Obstructive sleep apnea in children
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Obstructive Sleep Apnea in Children. Alyssa Brzenski. Case .

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Case

  • 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.





What is osa in kids
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 differences peds vs adults
OSA Differences- Pedsvs Adults


How should we screen for osa in our patients
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
Screening with Polysomnography






What anesthetic should be used
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
Increased Sensitivity to Narcotics

  • OSA Kids with younger age and lower preoperative O2 Nadir correlates with increased narcotic sensitivity

  • Avoid Codeine products


Sources
Sources

  • 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.


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