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© Borgis - New Medicine 3/2020, s. 87-91 | DOI: 10.25121/NewMed.2020.24.3.87
Tomasz Lis, *Lidia Zawadzka-Głos
Diagnosis and evaluation of a child suspected for obstructive sleep apnea: an overview
Diagnoza i ocena dziecka z podejrzeniem obturacyjnego bezdechu sennego: przegląd
Department of Pediatric Otolaryngology, Medical University of Warsaw, Poland
Head of Department: Associate Professor Lidia Zawadzka-Głos, MD, PhD
Streszczenie
Obturacyjny bezdech senny (OBS) jest często występującym zaburzeniem w populacji pediatrycznej, charakteryzującym się blokadą dróg oddechowych w trakcie snu, prowadzącym do wielu niekorzystnych efektów zdrowotnych. Te dotyczą przede wszystkim układu sercowo-naczyniowego, funkcji poznawczych i metabolizmu. Wczesna diagnoza OBS jest ważna, aby zapobiec poważnym negatywnym konsekwencjom zdrowotnym. W tej pracy przeglądowej zawarliśmy bieżącą wiedzę dotyczącą oceny dziecka z podejrzewanym OBS. Skupiliśmy się na możliwościach diagnostycznych, do których należą nadzorowane badania w laboratorium snu, z polisomnografią (PSG), pozostającą złotym standardem diagnostyki OBS u dzieci, oraz szeroko rozwijanymi domowymi badaniami bezdechu sennego (HSAT – home sleep apnea testing) należącymi do badań ambulatoryjnych. Kolejna przedstawiona kwestia dotyczy dostępnych technik ewaluacji. Do tych należą badanie podmiotowe i przedmiotowe oraz kwestionariusze jakości snu. Ewaluacja jest również oparta na badaniach endoskopowych przy użyciu giętkich fiberoskopów oraz szerokiej puli radiologicznych badań obrazowych. Te dwie formy obrazowania pomagają zidentyfikować miejsce lub miejsca występującej obstrukcji dróg oddechowych.
Summary
Obstructive sleep apnea (OSA) is a frequent disorder in pediatric population characterized by airway blockage while asleep, leading to many adverse health effects. These involve foremost cardiovascular, neurocognitive, and metabolic systems. Early identification of OSA patient is crucial in order prevent serious negative health consequences. In this review article we provide up-to-date overview concerning assessment of a child with suspected OSA. We focus on available diagnostic modalities, which include attended in-lab sleep studies, with polysomnography (PSG) remaining a gold standard in diagnosing OSA in children, and widely developed home sleep apnea testing (HSAT) belonging to ambulatory sleep studies. The other presented matter apply to available evaluation techniques. These feature history and physical examination as well as sleep questionaires. Evaluation is also based on endoscopic procedures using mainly flexible devices, as well as wide variety of radiology imaging modalities. These two forms of imaging are used to help to identify site or sites of airway obstruction.
Introduction
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder (SRBD) characterized by episodes of complete and/or partial upper airway obstruction during sleep, followed by alteration in gas exchange. According to recent American Academy of Sleep Medicine (AASM) guidelines (1), diagnostic criteria for pediatric OSA include presence of one or more clinical symptoms as well as one or both polysomnographic (PSG) findings:
1. clinical criteria (A criteria):
– snoring,
– laboured/obstructive breathing,
– daytime consequences (sleepiness, hyperactivity, behavioral problems),
2. polysomnographic criteria (B criteria):
– one or more obstructive event per hour of sleep,
– obstructive hypoventilation, manifested by partial pressure of carbon dioxide (PaCO2) > 50 mmHg for at least 25 percent of total sleep time, coupled with snoring, paradoxical thoracoabdominal movement, or flattening of the nasal airway pressure waveform.
This study focuses on describing different possibilities to diagnose and evaluate child with suspected OSA and does not take into account indications to use certain diagnostic method, which may vary depending on guidelines, e.g. indications for PSG according to AASM, American Academy of Pediatrics (AAP) and American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF). In some cases though, usually when these guidelines comply with each other, indications are presented.
Epidemiology
The estimated prevalence of pediatric OSA range between 1 to 5% (2). It affects mostly children between two and eight years of age (2), which coincides with the peak age of the overgrowth of the upper airways’ lymphatic tissue.
Untreated OSA is associated with academic difficulties, behavioral and neurocognitive problems (3, 4), cardiovascular complications (5-7), metabolic disorders (7) as well as failure to thrive (8). Additionally children with OSA are more likely to have significant decrease in quality of life (4). Early identification and treatment can prevent or reverse many of these negative health effects. Nonetheless, diagnosis is often delayed.
Risk factors
Adenotonsillar hypertrophy and obesity are recognized as the most significant risk factors for OSA in otherwise healthy children. Other risk contributors to OSA include craniofacial anomalies, and neuromuscular disorders (9). Examples of certain conditions associated with SRBD are in listed in table 1 (10) (fig. 1, tab. 1).
Fig. 1. Tonsillar hypertrophy
Tab. 1. Conditions associated with an elevated prevalence for SRBD (including OSA)
High risk for SRBDIntermediate risk for SRBD
ObesityHistory of prematurity
Down syndromeAfrican American race
Prader-Willi syndromeFamily history of OSA
Duchenne muscular dystrophyAllergic rhinitis
Achondroplasia
Pierre Robin sequence
Craniofacial dysostoses
Chiari malformations and myelomeningocele
Children suffering from above demonstrated, especially high-risk complex-conditions, should be supervised for signs and symptoms of OSA. If present, PSG is usually recommended in such patients.
Diagnosis
Attended in-lab studies
The gold standard test for the diagnosis of OSAS and assessment of its severity is an overnight, attended, in-laboratory PSG. Following parameters are recorded during a typical PSG examination in children: electroencephalography (EEG), bilateral electrooculography (EOG), submental electromyography (EMG), limb movement, electrocardiography (ECG), snoring, airflow, respiratory effort, blood oxygenation, end-tidal or transcutaneous capnography, body position and behavioral observation (video monitoring system).
Nap PSG is an abbreviated study which may be conducted in children who could go asleep in the sleep laboratory during daytime. It is not as reliable as overnight PSG and is not recommended for definite diagnosis of obstructive sleep apnea syndrome in children (10).
Obstructive events recorded on PSG are summarized by the apnea-hypopnea index (AHI), which represents the average number of apneas and hypopneas per hour of sleep. There are special pediatric scoring rules for OSA severity, which are practice-derived and not evidence based. These are presented in table 2.
Tab. 2. OSA severity according to AHI
OSA severityAHI (events/h)
Mild1 to 4.9
Moderate5 to 9.9
Severe> 10

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Piśmiennictwo
1. Sateia MJ: International classification of sleep disorders-third edition: highlights and modifications. Chest 2014; 146(5): 1387-1394.
2. Tan HL, Gozal D, Kheirandish-Gozal L: Obstructive sleep apnea in children: a critical update. Nat Sci Sleep 2013; 5: 109-123.
3. Beebe DW, Ris MD, Kramer ME et al.: The association between sleep disordered breathing, academic grades, and cognitive and behavioral functioning among overweight subjects during middle to late childhood. Sleep 2010; 33(11): 1447-1456.
4. Mitchell RB, Kelly J: Behavior, neurocognition and quality-of-life in children with sleep-disordered breathing. Int J Pediatr Otorhinolaryngol 2006; 70(3): 395-406.
5. Marcus CL, Greene MG, Carroll JL: Blood pressure in children with obstructive sleep apnea. Am J Respir Crit Care Med 1998; 157(4 Pt 1): 1098-1103.
6. Li AM, Au CT, Sung RY et al.: Ambulatory blood pressure in children with obstructive sleep apnoea: a community based study. Thorax 2008; 63(9): 803-809.
7. Sun SS, Grave GD, Siervogel RM et al.: Systolic blood pressure in childhood predicts hypertension and metabolic syndrome later in life. Pediatrics 2007; 119(2): 237-246.
8. Nieminen P, Löppönen T, Tolonen U et al.: Growth and biochemical markers of growth in children with snoring and obstructive sleep apnea. Pediatrics 2002; 109(4): e55.
9. Marcus CL, Brooks LJ, Draper KA et al.: Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012; 130(3): e714-755.
10. Aurora RN, Zak RS, Karippot A et al.: Practice parameters for the respiratory indications for polysomnography in children. Sleep 2011; 34(3): 379-388.
11. Marcus CL, Traylor J, Biggs SN et al.: Feasibility of comprehensive, unattended ambulatory polysomnography in school-aged children. J Clin Sleep Med 2014; 10(8): 913-918.
12. Tan HL, Kheirandish-Gozal L, Gozal D: Pediatric Home Sleep Apnea Testing: Slowly Getting There! Chest 2015; 148(6): 1382-1395.
13. Choi JH, Kim EJ, Kim YS et al.: Validation study of portable device for the diagnosis of obstructive sleep apnea according to the new AASM scoring criteria: Watch-PAT 100. Acta Otolaryngol 2010; 130(7): 838-843.
14. Fishman H, Massicotte C, Li R et al.: The Accuracy of an Ambulatory Level III Sleep Study Compared to a Level I Sleep Study for the Diagnosis of Sleep-Disordered Breathing in Children With Neuromuscular Disease. J Clin Sleep Med 2018; 14(12): 2013-2020.
15. Brouillette RT, Morielli A, Leimanis A et al.: Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Pediatrics 2000; 105(2): 405-412.
16. Sivan Y, Kornecki A, Schonfeld T: Screening obstructive sleep apnoea syndrome by home videotape recording in children. Eur Respir J 1996; 9(10): 2127-2131.
17. Nolan J, Brietzke SE: Systematic review of pediatric tonsil size and polysomnogram-measured obstructive sleep apnea severity. Otolaryngol Head Neck Surg 2011; 144(6): 844-850.
18. Ehsan Z, Ishman SL: Pediatric Obstructive Sleep Apnea. Otolaryngol Clin North Am 2016; 49(6): 1449-1464.
19. Fishman G, Zemel M, DeRowe A et al.: Fiber-optic sleep endoscopy in children with persistent obstructive sleep apnea: inter-observer correlation and comparison with awake endoscopy. Int J Pediatr Otorhinolaryngol 2013; 77(5): 752-755.
20. Wilcox LJ, Bergeron M, Reghunathan S, Ishman SL: An updated review of pediatric drug-induced sleep endoscopy. Laryngoscope Investig Otolaryngol 2017; 2(6): 423-431.
21. Friedman NR, Parikh SR, Ishman SL et al.: The current state of pediatric drug-induced sleep endoscopy. Laryngoscope 2017; 127(1): 266-272.
22. Slaats MA, Van Hoorenbeeck K, Van Eyck A et al.: Upper airway imaging in pediatric obstructive sleep apnea syndrome. Sleep Med Rev 2015; 21: 59-71.
23. Camacho M, Capasso R, Schendel S: Airway changes in obstructive sleep apnoea patients associated with a supine versus an upright position examined using cone beam computed tomography. J Laryngol Otol 2014; 128(9): 824-830.
24. Manickam PV, Shott SR, Boss EF et al.: Systematic review of site of obstruction identification and non-CPAP treatment options for children with persistent pediatric obstructive sleep apnea. Laryngoscope 2016; 126(2): 491-500.
otrzymano: 2020-07-01
zaakceptowano do druku: 2020-07-22

Adres do korespondencji:
*Lidia Zawadzka-Głos
Klinika Otolaryngologii Dziecięcej Warszawski Uniwersytet Medyczny
ul. Żwirki i Wigury 63A, 02-091 Warszawa
tel.: +48 (22) 317-97-21
laryngologia.dsk@uckwum.pl

New Medicine 3/2020
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