Naslov
“Update on the recognition and management of childhood obstructive sleep apnea”

Autori
Šimurina, Tatjana

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, pp prezentacija, ostalo

Skup
The 3rd Croatian Symposium of Pediatric Anesthesiologists with International Participation

Mjesto i datum
Vodice, Hrvatska, 05.10.2018. - 06.10.2018

Vrsta sudjelovanja
Pozvano predavanje

Vrsta recenzije
Domaća recenzija

Ključne riječi
opstrukcijska apneja u djece
(childhood sleep apnea)

Sažetak
Obstructive sleep apnea (OSA) is a common sleep-disordered breathing (SDB) with a prevalence of 1 % to 5% in children. OSA is characterized by periodic collapse of the upper airway during sleep with resultant intermittent hypoxemia and hypercapnia, leading to increased work of breathing, sleep fragmentation and habitual snoring. A wide range of adverse health outcomes has been associated with untreated OSA in children: impairment of neurocognitive and behavioural development, impaired growth, cardiovascular and metabolic comorbidities, noctural enuresis, hyperactivity, difficulty concentrating and bahavior difficulties. Children with OSA have increased healthcare utilization and higher prescription drug, resulting in higher overall healthcare costs. OSA symptoms in children are often unrecognized before preoperative visit with potentially serious or even fatal perioperative outcomes. However, anesthesiologists are often unaware of the advancements and the remedies available to recognize symptoms and novel treatment options for OSA in children. Aim: The purpose of this narrative review is to provide a critical update on the recognition and management of pediatric OSA. Methods: A literature review was carried out using key words: Pediatric obstructive sleep apnea ; Sleep-disordered breathing in children, in PubMed/ MEDLINE databases in the last five years. Results/ Discussion: Screening for and diagnosing childhood OSA is done by joint effort of the primary care physician, pediatrician, sleep medicine specialist and ENT specialist. Most previously published clinical studies failed to closely examine OSA as a perioperative risk factor. Anesthesia care providers must be aware of unrecognized OSA symptoms in children and involved in preoperative screening for OSA. Recently published updated evidences help us to overcome the diffculties posed by late recognition of pediatric OSA during preoperative examination and provide recommendations for treatment strategy combined of different therapeutic modalities depending on severity and cause of OSA. The gold standard test for diagnosis of OSA and assessment of its severity is an overnight, inlaboratory polysomnography (PSG). Accoding to the recently published literature practical alternatives that have some limitations but often less expensive and easily available are noctural oxymetry, respiratory polygraphy (RP), ambulatory RP or PSG, pediatric sleep questionnaire and sleep clinical record. Childhood OSA has become a major public health problem as incidence and severity of symptoms have increased along with the obesity epidemic in recent years. Clinical presentation of typical OSA children was changed from those with adenotonsillar hypertrophy who failure to thrive to obese ones who suffer from excessive daytime sleepness similar to adult OSA phenotype. Individual risk factors for OSA and OSA related complications as well as severity of symptoms are main determinants for tretament priority and therapeutic strategy. Proposed stepwise tretament approach include weight loss for overweight and obese children, nasal corticosteroids and oral montelukast, adenotonsillectomy, rapid maxillar expansion or orthodonic appliance, continuous positive pressure ventilation (CPAP) or non-invasive positive pressure ventilation (NIPPV), tracheostomy and craniofacial surgery. Conclusion: Children with OSA present special challenges that must be addressed before anesthesia to minimize the risk of perioperative complications. This critical update highlights the latest developments and emerging therapies for personalized management approaches for OSA in children. Advances in diagnosis and management can alleviate morbidity and mortality associated with childhood OSA.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA