Obstructive Sleep Apnea in Children. Alyssa Brzenski. Case .
Obstructive Sleep Apnea in Children
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A 31 month old term 17kg girl presents for Tonsillectomy and Adenoidectomy as an outpatient. She has a history of frequent ear infections, which have resolved since ear tubes were placed. According to her mom she snores loudly and is much more active than the other children her age. Mom doesn’t think that she stops breathing at night but notices that she always breathes through her mouth and always seems to have bad breath. She has no other past medical history. On exam you observe an overweight female with grade III tonsils but an otherwise unremarkable airway, heart and lung exam.
Tonsillectomy and Adenoidectomy
Indications for T&A
What is OSA in kids?
OSA is a “disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns.”
In kids this commonly occurs in REM.
Obstructions worsen throughout the sleep period.
OSA in kids
OSA in Kids
Syndromes associated with OSA
OSA Differences- Pedsvs Adults
How should we screen for OSA in our patients?
“Does your child snore?”
Should be referred for evaluation by a specialist or with a sleep study if
snores more than 3 times a week
1 or more associated signs or symptoms
Screening with Polysomnography
Pediatric Sleep Studies
What should we be asking?
Treatment of OSA in Children
Should kids with OSA stay overnight after anesthesia?
What anesthetic should beused?
No standard anesthetic recommended
Reduce the use of narcotics
Use a balanced technique, maximizing non-opioid strategies and regional anesthesia
Increased Sensitivity to Narcotics
OSA Kids with younger age and lower preoperative O2 Nadir correlates with increased narcotic sensitivity
Avoid Codeine products
Schwengel D, Sterni LM, Tunkel DE, Heitmiller E. Perioperative Management of Children with Obstructive Sleep Apnea. Anesthesia and Analgesia. 2009; 109: 60-75.
Marcus CL, et al. Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome. Pediatrics. 2012; 130: e714-755.