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The prevalence of pediatric OSA is 1 " “2% in children 4 to 5 years of age, and the peak incidence is between 3 and 6 years of age.
Predominant sex: male = female
Etiology: The most common cause is tonsillar hypertrophy. Additional causes are obesity and craniofacial abnormalities. OSA is also seen in children with neuromuscular diseases, such as cerebral palsy and spinal muscular atrophy, due to abnormal pharyngeal muscle control.
Signs and symptoms
Nighttime: loud snoring, restlessness, and sweating
Daytime: hyperactivity and decreased school performance
EDS is not a significant symptom.
Diagnosis: Gold standard is PSG (PSG may be an even better tool in children due to lessened night-to-night variation. There is a lack of studies showing efficacy of home-based diagnostic studies vs. PSG in children). Abnormal AHI is different in children: >1 to 2/hr is abnormal.
Treatment: Surgery is the 1st-line treatment in cases due to tonsillar enlargement (reduces symptoms in 70%). Some data suggest improved academic performance if tonsillectomy is performed for OSA. For cases due to obesity/craniofacial abnormalities, patients can use CPAP treatment. (16)[A]
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Geriatric Considerations
The presence of sleep apnea in the geriatric population may be associated with earlier onset of mild of cognitive impairment as well as Alzheimer 's Dementia at an earlier age. The rate of decline of cognitive function may be slowed by the usage of cpap. (17)[B]
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REFERENCES
11 Myers ‚ KA, Mrkobrada ‚ M, Simel ‚ DL. Does this patient have obstructive sleep apnea?: the rational clinical examination systematic review. JAMA. 2013;310(7):731 " “741.22 Wittine ‚ LM, Olson ‚ EJ, Morgenthaler ‚ TI. Effect of recording duration on the diagnostic accuracy of out-of-center sleep testing for obstructive sleep apnea. Sleep. 2014;37(5):969 " “975.33 Anandam ‚ A, Akinnusi ‚ M, Kufel ‚ T, et al. Effects of dietary weight loss on obstructive sleep apnea: a meta-analysis. Sleep Breath. 2013;17(1):227 " “234.44 van Maanen ‚ JP, de Vries ‚ N. Long-term effectiveness and compliance of positional therapy with the sleep position trainer in the treatment of positional obstructive sleep apnea syndrome. Sleep. 2014;37(7):1209 " “1215.55 Weaver ‚ TE, Mancini ‚ C, Maislin ‚ G, et al. Continuous positive airway pressure treatment of sleepy patients with milder obstructive sleep apnea: results of the CPAP Apnea Trial North American Program (CATNAP) randomized clinical trial. Am J Respir Crit Care Med. 2012;186(7):677 " “683.66 Giles ‚ TL, Lasserson ‚ TJ, Smith ‚ BH, et al. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2008;4:CD001106.77 Drager ‚ LF, Polotsky ‚ VY, Lorenzi-Filho ‚ G. Obstructive sleep apnea: an emerging risk factor for atherosclerosis. Chest. 2011;140(2):534 " “542.88 Yang ‚ D, Liu ‚ Z, Yang ‚ H, et al. Effects of continuous positive airway pressure on glycemic control and insulin resistance in patients with obstructive sleep apnea: a meta-analysis. Sleep Breath. 2013;17(1):33 " “38.99 Barbe ‚ F, Dur ƒ ¡n-Cantolla ‚ J, S ƒ ¡nchez-de-la-Torre ‚ M, et al. Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial. JAMA. 2012;307(20):2161 " “2168.1010 Chai ‚ CL, Pathinathan ‚ A, Smith ‚ B. Continuous positive airway pressure delivery interfaces for obstructive sleep apnoea. Cochrane Database Syst Rev. 2014;(6):CD005308. Amended 2014.1111 Lim ‚ J, Lasserson ‚ TJ, Fleetham ‚ J, et al. Oral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev. 2009;(3):CD004435.1212 Mason ‚ M, Welsh ‚ EJ, Smith ‚ I. Drug therapy for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2013;(5):CD003002.1313 Sundaram ‚ S, Bridgman ‚ SA, Lim ‚ J, et al. Surgery for obstructive sleep apnoea. Cochrane Database Syst Rev. 2013;(2):CD001004.1414 Shneerson ‚ J, Wright ‚ JJ. Lifestyle modification for obstructive sleep apnoea. Cochrane Database Syst Rev. 2009;(4):CD002875.1515 Mason ‚ M, Cates ‚ CJ, Smith ‚ I. Effects of opioid, hypnotic and sedating medications on sleep-disordered breathing in adults with obstructive sleep apnoea. Cochrane Database Syst Rev. 2015;(7):CD011090.1616 Marcus ‚ CL, Brooks ‚ LJ, Draper ‚ KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130(3):e714 " “e755.1717 Osorio ‚ RS, Gumb ‚ T, Pirraglia ‚ E, et al. Sleep-disordered breathing advances cognitive decline in the elderly. Neurology. 2015;84(19):1964 " “1971.
CODES
ICD10
G47.33 Obstructive sleep apnea (adult) (pediatric) ‚
ICD9
327.23 Obstructive sleep apnea (adult)(pediatric) ‚
SNOMED
- 78275009 Obstructive sleep apnea syndrome (disorder)
- 1101000119103 Obstructive sleep apnea of adult (disorder)
- 1091000119108 obstructive sleep apnea of child (disorder)
CLINICAL PEARLS
- OSA is characterized by repetitive episodes of apnea at the pharynx, often terminating in a snort/gasp.
- Laboratory PSG is the key to diagnosis.
- CPAP is the most effective form of treatment for both mild to moderate and moderate to severe OSA.
- Central sleep apnea may mimic OSA.