Obstructive Sleep Apnea Syndrome in Children

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Pulmonary and Sleep Medicine".

Deadline for manuscript submissions: closed (20 August 2022) | Viewed by 46559

Special Issue Editors


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Guest Editor
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
Interests: obstructive sleep apnea; clinical sleep disorders; craniofacial development; systemic inflammation and sleep disorders
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Division of Pediatric Pulmonary and Sleep Medicine, Valley Children’s Hospital, Madera, CA 93636, USA
Interests: pediatric obstructive sleep apnea; clinical sleep disorders; sleep disordered breathing
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Obstructive sleep apnea is a common sleep disorder in children with a prevalence of 1–6%. Children can be affected from birth to adulthood. Many sequalae have been linked to untreated obstructive sleep apnea and include cognitive deficits, poor emotional regulation and failure to thrive. Emerging evidence has shown that obstructive sleep apnea is linked to various systemic conditions such as cardiovascular dysfunction, obesity, insulin resistance, systemic inflammation, and worsening asthma control. Children that are born premature and from disadvantaged backgrounds have a higher prevalence. There is also a familial predisposition to the condition. Removal of the tonsils and adenoids is currently the treatment of choice in children, but evidence suggests that not all children are actually cured by surgery. Emerging treatment options are being explored as is the possibility of identifying risk factors early in the condition. This series of articles will explore the most recent evidence for both identifying and treating obstructive sleep apnea in children.

Dr. Manisha Witmans
Dr. Mary Anne Tablizo
Guest Editors

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Keywords

  • obstructive sleep apnea
  • sleep related breathing disorders
  • children
  • sleep disordered breathing
  • apnea

Published Papers (10 papers)

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Editorial

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3 pages, 179 KiB  
Editorial
Current Concepts in Pediatric Obstructive Sleep Apnea
by Manisha Witmans and Mary Anne Tablizo
Children 2023, 10(3), 480; https://doi.org/10.3390/children10030480 - 1 Mar 2023
Cited by 1 | Viewed by 1628
Abstract
Obstructive sleep apnea (OSA) is described as intermittent partial or complete upper airway obstruction that can disrupt respiratory and ventilatory patterns during sleep [...] Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome in Children)

Research

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10 pages, 253 KiB  
Article
Clinical Characteristics and Post-Operative Outcomes in Children with Very Severe Obstructive Sleep Apnea
by Nancy Saied, Roberto Noel Solis, Jamie Funamura, Joy Chen, Cathleen Lammers and Kiran Nandalike
Children 2022, 9(9), 1396; https://doi.org/10.3390/children9091396 - 15 Sep 2022
Cited by 1 | Viewed by 1559
Abstract
Available information on clinical characteristics and post-operative outcomes in children with very severe obstructive sleep apnea (OSA) is limited. Our study evaluates the clinical features and polysomnographic (PSG) variables that predict post-operative outcomes in children with an obstructive apneal hypopnea index (AHI) of [...] Read more.
Available information on clinical characteristics and post-operative outcomes in children with very severe obstructive sleep apnea (OSA) is limited. Our study evaluates the clinical features and polysomnographic (PSG) variables that predict post-operative outcomes in children with an obstructive apneal hypopnea index (AHI) of more than 25 events/hr. In this study from a single tertiary care center, we performed a retrospective chart review of patients with an AHI > 25/hr, who underwent tonsillectomy and adenoidectomy (T&A) between January 2016 and September 2021. In total, 50 children were included in the study: 26.0% (13/50) of children experienced post-operative respiratory events and four children needed intubation and ventilator support. Compared with children without respiratory events, children requiring post-operative respiratory interventions were younger (4.4 ± 5.2 vs. 8.0 ± 5.2 years; p = 0.04), had higher pre-operative AHI (73.6 ± 27.4 vs. 44.8 ± 24.9; p < 0.01), lower oxygen nadirs (70.0 ± 13.0% vs. 83.0 ± 7.0%; p < 0.01), and had lower body metabolic index Z-scores (−0.51 ± 2.1 vs. 0.66 ± 1.5; p < 0.04). Moderate to severe residual OSA was identified in 70% (24/34) of children with available post-operative PSG; younger children had better PSG outcomes. Our study shows that post-operative respiratory events are frequent in children with very severe OSA, particularly with an AHI > 40/h, younger children (<2 years of age), lower oxygen saturation (SpO2), and poor nutritional status, necessitating close monitoring. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome in Children)
12 pages, 1734 KiB  
Article
Intermittent Hypoxia Interferes with Autocrine Effects of GABA on Insulin Secretion in Postnatal Rodents—Implications for Pediatric Obstructive Sleep Apnea
by Eung-Kwon Pae, Man-Kyo Chung and Ronald M. Harper
Children 2022, 9(9), 1305; https://doi.org/10.3390/children9091305 - 28 Aug 2022
Cited by 4 | Viewed by 1537
Abstract
Gamma-amino butyric acid (GABA) is well known to help elevate pancreatic β cell vitality and insulin levels in blood. GABA works via a coupling with GABA receptors; thus, the concentration of GABAA receptors on the plasma membrane of β cells appears to [...] Read more.
Gamma-amino butyric acid (GABA) is well known to help elevate pancreatic β cell vitality and insulin levels in blood. GABA works via a coupling with GABA receptors; thus, the concentration of GABAA receptors on the plasma membrane of β cells appears to be critical for insulin regulation. Various medical conditions, such as pediatric and adult obstructive sleep apnea (OSA), show high levels of Type 2 diabetes; such patients also are exposed to intermittent hypoxia (IH), which modifies the GABA levels. To evaluate the potential therapeutic roles of GABA for diabetic patients with OSA, we studied the interactions of IH with GABA and GABAA receptors in young rats. Using rat pups and primary pancreatic islets, we evaluated the roles of GABA in insulin secretion. We show that GABA effectively increased the insulin secretion of pancreatic islets under normal ambient oxygen levels, as well as in culture medium with a glucose level of 2 mM. GABA also increased islet insulin secretion conditioned under IH in a 16 mM glucose medium. When islets were IH-treated, insulin secretion decreased due to lower intracellular chloride levels in accordance with the increased KCC2 levels. The results show that IH challenges down-regulate the GABAA receptor levels in pancreatic islets, which decreases GABA–GABAA receptor coupling action, as well as membrane depolarization for insulin secretion. The findings have the potential to suggest novel interventions for insulin regulation during IH of disordered breathing, including OSA. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome in Children)
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7 pages, 251 KiB  
Article
Association between Hepatic Steatosis and Obstructive Sleep Apnea in Children and Adolescents with Obesity
by Marco Carotenuto, Anna Di Sessa, Maria Esposito, Anna Grandone, Pierluigi Marzuillo, Ilaria Bitetti, Giuseppina Rosaria Umano, Francesco Precenzano, Emanuele Miraglia del Giudice and Nicola Santoro
Children 2021, 8(11), 984; https://doi.org/10.3390/children8110984 - 1 Nov 2021
Cited by 5 | Viewed by 1998
Abstract
Background: Owing to the increasing rate of pediatric obesity, its complications such as non-alcoholic fatty liver disease (NAFLD) and obstructive sleep apnea (OSA) have become prevalent already in childhood. We aimed to assess the relationship between these two diseases in a cohort of [...] Read more.
Background: Owing to the increasing rate of pediatric obesity, its complications such as non-alcoholic fatty liver disease (NAFLD) and obstructive sleep apnea (OSA) have become prevalent already in childhood. We aimed to assess the relationship between these two diseases in a cohort of children with obesity. Methods: We enrolled 153 children with obesity (mean age 10.5 ± 2.66, mean BMI 30.9 ± 5.1) showing OSA. Subjects underwent a laboratory evaluation, a cardio-respiratory polysomnography (PSG), and a liver ultrasound. Results: All subjects had a clinical diagnosis of OSA based on the AHI > 1/h (mean AHI 8.0 ± 5.9; range 2.21–19.0). Of these, 69 showed hepatic steatosis (62.3% as mild, 20.3% as moderate, and 17.4% as severe degree). A strong association between ALT and apnea/hypopnea index (AHI) was observed (p = 0.0003). This association was not confirmed after adjusting for hepatic steatosis (p = 0.53). By subdividing our population according to the presence/absence of steatosis, this association was found only in the steatosis group (p = 0.009). As the severity of steatosis increased, the significance of its association with AHI compared to the absence of steatosis became progressively stronger (all p < 0.0001). Conclusions: Hepatic steatosis seems to drive the association between OSA and ALT levels, suggesting a potential pathogenic role of OSA in NAFLD. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome in Children)
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11 pages, 501 KiB  
Article
Pediatric Obstructive Sleep Apnea: Knowledge and Attitudes of Medical and Dental Students and Fresh Graduates from Saudi Arabia
by Lamyaa N. Alharbi, Mashail A. Alsaikhan, Sanaa N. Al-Haj Ali and Ra’fat I. Farah
Children 2021, 8(9), 768; https://doi.org/10.3390/children8090768 - 31 Aug 2021
Cited by 4 | Viewed by 2084
Abstract
This study aimed to assess the knowledge level and attitudes of graduating Saudi medical and dental students and fresh graduates from those faculties about pediatric obstructive sleep apnea (OSA), and the relation of their knowledge level to sociodemographic variables. In this cross-sectional study, [...] Read more.
This study aimed to assess the knowledge level and attitudes of graduating Saudi medical and dental students and fresh graduates from those faculties about pediatric obstructive sleep apnea (OSA), and the relation of their knowledge level to sociodemographic variables. In this cross-sectional study, 722 graduating students and fresh graduates were requested to answer a questionnaire pretested for validity and reliability. The data were analyzed statistically. Results revealed that medical participants scored 15.45 (out of 22), with 38% of them showing good knowledge about pediatric OSA, while dental participants scored 14.59, with 25.2% of them showing good knowledge. By regression analysis, medical participants (odds ratio (OR): 1.529) were more likely to have good knowledge than dental participants, while participants who belonged to institutions located in the central region (OR: 0.546) were less likely to have good knowledge than those from southern region institutions. In addition, participants from public institutions (OR: 0.290) were less likely to have good knowledge than those from private institutions. Regarding attitudes, medical participants scored 14.13 (out of 20), and dental participants scored 14.64. We detected a significant positive correlation between knowledge and attitude scores of dental participants. Given these findings, the knowledge level of graduating Saudi medical and dental students and fresh graduates about pediatric OSA was not optimal. The college type, institution sector, and location in the kingdom were factors associated with good knowledge. There is a need for further education and training about pediatric OSA in the undergraduate Saudi medical and dental curricula and continuing professional development programs about the topic after graduation. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome in Children)
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Review

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16 pages, 1945 KiB  
Review
Much Ado about Sleep: Current Concepts on Mechanisms and Predisposition to Pediatric Obstructive Sleep Apnea
by Ashley L. Saint-Fleur, Alexa Christophides, Prabhavathi Gummalla and Catherine Kier
Children 2021, 8(11), 1032; https://doi.org/10.3390/children8111032 - 11 Nov 2021
Cited by 5 | Viewed by 2790
Abstract
Obstructive Sleep Apnea (OSA) is a form of sleep-disordered breathing characterized by upper airway collapse during sleep resulting in recurring arousals and desaturations. However, many aspects of this syndrome in children remain unclear. Understanding underlying pathogenic mechanisms of OSA is critical for the [...] Read more.
Obstructive Sleep Apnea (OSA) is a form of sleep-disordered breathing characterized by upper airway collapse during sleep resulting in recurring arousals and desaturations. However, many aspects of this syndrome in children remain unclear. Understanding underlying pathogenic mechanisms of OSA is critical for the development of therapeutic strategies. In this article, we review current concepts surrounding the mechanism, pathogenesis, and predisposing factors of pediatric OSA. Specifically, we discuss the biomechanical properties of the upper airway that contribute to its primary role in OSA pathogenesis and examine the anatomical and neuromuscular factors that predispose to upper airway narrowing and collapsibility. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome in Children)
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13 pages, 2347 KiB  
Review
Positive Airway Pressure Therapy for Pediatric Obstructive Sleep Apnea
by Kelly K. Hady and Caroline U. A. Okorie
Children 2021, 8(11), 979; https://doi.org/10.3390/children8110979 - 29 Oct 2021
Cited by 5 | Viewed by 4518
Abstract
Pediatric obstructive sleep apnea syndrome (OSAS) is a disorder of breathing during sleep, characterized by intermittent or prolonged upper airway obstruction that can disrupt normal ventilation and/or sleep patterns. It can affect an estimated 2–4% of children worldwide. Untreated OSAS can have far [...] Read more.
Pediatric obstructive sleep apnea syndrome (OSAS) is a disorder of breathing during sleep, characterized by intermittent or prolonged upper airway obstruction that can disrupt normal ventilation and/or sleep patterns. It can affect an estimated 2–4% of children worldwide. Untreated OSAS can have far reaching consequences on a child’s health, including low mood and concentration as well as metabolic derangements and pulmonary vascular disease. Most children are treated with surgical intervention (e.g., first-line therapy, adenotonsillectomy); however, for those for whom surgery is not indicated or desired, or for those with postoperative residual OSAS, positive airway pressure (PAP) therapy is often employed. PAP therapy can be used to relieve upper airway obstruction as well as aid in ventilation. PAP therapy is effective in treatment of OSAS in children and adults, although with pediatric patients, additional considerations and limitations exist. Active management and care for various considerations important to pediatric patients with OSAS can allow PAP to be an effective and safe therapy in this population. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome in Children)
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14 pages, 295 KiB  
Review
Considerations in Surgical Management of Pediatric Obstructive Sleep Apnea: Tonsillectomy and Beyond
by T. C. Uwiera
Children 2021, 8(11), 944; https://doi.org/10.3390/children8110944 - 20 Oct 2021
Cited by 6 | Viewed by 2465
Abstract
Obstructive sleep apnea (OSA) is an increasingly recognized disorder with a reported incidence of 5.7% in children. Tonsillectomy (with or without adenoidectomy) in pediatric OSA in otherwise healthy non-obese children has a success rate of approximately 75%. However, the cure rate reported for [...] Read more.
Obstructive sleep apnea (OSA) is an increasingly recognized disorder with a reported incidence of 5.7% in children. Tonsillectomy (with or without adenoidectomy) in pediatric OSA in otherwise healthy non-obese children has a success rate of approximately 75%. However, the cure rate reported for all children undergoing tonsillectomy varies from 51% to 83%. This article reviews the history of tonsillectomy, its indications, techniques, various methods, risks, and successes. The article also explores other surgical options in children with residual OSA post-tonsillectomy. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome in Children)
11 pages, 228 KiB  
Review
The Link between Pediatric Obstructive Sleep Apnea (OSA) and Attention Deficit Hyperactivity Disorder (ADHD)
by Gino Luis Urbano, Bea Janine Tablizo, Youmna Moufarrej, Mary Anne Tablizo, Maida Lynn Chen and Manisha Witmans
Children 2021, 8(9), 824; https://doi.org/10.3390/children8090824 - 19 Sep 2021
Cited by 25 | Viewed by 7200
Abstract
Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing that affects up to 9.5% of the pediatric population. Untreated OSA is associated with several complications, including neurobehavioral sequelae, growth and developmental delay, cardiovascular dysfunction, and insulin resistance. Attention-deficit/hyperactivity disorder (ADHD) is among [...] Read more.
Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing that affects up to 9.5% of the pediatric population. Untreated OSA is associated with several complications, including neurobehavioral sequelae, growth and developmental delay, cardiovascular dysfunction, and insulin resistance. Attention-deficit/hyperactivity disorder (ADHD) is among the neurobehavioral sequelae associated with OSA. This review aims to summarize the research on the relationship between OSA and ADHD and investigate the impacts of OSA treatment on ADHD symptoms. A literature search was conducted on electronic databases with the key terms: “attention deficit hyperactivity disorder” or “ADHD”, “obstructive sleep apnea” or “OSA”, “sleep disordered breathing”, and “pediatric” or “children”. Review of relevant studies showed adenotonsillectomy to be effective in the short-term treatment of ADHD symptoms. The success of other treatment options, including continuous positive airway pressure (CPAP), in treating ADHD symptoms in pediatric OSA patients has not been adequately evaluated. Further studies are needed to evaluate the long-term benefits of surgical intervention, patient factors that may influence treatment success, and the potential benefits of other OSA treatment methods for pediatric ADHD patients. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome in Children)

Other

33 pages, 620 KiB  
Systematic Review
The Effect of Adenotonsillectomy on Children’s Behavior and Cognitive Performance with Obstructive Sleep Apnea Syndrome: State of the Art
by Paola Di Mauro, Salvatore Cocuzza, Antonino Maniaci, Salvatore Ferlito, Deborak Rasà, Roberta Anzivino, Claudio Vicini, Giannicola Iannella and Ignazio La Mantia
Children 2021, 8(10), 921; https://doi.org/10.3390/children8100921 - 15 Oct 2021
Cited by 27 | Viewed by 4312
Abstract
(1) Background: This systematic review was designed to analyze adenotonsillectomy’s role in treating behavioural disorders and sleep-related quality of life in pediatric OSAS. (2) Methods: Papers that report pre-operative and post-operative outcomes by using the Epworth sleepiness scale, OSA-18, NEPSY, Conners’ rating scale, [...] Read more.
(1) Background: This systematic review was designed to analyze adenotonsillectomy’s role in treating behavioural disorders and sleep-related quality of life in pediatric OSAS. (2) Methods: Papers that report pre-operative and post-operative outcomes by using the Epworth sleepiness scale, OSA-18, NEPSY, Conners’ rating scale, BRIEF, PSQ-SRBD, PedsQL and CBCL. We performed a comprehensive review of English papers published during the last 20 years regarding behavioural disorders in OSAS patients and adenotonsillectomy. (3) Results: We included 11 studies reporting behavioral outcomes and sleep related quality of life after surgery. We investigated changes in behavior and cognitive outcomes after AT, and we found significant improvements of the scores post-AT in almost all studies. After comparing the AT group and control group, only one study had no difference that reached significance at one year post-AT. In another study, it did not show any significant improvement in terms of all behavioural and cognitive outcomes. The questionnaires on sleep-related quality of life after AT (PSQ-SRBD or ESS or OSA-18 or KOSA) may improve with positive changes in sleep parameters (AHI, ODI and SpO2). Furthermore, there is a significantly higher decrease in OSAS symptoms than the pre-AT baseline score. (4) Conclusion: Future studies should pay more attention to characterizing patient populations as well as rapid surgical treatments through existing criteria. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome in Children)
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