nach oben

Erschienen in:

01.09.2020 | ENT • Original Article

Polysomnography outcomes of sleep endoscopy–directed intervention in surgically naïve children at risk for persistent obstructive sleep apnea

verfasst von: Erin Kirkham, Cheng-Cheng Ma, Natalia Filipek, David L. Horn, Kaalan Johnson, Maida L. Chen, Sanjay R. Parikh

Erschienen in: Sleep and Breathing | Ausgabe 3/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Drug-induced sleep endoscopy (DISE) is useful in children with obstructive sleep apnea (OSA) that persists after adenotonsillectomy (AT), but its utility in surgically naïve children is unclear. We report polysomnography outcomes of surgically naïve children who underwent DISE-directed intervention because they were considered high risk for persistent OSA after adenotonsillectomy.

Methods

This study is a case series of 62 surgically naïve children with OSA who were considered high risk for persistence after AT and underwent DISE-directed intervention with pre- and postoperative polysomnography between 2012 and 2016. Analysis was performed with the paired t test.

Results

Children were on average 5.9 (± 5.5, 0.2–18.6) years old at the time of surgery, 68% male, 18% obese, and 60% white. Thirty-eight percent had a syndromic diagnosis: 19% trisomy 21, 11% hypotonic neuromuscular disorder, and 8% craniofacial condition. The remaining 62% were non-syndromic but underwent DISE because they had at least one risk factor for OSA persistence after AT (age > 7 years, black race, 1+ tonsils, obesity, and/or severe OSA). Forty-two percent underwent AT, while 58% underwent treatment other than AT, including 18% who had multilevel surgery. Children improved significantly in 4 out of 5 polysomnography parameters tested, including obstructive apnea-hypopnea index (oAHI; 22.2 to 7.2, p < 0.01) and oxygen nadir (82 to 87, p < 0.01). Thirty-eight (61%) had a postoperative oAHI < 5; 16 (21%) had a postoperative oAHI < 2.

Conclusion

DISE resulted in intervention other than AT in 58% of surgically naïve children at high risk for persistent OSA after AT. DISE-directed intervention resulted in significant mean improvement in postoperative OSA.

Capdevila OS, Kheirandish-Gozal L, Dayyat E, Gozal D (2008) Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc 5(2):274–282. https://doi.org/10.1513/pats.200708-138MGCrossRefPubMedPubMedCentral

Imanguli M, Ulualp SO (2016) Risk factors for residual obstructive sleep apnea after adenotonsillectomy in children. Laryngoscope 126(11):2624–2629. https://doi.org/10.1002/lary.25979CrossRefPubMed

Bixler EO, Vgontzas AN, Lin HM, Liao D, Calhoun S, Fedok F, Vlasic V, Graff G (2008) Blood pressure associated with sleep-disordered breathing in a population sample of children. Hypertension 52(5):841–846CrossRef

Galland BC, Tripp EG, Gray A, Taylor BJ (2011) Apnea-hypopnea indices and snoring in children diagnosed with ADHD: a matched case-control study. Sleep Breath 15(3):455–462. https://doi.org/10.1007/s11325-010-0357-0CrossRefPubMed

Stillwell PC, Chapman DL, Ward SLD, Howenstine M, Light MJ, McColley SA, Schaeffer DA, Wagener JS (2002) Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 109(4):704–712CrossRef

Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor HG, Mitchell RB, Amin R, Katz ES, Arens R, Paruthi S, Muzumdar H, Gozal D, Thomas NH, Ware J, Beebe D, Snyder K, Elden L, Sprecher RC, Willging P, Jones D, Bent JP, Hoban T, Chervin RD, Ellenberg SS, Redline S, Childhood Adenotonsillectomy T (2013) A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 368(25):2366–2376. https://doi.org/10.1056/NEJMoa1215881CrossRefPubMedPubMedCentral

Friedman M, Wilson M, Lin HC, Chang HW (2009) Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 140(6):800–808. https://doi.org/10.1016/j.otohns.2009.01.043CrossRefPubMed

Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Mitchell RB, Promchiarak J, Simakajornboon N, Kaditis AG, Splaingard D, Splaingard M, Brooks LJ, Marcus CL, Sin S, Arens R, Verhulst SL, Gozal D (2010) Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med 182(5):676–683. https://doi.org/10.1164/rccm.200912-1930OCCrossRefPubMed

Mitchell RB (2007) Adenotonsillectomy for obstructive sleep apnea in children: outcome evaluated by pre- and postoperative polysomnography. Laryngoscope 117(10):1844–1854. https://doi.org/10.1097/MLG.0b013e318123ee56CrossRefPubMed

10.

Mitchell RB, Kelly J (2004) Outcome of adenotonsillectomy for severe obstructive sleep apnea in children. Int J Pediatr Otorhinolaryngol 68(11):1375–1379. https://doi.org/10.1016/j.ijporl.2004.04.026CrossRefPubMed

11.

Mitchell RB, Kelly J (2004) Adenotonsillectomy for obstructive sleep apnea in obese children. Otolaryngol Head Neck Surg 131(1):104–108. https://doi.org/10.1016/j.otohns.2004.02.024CrossRefPubMed

12.

Mitchell RB, Kelly J (2007) Outcome of adenotonsillectomy for obstructive sleep apnea in obese and normal-weight children. Otolaryngol Head Neck Surg 137(1):43–48. https://doi.org/10.1016/j.otohns.2007.03.028CrossRefPubMed

13.

Mitchell RB, Boss EF (2009) Pediatric obstructive sleep apnea in obese and normal-weight children: impact of adenotonsillectomy on quality-of-life and behavior. Dev Neuropsychol 34(5):650–661. https://doi.org/10.1080/87565640903133657CrossRefPubMed

14.

Lennon CJ, Wang RY, Wallace A, Chinnadurai S (2017) Risk of failure of adenotonsillectomy for obstructive sleep apnea in obese pediatric patients. Int J Pediatr Otorhinolaryngol 92:7–10. https://doi.org/10.1016/j.ijporl.2016.09.026CrossRefPubMed

15.

Nino G, Gutierrez MJ, Ravindra A, Nino CL, Rodriguez-Martinez CE (2012) Abdominal adiposity correlates with adenotonsillectomy outcome in obese adolescents with severe obstructive sleep apnea. Pulm Med 2012:351037. https://doi.org/10.1155/2012/351037CrossRefPubMedPubMedCentral

16.

Thottam PJ, Trivedi S, Siegel B, Williams K, Mehta D (2015) Comparative outcomes of severe obstructive sleep apnea in pediatric patients with trisomy 21. Int J Pediatr Otorhinolaryngol 79(7):1013–1016. https://doi.org/10.1016/j.ijporl.2015.04.015CrossRefPubMed

17.

Maris M, Verhulst S, Wojciechowski M, Van de Heyning P, Boudewyns A (2017) Outcome of adenotonsillectomy in children with Down syndrome and obstructive sleep apnoea. Arch Dis Child 102(4):331–336. https://doi.org/10.1136/archdischild-2015-310,351CrossRefPubMed

18.

Shete MM, Stocks RM, Sebelik ME, Schoumacher RA (2010) Effects of adeno-tonsillectomy on polysomnography patterns in Down syndrome children with obstructive sleep apnea: a comparative study with children without Down syndrome. Int J Pediatr Otorhinolaryngol 74(3):241–244. https://doi.org/10.1016/j.ijporl.2009.11.006CrossRefPubMed

19.

Amonoo-Kuofi K, Phillips SP, Randhawa PS, Lane R, Wyatt ME, Leighton SE (2009) Adenotonsillectomy for sleep-disordered breathing in children with syndromic craniosynostosis. J Craniofac Surg 20(6):1978–1980. https://doi.org/10.1097/SCS.0b013e3181bd2c9aCrossRefPubMed

20.

Mitchell RB, Kelly J (2005) Outcome of adenotonsillectomy for obstructive sleep apnea in children under 3 years. Otolaryngol Head Neck Surg 132(5):681–684. https://doi.org/10.1016/j.otohns.2004.12.010CrossRefPubMed

21.

Willington AJ, Ramsden JD (2012) Adenotonsillectomy for the management of obstructive sleep apnea in children with congenital craniosynostosis syndromes. J Craniofac Surg 23(4):1020–1022. https://doi.org/10.1097/SCS.0b013e31824e6cf8CrossRefPubMed

22.

Lin AC, Koltai PJ (2009) Persistent pediatric obstructive sleep apnea and lingual tonsillectomy. Otolaryngol Head Neck Surg 141(1):81–85. https://doi.org/10.1016/j.otohns.2009.03.011CrossRefPubMed

23.

Mase CA, Chen ML, Horn DL, Parikh SR (2015) Supraglottoplasty for sleep endoscopy diagnosed sleep dependent laryngomalacia. Int J Pediatr Otorhinolaryngol 79(4):511–515. https://doi.org/10.1016/j.ijporl.2015.01.018CrossRefPubMed

24.

Fishman G, Zemel M, DeRowe A, Sadot E, Sivan Y, Koltai PJ (2013) Fiber-optic sleep endoscopy in children with persistent obstructive sleep apnea: inter-observer correlation and comparison with awake endoscopy. Int J Pediatr Otorhinolaryngol 77(5):752–755. https://doi.org/10.1016/j.ijporl.2013.02.002CrossRefPubMed

25.

Ulualp SO, Szmuk P (2013) Drug-induced sleep endoscopy for upper airway evaluation in children with obstructive sleep apnea. Laryngoscope 123(1):292–297. https://doi.org/10.1002/lary.23832CrossRefPubMed

26.

Gazzaz MJ, Isaac A, Anderson S, Alsufyani N, Alrajhi Y, El-Hakim H (2017) Does drug-induced sleep endoscopy change the surgical decision in surgically naive non-syndromic children with snoring/sleep disordered breathing from the standard adenotonsillectomy? A retrospective cohort study. J Otolaryngol Head Neck Surg 46(1):12. https://doi.org/10.1186/s40463-017-0190-6CrossRefPubMedPubMedCentral

27.

Galluzzi F, Pignataro L, Gaini RM, Garavello W (2015) Drug induced sleep endoscopy in the decision-making process of children with obstructive sleep apnea. Sleep Med 16(3):331–335. https://doi.org/10.1016/j.sleep.2014.10.017CrossRefPubMed

28.

Boudewyns A, Saldien V, Van de Heyning P, Verhulst S (2018) Drug-induced sedation endoscopy in surgically naive infants and children with obstructive sleep apnea: impact on treatment decision and outcome. Sleep Breath 22(2):503–510. https://doi.org/10.1007/s11325-017-1581-7CrossRefPubMed

29.

Boudewyns A, Van de Heyning P, Verhulst S (2017) Drug-induced sedation endoscopy in children < 2 years with obstructive sleep apnea syndrome: upper airway findings and treatment outcomes. Eur Arch Otorhinolaryngol 274(5):2319–2325. https://doi.org/10.1007/s00405-017-4481-3CrossRefPubMed

30.

Boudewyns A, Verhulst S, Maris M, Saldien V, Van de Heyning P (2014) Drug-induced sedation endoscopy in pediatric obstructive sleep apnea syndrome. Sleep Med 15(12):1526–1531. https://doi.org/10.1016/j.sleep.2014.06.016CrossRefPubMed

31.

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J (2009) Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381CrossRef

32.

Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep M (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619. https://doi.org/10.5664/jcsm.2172CrossRefPubMedPubMedCentral

33.

Sheldon SH, Ferber R, Kryger MH (2014) Principles and practice of pediatric sleep medicine. Second edition. Elsevier Saunders, London

34.

Chan DK, Liming BJ, Horn DL, Parikh SR (2014) A new scoring system for upper airway pediatric sleep endoscopy. JAMA Otolaryngol Head Neck Surg 140(7):595–602. https://doi.org/10.1001/jamaoto.2014.612CrossRefPubMed

35.

Maris M, Verhulst S, Saldien V, Van de Heyning P, Wojciechowski M, Boudewyns A (2016) Drug-induced sedation endoscopy in surgically naive children with Down syndrome and obstructive sleep apnea. Sleep Med 24:63–70. https://doi.org/10.1016/j.sleep.2016.06.018CrossRefPubMed

36.

Truong MT, Woo VG, Koltai PJ (2012) Sleep endoscopy as a diagnostic tool in pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 76(5):722–727. https://doi.org/10.1016/j.ijporl.2012.02.028CrossRefPubMed

37.

He S, Peddireddy NS, Smith DF, Duggins AL, Heubi C, Shott SR, Ishman SL (2018) Outcomes of drug-induced sleep endoscopy-directed surgery for pediatric obstructive sleep apnea. Otolaryngol Head Neck Surg 158(3):559–565. https://doi.org/10.1177/0194599817740332CrossRefPubMed

38.

Bhushan B, Schroeder JW Jr, Billings KR, Giancola N, Thompson DM (2019) Polysomnography outcomes after supraglottoplasty in children with obstructive sleep apnea. Otolaryngol Head Neck Surg 161(4):694–698. https://doi.org/10.1177/0194599819844512CrossRefPubMed

39.

Farhood Z, Ong AA, Nguyen SA, Gillespie MB, Discolo CM, White DR (2016) Objective outcomes of supraglottoplasty for children with laryngomalacia and obstructive sleep apnea: a meta-analysis. JAMA Otolaryngol Head Neck Surg 142(7):665–671. https://doi.org/10.1001/jamaoto.2016.0830CrossRefPubMed

40.

Amin MR, Isaacson G (1997) State-dependent laryngomalacia. Ann Otol Rhinol Laryngol 106(11):887–890. https://doi.org/10.1177/000348949710601101CrossRefPubMed

41.

Digoy GP, Shukry M, Stoner JA (2012) Sleep apnea in children with laryngomalacia: diagnosis via sedated endoscopy and objective outcomes after supraglottoplasty. Otolaryngol Head Neck Surg 147(3):544–550. https://doi.org/10.1177/0194599812446903CrossRefPubMed

42.

Camacho M, Dunn B, Torre C, Sasaki J, Gonzales R, Liu SY, Chan DK, Certal V, Cable BB (2016) Supraglottoplasty for laryngomalacia with obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 126(5):1246–1255. https://doi.org/10.1002/lary.25827CrossRefPubMed

43.

Bliss M, Yanamadala S, Koltai P (2018) Utility of concurrent direct laryngoscopy and bronchoscopy with drug induced sleep endoscopy in pediatric patients with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 110:34–36. https://doi.org/10.1016/j.ijporl.2018.04.009CrossRefPubMed

44.

Baldassari CM, Mitchell RB, Schubert C, Rudnick EF (2008) Pediatric obstructive sleep apnea and quality of life: a meta-analysis. Otolaryngol Head Neck Surg 138(3):265–273. https://doi.org/10.1016/j.otohns.2007.11.003CrossRefPubMed

Titel: Polysomnography outcomes of sleep endoscopy–directed intervention in surgically naïve children at risk for persistent obstructive sleep apnea
verfasst von: Erin Kirkham
Cheng-Cheng Ma
Natalia Filipek
David L. Horn
Kaalan Johnson
Maida L. Chen
Sanjay R. Parikh
Publikationsdatum: 01.09.2020
Verlag: Springer International Publishing
Erschienen in: Sleep and Breathing / Ausgabe 3/2020
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-019-02006-y

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2020

Prevalence and predictors of restless legs syndrome in non-pregnant Saudi women of childbearing age

Long-term follow-up of the German post-market study for upper airway stimulation for obstructive sleep apnea

Development of positional obstructive sleep apnea (POSA) after upper airway surgery in OSA patients

Polysomnographic scoring of sleep bruxism events is accurate even in the absence of video recording but unreliable with EMG-only setups

Craniofacial photography and association with sleep-disordered breathing severity in children