Role of upper airway evaluation in the multidisciplinary management of obstructive sleep apnea in children below two years of age.

Autor: Blancke H; Faculty of Medicine, University of Antwerp, Antwerp, Belgium., Platteau C; Faculty of Medicine, University of Antwerp, Antwerp, Belgium., Slosse E; Faculty of Medicine, University of Antwerp, Antwerp, Belgium., Verhulst S; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.; Lab of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium., Installé S; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium., Jouret N; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium., Van Hoorenbeeck K; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.; Lab of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium., Boudewyns A; Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.; Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium.
Jazyk: angličtina
Zdroj: Pediatric pulmonology [Pediatr Pulmonol] 2024 Jun; Vol. 59 (6), pp. 1716-1723. Date of Electronic Publication: 2024 Mar 22.
DOI: 10.1002/ppul.26979
Abstrakt: Background: Diagnosis and treatment of obstructive sleep apnea (OSA) in infants and young children is challenging because of its clinical heterogeneity and lack of age-specific guidelines.
Aim: We report the management and treatment outcome of OSA in children below 2 years of age. Treatment decisions were based upon the pattern of upper airway (UA) obstruction, clinical presentation and OSA severity.
Methods: Retrospective, non-randomized observational cohort study at a tertiary center. Children with OSA who underwent an UA evaluation (drug-induced sleep endoscopy or direct laryngoscopy) were included.
Results: We studied 100 patients, 57 boys and 43 girls, age 0.72 years (0.0-2.0) and OSA confirmed by polysomnography. Multilevel UA collapse was present in 26%, (adeno)tonsillar hypertrophy in 31% and 21% had laryngomalacia. Laryngomalacia was more common in children below 6 months of age and adenotonsillar hypertrophy was observed mainly in children >1.5 year of age. Surgical and nonsurgical treatment guided by UA findings, improved OSA severity at group level with a significant reduction (p < 0.001) in obstructive apnea/hypopnea index from 10.8/h (2.1-99.1) to 1.7/h (0.0-73.0), an improvement in mean oxygen saturation from 96.9% (88.9-98.4) to 97.4% (92.3-99.0), in minimal oxygen saturation from 85.4% (37.0-96.0) to 88.8% (51.0-95.5) and oxygen desaturation index from 5.1/h (0.2-52.0) to 1.3/h (0.0-47.8).
Conclusion: Multidisciplinary management of young children with OSA guided by the pattern of UA obstruction and OSA severity, reduces OSA severity. The pattern of UA obstruction changes in the first 2 years of life from a dynamic collapse to structural abnormalities.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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