e575–80CrossRefGoogle ScholarPubMed
28Marcus, CL, Beck, SE, Traylor, J, Cornaglia, MA, Meltzer, LJ, DiFeo, N et al. Randomised, double-blind clinical trial of two different modes of positive airway pressure therapy on adherence and efficacy in children. J Clin Sleep Med 2012;8:37–42Google Scholar
29Marcus, CL, Moore, RH, Rosen, CL, Giordani, B, Garetz, SL, Taylor, HG et al. ; Childhood Adenotonsillectomy Trial (CHAT). A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 2013;368:2366–76Google Scholar
30Mitchell, RB, Garetz, S, Moore, RH, Rosen, CL, Marcus, CL, Katz, ES et al. The use of clinical parameters to predict obstructive sleep apnea syndrome severity in children: the Childhood Adenotonsillectomy (CHAT) Study randomized clinical trial. JAMA Otolaryngol Head Neck Surg 2015;141:130–6Google Scholar
31Chan, CC, Au, CT, Lam, HS, Lee, DL, Wing, YK. Intranasal corticosteroids for mild childhood obstructive sleep apnea - a randomised, placebo-controlled study. Sleep Med 2015;16:358–63Google Scholar
32Goldbart, AD, Goldman, JL, Li, RC, Brittian, KR, Tauman, R, Gozal, D. Differential expression of cysteinyl leukotriene receptors 1 and 2 in tonsils of children with obstructive sleep apnea syndrome or recurrent infection. Chest 2004;126:13–18Google Scholar
33Kheirandish, L, Goldbart, AD, Gozal, D. Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics 2006;117:e61–6CrossRefGoogle ScholarPubMed
34Dayyat, E, Kheirandish-Gozal, L, Sans, Capdervila O, Maarefeya, MM, Gozal, D. Obstructive sleep apnoea in children: relative contributions of body mass index and adenotonsillar hypertrophy. Chest 2009;136:137–44Google Scholar
35Arens, R, Sin, S, Nandalike, K, Rieder, J, Khan, UI, Freeman, K et al. Upper airway structure and body fat composition in obese children with obstructive sleep apnoea. Am J Respir Crit Care Med 2011;186:782–7Google Scholar
36Vitelli, O, Tabarrini, A, Miano, S, Rabasco, J, Pietropaoli, N, Forlani, M et al. Impact of obesity on cognitive outcome in children with sleep-disordered breathing. Sleep Med 2015;16:625–30Google Scholar
37McColley, SA, Carroll, JK, Curtis, S, Loughlin, GM, Sampson, HA. High prevalence of allergic sensitization in children with habitual snoring and obstructive sleep apnoea. Chest 1997;111:170–3CrossRefGoogle Scholar
38Brouillette, RT, Morielli, A, Leimanis, A, Waters, KA, Luciano, R, Ducharme, FM. Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Pediatrics 2000;105:405–12Google Scholar
39Nieminen, P, Lopponen, T, Tolonen, U, Lanning, P, Knip, M, Lopponen, H. Growth and biochemical markers of growth in children with snoring and obstructive sleep apnea. Pediatrics 2002;109:e55Google Scholar
40Massa, F, Gonsalez, S, Laverty, A, Wallis, C, Lane, R. The use of nasal continuous positive airway pressure to treat obstructive sleep apnoea. Arch Dis Child 2002;87:438–43Google Scholar
41Nixon, GM, Kermack, AS, Davis, GM, Manoukian, JJ, Brown, KA, Brouillette, RT. Planning adenotonsillectomy in children with obstructive sleep apnea: the role of overnight oximetry. Pediatrics 2004;113:e19–25Google Scholar
42Ahmed, J, Marucci, D, Cochrane, L, Heywood, RL, Wyatt, ME, Leighton, SE. The role of the nasopharyngeal airway for obstructive sleep apnoea in syndromic craniosynostosis. J Craniofac Surg 2008;19:659–63Google Scholar
43Budhiraja, R, Quan, SF. Outcomes from the Tucson Children's Assessment of Sleep Apnea Study (TuCASA). Sleep Med Clin 2009;4:9–18Google Scholar
44Ross, KR, Storfer-Isser, A, Hart, MA, Kibler, AM, Rueschman, M, Rosen, CL et al. Sleep-disordered breathing is associated with asthma severity in children. J Pediatr 2012;160:736–42Google Scholar
45Nout, E, Bannicnk, N, Koudstaal, MJ, Veenland, JF, Joosten, KF, Poublon, RM. Upper airway changes in syndromic craniosynostosis patients following midface or monobloc advancement: correlation between volume changes and respiratory outcome. J Craniomaxillofac Surg 2012;40:209–14Google Scholar
46Tan, E, Healey, D, Schaughency, E, Dawes, P, Galland, B. Neurobehavioural correlates in older children and adolescents with obesity and obstructive sleep apnoea. J Paediatr Child Health 2014;50:16–23Google Scholar
47Nisbet, LC, Yiallourou, SR, Walter, LM, Horne, RS. Blood pressure regulation, autonomic control and sleep disordered breathing in children. Sleep Med Rev 2014;18:179–89CrossRefGoogle ScholarPubMed
48DeHaan, KL, Seton, C, Fitzgerald, DA, Waters, KA, MacLean, JE. Polysomnography for the diagnosis of sleep disordered breathing in children under 2 years of age. Pediatr Pulmonol 2015;50:1346–53Google Scholar
49Moraleda-Cibrian, M, Edwards, SP, Kasten, SJ, Berger, M, O'Brien, LM. Obstructive sleep apnoea pretreatment and posttreatment in symptomatic children with congenital craniofacial malformations. J Clin Sleep Med 2015;11:37–43CrossRefGoogle ScholarPubMed
50Mahajan, M, Thakur, JS, Azad, RK, Mohindroo, NK, Negi, PC. Cardiopulmonary functions and adenotonsillectomy: surgical indications need revision. J Laryngol Otol 2016;130:1120–4Google Scholar
51Chng, SY, Goh, DY, Wang, XS, Tan, TN, Ong, NB. Snoring and atopic disease: a strong association. Pediatr Pulmonol 2004;38:210–16Google Scholar
52Robb, PJ, Bew, S, Kubba, H, Murphy, N, Primhak, R, Rollin, AM. Tonsillectomy and adenoidectomy in children with sleep related breathing disorders: consensus statement of a UK multidisciplinary working party. Ann R Coll Surg Engl 2009;91:371–3CrossRefGoogle ScholarPubMed
53Roland, PS, Rosenfeld, RM, Brooks, LJ, Friedman, NR, Jones, J, Kim, TW et al. Clinical practice guideline: polysomnography for sleep disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg 2011;145(1 suppl):S1–15Google Scholar
54Health Survey for England, 2015. In: http://www.content.digital.nhs.uk/catalogue/PUB22610/HSE2015-Child-obe.pdf [5 January 2018]Google Scholar
55Sharma, SD, Kanona, H, Kumar, G, Kotecha, B. Latest trends in the assessment and management of paediatric snoring and sleep apnoea. J Laryngol Otol 2016;130:482–9Google Scholar