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Obstructive Sleep Apnea in ChildrenAka: Sleep Apnea in Children, Pediatric Sleep-Disordered Breathing

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  1. See Also
    1. Obstructive Sleep Apnea
  2. Epidemiology: Prevalence in Children
    1. Snoring: 3-12%
    2. Obstructive Sleep Apnea: 1-10%
  3. Types
    1. Obstructive Sleep Apnea (OSA)
    2. Upper airway resistance syndrome (UARS)
      1. Disordered breathing despite normal Polysomnogram
  4. Causes
    1. Large tonsils, adenoids (Adenotonsillar Hypertrophy)
    2. Nasoseptal obstruction
    3. Allergic Rhinitis
    4. Obesity
    5. Macroglossia
    6. Neuromuscular disease
    7. Craniofacial abnormalities
      1. Craniosynostosis (e.g. Apert's Syndrome)
      2. Micrognathia (e.g. Pierre Robin Syndrome)
      3. Trisomy 21
  5. Symptoms
    1. Snoring
    2. Mouth breathing
    3. Nocturnal awakenings
    4. Witnessed apneas
    5. Behavior changes
      1. Daytime Sleepiness (seen in obese children)
      2. Nocturnal Enuresis
      3. Decreased attention
      4. Unusual behavior
      5. Poor academic performance
  6. Signs
    1. Adenotonsillar Hypertrophy
      1. See Tonsillar Hypertrophy Grading Scale
      2. See Mallampati Score
    2. Craniofacial abnormalities (e.g. Micrognathia)
    3. Nasal obstruction
      1. Choanal Atresia or septal deviation in infants
      2. Turbinate swelling or Nasal Polyps in children
    4. Neurologic
    5. Assess growth
      1. Obtain height and weight and plot for growth velocity
      2. Assess for Failure to Thrive
      3. Calculate Body Mass Index for pediatric Obesity
  7. Radiology
    1. Lateral neck XRay
  8. Complications
    1. Failure to Thrive
    2. Pulmonary Hypertension
  9. Diagnosis
    1. Adenotonsillar Hypertrophy with OSA symptoms
      1. See Tonsillar Hypertrophy Grading Scale
      2. No further studies needed to indicate tonsillectomy
    2. Polysomonogram
      1. Indications
        1. Craniofacial abnormalities
        2. Comorbid conditions
        3. Unclear diagnosis
      2. Precautions
        1. Polysomnogram may be normal despite UARS (above)
      3. Criteria for Obstructive Sleep Apnea Diagnosis
        1. Pediatric criteria differs from that for adults
        2. Apnea-Hypopnea Index >1 event per hour of sleep
        3. Minimum Oxygen Saturation <92%
  10. Management
    1. Adenotonsillar Hypertrophy
      1. Adenotonsillectomy is treatment of choice
        1. Tarasiuk (2004) Pediatrics 113:351
    2. Management if tonsillectomy not effective or indicated
      1. Continuous positive airway pressure (CPAP)
        1. Recheck mask fitting every 6 months
      2. Treat concurrent Allergic Rhinitis
        1. Nasal Corticosteroids
      3. Treat recurrent Tonsillitis
        1. Consider course of antibiotics
      4. Uvulopalatopharyngoplasty (UPPP) Indications
        1. Oropharyngeal soft tissue obstruction
          1. See Mallampati Score
        2. Severe OSA without Adenotonsillar Hypertrophy
        3. Trisomy 21
    3. Management of severe OSA refractory to above measures
      1. Tracheotomy
  11. References
    1. Chan (2004) Am Fam Physician 69:1147
    2. Messner (2000) Am J Otolaryngol 21:98

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