Snoring and Obstructive Sleep Apnea Syndrome in Children 2013 Gerald M. Loughlin Weill Cornell Medical College Komansky Center for Child Health New York Presbyterian Hospital. 19th century original observations….
Snoring and Obstructive Sleep Apnea Syndromein Children2013Gerald M. LoughlinWeill Cornell Medical CollegeKomansky Center for Child HealthNew York Presbyterian Hospital
“At night the child’s sleep is greatly disturbed; the respirations are loud and snorting, and there are sometimes prolonged pauses, followed by deep, noisy inspirations.”
William Osler, 1892
Tonsils & adenoids
Genetics & Race
10% - 12% of children snore loudly, nightly
1-3% of children
“The expression is dull, heavy, and apathetic… In long-standing cases the child is very stupid-looking, responds slowly to questions, and may be sullen and cross.”“Among other symptoms may be mentioned headache, which is by no means uncommon, general listlessness, and an indisposition for physical or mental exertion. The influence upon the mental development is striking.”
William Osler, 1892
Chronic oppositional behavior - “difficult child”
Easily fatigued, “always tired”
Lethargy / sleepiness or hyperactivity
Abnormal shyness, social withdrawal
Hyperactivity/ aggressiveness / attention problems
Unexplained poor school performance
Decreased executive functions, visual attention, conceptual ability and phonologic functioning
The association between sleep disordered breathing, academic grades, and cognitive and behavioral functioning among overweight subjects during middle to late childhood. Beebe DW et al. Sleep 2010;33:1447-1456
Study of 163 overweight adolescents divided based on AHI into 4 groups -Moderate/Severe OSA vs. mild vs. snorers without apnea vs. non snorers
Measurements – PSG, neuropsych testing, parent and teacher reports of grades, sleep , behavior
Findings: SDB in overwgt adolescents 10-16yrs associated with lower grades and worse behavior: Data suggests that alterations in academic performance arise from negative behaviors
Surgical treatment for OSAS
Anesthesiology – pre and intra-operative airway management
Cardiology – cor pulmonale, ventricular dysfunction, hypertension
Critical Care – post–op management (pulmonary edema, airway obstruction)
Developmental and General Pediatrics – developmental delay, FTT, enuresis
Endocrine – obesity, growth problems, puberty
Gastroenterology –possible increase in GER
Genetics – increased risk in African –Americans, gender issues
Hematology – differential diagnosis ofpolycythemia
Infectious Disease – recurrent adenotonsillitis
Neonatology – increased risk in former premature infants
Nephrology – hypertension, enuresis
Neurology – neuro-cognitive problems, school problems
Neuro-radiology – functional MRI
Neurosurgery – brainstem compression syndromes
Otolaryngology – most common indication for T&A
Orthopediatics – fractures from falling out of bed
Outcomes and Health Services Research – data needed on natural history, approach to diagnosis and therapy, who to treat and how
Pulmonary – abnormal respiration and gas exchange
Sleep Medicine – perhaps most common & severe sleep disorder in children
Urology – enuresis
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Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome. 2002; 109 704-712.
Beebe DW, et.al. Theassociation between sleep disordered breathing, academic grades,and cognitive and behavioral functioning among overweight subjects during middle to late childhood. Sleep 2010;33:1447-1456.
Redline S Amin R et.al. The Childhood Adenotonsillectomy Trial (CHAT): Rationale, Design, and Challenges of a Randomized Controlled Trial Evaluating a Standard Surgical Procedure in a Pediatric Population. Sleep 2011; 34: 1509-1517.
Macey PM, et.al. Brain Morphology Associated with Obstructive Sleep Apnea. AJRRCM 166: 1382, 2002
Weissbluth M, et.al. Signs of airway obstruction during sleep and behavioral, developmental and academic problems. J Dev Behav Pediatr 1983; 4:119-121.
Urschitz MS, et. al. Snoring, intermittent hypoxia and academic performance in primary school children. Pediatrics 2004; 114:1041-1048.
Gozal D, Pope D. Sleep disordered breathing and school performance in children. Pediatrics 1998; 102: 616-620.
Ali NJ, et al. Snoring, sleep disturbance and behavior in 4-5 year olds. Arch Dis Child 1993;68:360-68.
Neuropsychological and psychological function in children with a history of snoring or behavioral sleep problems. S. Blunden et al. J Pediatr 146:780-786, 2005.
Bonuck K, et.al. Sleep-disordered breathing in a population-based cohort: Behavioral Outcomes at 4 and 7 years. Pediatrics 2102; 129:1-9.
Redline S, et.al.The Childhood Adenotonsillectomy Trial (CHAT): Arationale design, and challenges of a Randomized Controlled Trial Eva;uating a Standard Surgical Procedure in a Pediatric Population. Sleep 2011; 34:1509-1517.
Dillon JE, et.al. DSM-IV Diagnoses and Obstructive Sleep Apnea in Children Before and 1 year after Adenotonsillectomy
J Am Acad Child Adolesc Psychiatry 2007; 46: 1425-1436.