Obstructive sleep apnoea

Question 1

OSA - overview

Answer 1

Definition = airway obstruction resulting in temporary apnoea while sleeping + respiratory effort + restless sleep + awakenings

Question 2

OSA - RF

Answer 2

1. Adenotonsillar hypertrophy
2. Obesity
3. CP
4. DS
5. Craniofacial anomalies (e.g. retrognathia, micrognathia, midface hypoplasia)

Question 3

OSA - sx

Answer 3

Nocturnal

1. Snoring
2. Pauses in breathing (apnoea), gasping
3. Mouth breathing
4. Night-time sweating
5. Restless sleep, frequent awakenings, sleeping in unusual positions

Daytime

1. Mouth breathing and hyponasal speech
2. Child often hard to wake in mornings; may complain of morning headache
3. Daytime somnolence - ask about age-inappropriate daytime napping, complaints of sleepiness, falling asleep in school or short car rides
4. May have poor school performance, developmental problems or behavioural problems
5. Severe cases - failure to thrive

Question 4

OSA - ix

Answer 4

1. Overnight pulse oximetry - can be performed in child’s home
2. Polysomnography - establishes dx and provides information about severity
3. Sometimes - EEG, electrooculogram and submental EMG to assess neurological arousals and sleep staging

Question 5

OSA - mx (2)

Answer 5

1. In cases due to adenotonsillar hypertrophy, adenotonsillectomy is usually curative
2. If OSA persists despite adenotonsillectomy, nasal or facemask continuous positive pressure ventilation (CPAP) or bi-level positive airway pressure (BiPAP) may be required at night