Paediatric Obstructive Sleep Apnoea

Question 1

Epidemiology of Paeds OSA

Answer 1

• Peaks in pre-school years
• Unlikely to be complete apnoea, but frequent episodic hypopnoea due to partial airway obstruction
• 1/3rd of affected children snore
• 10%of affected children snore most nights
• Majority are not obese.

Question 2

Causes of Paeds OSA

Answer 2

1. Enlarged tonsils and adenoids
2. Obesity
3. Allergic Rhinitis
4. Retrognathia / Micrognathia
5. Previous upper airway surgery

Question 3

Consequences of Paeds OSA

Answer 3

1. Increase BP during sleep
2. Increase ventricular wall thickness
3. Impairment in memory, attention, learning
4. Daytime behavioural difficulties

Question 4

Detection of Paeds OSA

Answer 4

• Noisy breathing in 3+ nights/week in absence of URTI
• Wakes tired and grumpy
• Secondary bedwetting after being dry for more than 6/12
• Poor weight gain
• Difficulties with behaviour or concentration.
• Morning headache
• Night sweats
• Daytime somnolence

Question 5

Important Clinical Examination in suspected Paeds OSA

Answer 5

1 - Growth - Slow weight gain or obesity
2 - Craniofacial structure (Retro/micrognathia, anenoidal facies)
3 - Nasal airflow - Deviated nasal septum , boggy turbinates ? Nasal mucosal inflammation/swelling
4 - Tongue, pharynx, palate, uvula, tonsils
- Tonsilar hypertrophy
5. Presence of RVH, Pulmonary HTN, systemic HTN.

Question 6

Confirmation of OSA

Answer 6

Sleep Study (Polysomnography)

Question 7

Treatment for Paeds OSA

Answer 7

1 - Tonsillectomy and Adenoidectomy
2 - Anti-inflammatories
- Intranasal steroids
Mometasone
50microg OD
- Leukotriene receptor antagonists -
3 - Dental therapies
4 - CPAP

Question 8

Method to assess adenoidal size

Answer 8

1 - Lateral X-Ray of the Head
2 - Experienced operator using nasendoscopy