Managing snoring and obstructive sleep apnoea in childhood
Nicholas M Fitzgerald
Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
Search for more papers by this authorCorresponding Author
Dominic A Fitzgerald
Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
Correspondence: Professor Dominic A Fitzgerald, Department of Respiratory Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia. Fax: +61 2 9845 3396; email: [email protected]Search for more papers by this authorNicholas M Fitzgerald
Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
Search for more papers by this authorCorresponding Author
Dominic A Fitzgerald
Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
Correspondence: Professor Dominic A Fitzgerald, Department of Respiratory Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia. Fax: +61 2 9845 3396; email: [email protected]Search for more papers by this authorAbstract
Snoring assessment and its differentiation from obstructive sleep apnoea are difficult based upon a parent history and physical examination of the size of the tonsils. Not only is the presence of obstructive sleep apnoea important to diagnose, but confirming its severity is the key determinant in prioritising treatment in a resource-limited setting. This review provides current knowledge on the utility of common diagnostic tests, results of treatment options available and implications of treatment and unrecognised or untreated obstructive sleep apnoea.
References
- 1 Greene MG, Carroll JL. Consequences of sleep disordered breathing in childhood. Curr. Opin. Pulm. Med. 1997; 3: 456–463.
- 2 Liu X, Liu L, Owens JA, Kaplan DL. Sleep patterns and sleep problems among school children in the United States and China. Pediatrics 2005; 115 (S1): 241–249.
- 3 Petry C, Pereira MU, Pitrez PM, Jones MH, Stein RT. The prevalence of symptoms of sleep disordered breathing in Brazilian schoolchildren. J. Pediatr. (Rio J) 2008; 84: 123–129.
- 4 Marcus CL, Brooks LJ, Davidson-Ward S et al. Diagnosis and management of childhood obstructive sleep apnoea syndrome. Pediatrics 2012; 130: e130.
- 5 Castronovo V, Zucconi M, Nosetti L et al. Prevalence of habitual snoring and sleep disordered breathing in pre-school aged children in an Italian community. J. Pediatr. 2003; 142: 377–382.
- 6
Marcus CL, Omlin KJ, Basinki DJ et al. Normal polysomnographic variables for children and adolescents. Am. Rev. Respir. Dis. 1992; 156: 1235–1239.
10.1164/ajrccm/146.5_Pt_1.1235 Google Scholar
- 7 Montgomery-Davis HE, O'Brien L, Gulliver TE, Gozal D. Polysomnographic characteristics in normal preschool and early school-aged children. Pediatrics 2006; 117: 741–753.
- 8 Verginis N, Jolley D, Horne RS, Davey MJ, Nixon GM. Sleep state distribution of obstructive events in children: is obstructive sleep apnoea (OSA) really a rapid eye movement sleep-related condition? J. Sleep Res. 2009; 18: 411–414.
- 9 Li AM, So HK, Au CT et al. Epidemiology of obstructive sleep apnoea syndrome in children in Chinese children: a two-phase community study. Thorax 2010; 65: 991–997.
- 10 Beebe DW, Lewin D, Zeller M et al. Sleep in overweight adolescents: shorter sleep, poorer sleep quality, sleepiness, and sleep-disordered breathing. J. Pediatr. Psychol. 2007; 32: 69–79.
- 11 Fitzgerald DA, Richmond C, Paul A. Severity of sleep disturbance in children with Down syndrome who snore. Arch. Dis. Child. 2007; 92: 423–425.
- 12 MacLean JE, Fitzsimons D, Hayward P, Waters K, Fitzgerald DA. Screening for obstructive sleep apnoea in pre-school children with cleft palate. Cleft Palate Craniofac. J. 2009; 46: 117–123.
- 13 Afsharaiman S, Sillence DO, Sheikhvatan M et al. Respiratory events and obstructive sleep apnea in children with achondroplasia: investigation and treatment outcomes. Sleep Breath. 2011; 15: 755–761.
- 14 Bixler EO, Vgontzas AN, Lin MH et al. Sleep disordered breathing in children in a general paediatric population sample: prevalence and risk factors. Sleep 2009; 32: 731–736.
- 15 Rosen CL, Larkin EK, Kirchner HL et al. Prevalence and risk factors for sleep-disordered breathing in 8- to 11-year-old children: association with race and prematurity. J. Pediatr. 2003; 142: 383–389.
- 16
Fitzgerald DA, Van Asperen PP, Feddema P et al. Sleep, respiratory rate and growth hormone in chronic neonatal lung disease. Pediatr. Pulmonol. 1998; 26: 241–249.
10.1002/(SICI)1099-0496(199810)26:4<241::AID-PPUL2>3.0.CO;2-1 CAS PubMed Web of Science® Google Scholar
- 17 Sogut A, Altin R, Uzun L et al. Prevalence of obstructive sleep apnoea syndrome and associated symptoms in 3–11 year old Turkish children. Pediatr. Pulmonol. 2005; 39: 251–256.
- 18 Sanchez-Armengol A, Fuentes-Pradera MA, Capote-Gil F et al. Sleep related breathing disorders in adolescents aged 12 to 16 years: clinical and polygraphic findings. Chest 2001; 119: 1393–1400.
- 19 Goodwin JL, Kaemingk KL, Mulvaney SA, Morgan WJ, Quan SF. Clinical screening of school children for polysomnography to detect sleep-disordered breathing – the Tucson Children's Assessment of Sleep Apnea study (TuCASA). J. Clin. Sleep Med. 2005; 1: 247–254.
- 20 Wing YK, Hui SH, Pak WM et al. A controlled study of sleep related disordered breathing in obese children. Arch. Dis. Child. 2003; 88: 1043–1047.
- 21 Xu Z, Jiaqing A, Yuchuan L, Shen K. A case–control study of obstructive sleep apnea-hypopnea syndrome in obese and non-obese Chinese children. Chest 2008; 133: 684–689.
- 22 Brunetti L, Tesse R, Miniello VL et al. Sleep disordered breathing in obese children: the southern Italy experience. Chest 2010; 137: 1085–1090.
- 23 Tauman R, Ivanenko A, O'Brien LM, Gozal D. Plasma C-reactive protein levels among children with sleep disordered breathing. Pediatrics 2004; 113: e564.
- 24 Tam CS, Wong M, McBain R, Bailey S, Waters KA. Inflammatory measures in children with obstructive sleep apnoea. J. Paediatr. Child Health 2006; 42: 277–282.
- 25 Young HK, Lowe A, Fitzgerald DA et al. Outcome of non-invasive ventilation in children with neuromuscular disease. Neurology 2007; 68: 198–201.
- 26 Arens R, Muzumdar H. Sleep, sleep disordered breathing, and nocturnal hypoventilation in children with neuromuscular diseases. Paediatr. Respir. Rev. 2010; 11: 24–30.
- 27 Wang CH, Dowling JJ, North K et al. Consensus statement on standard of care for congenital myopathies. J. Child Neurol. 2012; 27: 363.
- 28 Fitzgerald DA, Follett J, van Asperen PP. Assessing and managing lung disease and sleep disordered breathing in children with cerebral palsy. Paediatr. Respir. Rev. 2009; 10: 18–24.
- 29 Simpson C, Nixon GM, Davey MJ, Horne RS. Snoring and blood pressure. J. Paediatr. Child Health 2012; 48: 77–79.
- 30 Bourke R, Anderson V, Yang JS et al. Cognitive and academic functions are impaired in children with all severities of sleep-disordered breathing. Sleep Med. 2011; 12: 489–496.
- 31 Schechter MS; Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002; 109: e69.
- 32 Carroll JL, McColley SA, Marcus CL, Curtis S, Loughlin GM. Inability of clinical history to distinguish primary snoring from obstructive sleep apnea syndrome in children. Chest 1995; 108: 610–618.
- 33 Van Someren V, Burmester M, Alusi G, Lane R. Are sleep studies worth doing? Arch. Dis. Child. 2000; 83: 76–81.
- 34 Mallampati SR, Gatt S, Gugino LD et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can. Anaesth. Soc. J. 1985; 32: 429–434.
- 35 Goldstein NA, Pugazhendhi V, Rao SM et al. Clinical assessment of pediatric obstructive sleep apnea. Pediatrics 2004; 114: 33–43.
- 36 Xu Z, Cheuk DK, Lee SL. Clinical evaluation in predicting childhood obstructive sleep apnea. Chest 2006; 130: 1765–1771.
- 37 Jain A, Sahni JK. Polysomnographic studies in children undergoing adenoidectomy and/or tonsillectomy. J. Laryngol. Otol. 2002; 116: 711–715.
- 38 Kawashima S, Niikuni N, Chia-hung L et al. Cephalometric comparisons of craniofacial and upper airway structures in young children with obstructive sleep apnea syndrome. Ear Nose Throat J. 2000; 79: 499–502.
- 39 Zucconi M, Caprioglio A, Calori G et al. Craniofacial modifications in children with habitual snoring and obstructive sleep apnoea: a case–control study. Eur. Respir. J. 1999; 13: 411–417.
- 40 Schiffman PH, Rubin NK, Dominguez T et al. Mandibular dimensions in children with obstructive sleep apnea syndrome. Sleep 2004; 27: 959–965.
- 41 Brouillette 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: 405–412.
- 42 Nixon 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.
- 43 Kirk VG, Bohn SG, Flemmons WW, Remmers JE. Comparison of home oximetry monitoring with laboratory polysomnography in children. Chest 2003; 124: 1702–1708.
- 44 Sivan Y, Kornecki A, Schonfeld T. Screening obstructive sleep apnoea syndrome by home videotape recording in children. Eur. Respir. J. 1996; 9: 2127–2131.
- 45
Lamm C, Mandeli J, Kattan M. Evaluation of home audiotapes as an abbreviated test for obstructive sleep apnoea syndrome (OSAS) in children. Pediatr. Pulmonol. 1999; 27: 267–272.
10.1002/(SICI)1099-0496(199904)27:4<267::AID-PPUL7>3.0.CO;2-X CAS PubMed Web of Science® Google Scholar
- 46 Zucconi M, Calori G, Castronovo V, Ferini-Strambi L. Respiratory monitoring by means of an unattended device in children with suspected uncomplicated obstructive sleep apnea: a validation study. Chest 2003; 124: 602–607.
- 47 Derkay CS, Darrow DH, Welch C, Sinacori JT. Post-tonsillectomy morbidity and quality of life in paediatric patients with obstructive tonsils and adenoids: microdebrider vs electrocautery. Otolaryngol. Head Neck Surg. 2006; 134: 114–120.
- 48 Sobol SE, Wetmore RF, Marsh RR, Stow J, Jacobs IN. Post-operative recovery after microdebrider intracapsular or monopolar electrocautery tonsillectomy: a prospective, randomized, single-blinded study. Arch. Otolaryngol. Head Neck Surg. 2006; 132: 270–274.
- 49 Solares CA, Koempel JA, Hirose K et al. Safety and efficacy of powered intracapsular tonsillectomy: a multicentre retrospective case series. Int. J. Pediatr. Otorhinolaryngol. 2005; 69: 21–26.
- 50 Celenk F, Bayazit YA, Yilmaz M et al. Tonsillar regrowth following partial tonsillectomy with radiofrequency. Int. J. Pediatr. Otorhinolaryngol. 2008; 72: 19–22.
- 51 Marcus CL, Rosen G, Ward SL et al. Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatrics 2006; 117: e442.
- 52 Kheirandish-Gozal L, Gozal D. Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics 2008; 122: e149.
- 53 Goldbart AD, Goldman JL, Veling MC, Gozal D. Leukotriene modifier therapy for mild sleep disordered breathing in children. Am. J. Respir. Crit. Care Med. 2005; 172: 364–370.
- 54 Goldbart AD, Greenberg-Dotan S, Tal A. Montelukast for children with obstructive sleep apnea: a double-blind, placebo controlled study. Pediatrics 2012; 130: e575.
- 55 Kheirandish 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.
- 56 Cistulli PA. Craniofacial abnormalities in obstructive sleep apnoea: implications for treatment. Respirology 1996; 1: 167–174.
- 57 O'Brien LM, Mervis CB, Holbrook CR et al. Neurobehavioural implications of of habitual snoring in children. Pediatrics 2004; 114: 44–49.
- 58 Surrat PM, Barth JT, Diamond R et al. Reduced time in bed and obstructive sleep-disordered breathing in children are associated with cognitive impairment. Pediatrics 2007; 119: 320–329.
- 59 Halblower AC, Degaonkar M, Barker PB et al. Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury. PLoS Med. 2006; 3: e301.
- 60 Chervin RD, Ruzicka DL, Giordani BJ et al. Sleep-disordered breathing, behaviour, and cognition in children before and after adenotonsillectomy. Pediatrics 2006; 117: e769.
- 61 Friedman BC, Hendeles-Amitai A, Kozminsky E et al. Adenotonsillectomy improves neurocognitive function in children with obstructive sleep apnea syndrome. Sleep 2003; 26: 999–1005.
- 62 Kohler MJ, Lushington K, van den Heuvel C, Martin J, Pamula Y, Kennedy D. Adenotonsillectomy and neurocognitive deficits in children with sleep disordered breathing. PLoS ONE 2009; 4: e7343.
- 63 Bhattacharjee R, Kheirandish-Gozal L, Spruyt K et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnoea in children: a multi-centre retrospective study. Am. J. Respir. Crit. Care Med. 2010; 182: 676–683.