ATS: Adenotonsillectomy Offers Relief to Kids With Sleep Apnea

Are some cognitive deficits associated with obstructive sleep apnea inevitable, or are we not detecting this problem early enough? Dr. Susarla

ATS: Adenotonsillectomy Offers Relief to Kids With Sleep Apnea

TUESDAY, May 21 (HealthDay News) -- Compared to watchful waiting, early adenotonsillectomy improves some symptoms, but not attention or executive function, in school-age children with obstructive sleep apnea syndrome, according to a study published online May 21 in the New England Journal of Medicine to coincide with presentation at the annual meeting of the American Thoracic Society, held from May 17 to 22 in Philadelphia.

Carole L. Marcus, M.B., B.Ch., from the Children's Hospital of Philadelphia, and colleagues randomized 464 children (aged 5 to 9 years) with obstructive sleep apnea syndrome to either early adenotonsillectomy or watchful waiting. At baseline and after seven months, polysomnographic, cognitive, behavioral, and health outcomes were assessed.

The researchers found that the change in attention and executive function score on the Developmental Neuropsychological Assessment did not significantly differ between study groups (mean improvement, 7.1 in the early-adenotonsillectomy group and 5.1 in the watchful-waiting group). In the behavioral, quality-of-life, and polysomnographic findings, there were significant reductions in symptoms in the early-adenotonsillectomy group. A larger proportion of children in the intervention group had normalization of polysomnographic findings than did in the watchful waiting group (79 versus 46 percent).

"As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by means of neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy," the authors write.

Read article here.

Asthma, Insomnia Make Each Other Worse

One of the reasons asthma can present insidiously is it may manifest more at night.   You may not awaken with obvious symptoms of breathing problems, but sleep is disrupted enough to affect daytime function.  This is a problem I see frequently in children and adolescents.  Parents are often surprised to see how effective treating asthma can be at improving sleep quality.  Dr. Susarla

Asthma, Insomnia Make Each Other Worse

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If you experience breathing problems, you might need to actively treat those symptoms, or you could find that you’re being kept awake at night. According to a recent Swedish study, asthma sufferers are far more likely to suffer from insomnia than others.

The trial was a large one, with data collected from 25,610 adults in four Swedish cities. The participants were given a questionnaire that asked questions about insomnia, asthma, rhinitis, weight, height, tobacco use, and physical activity. For the purposes of the study, the researchers defined asthma as taking current medication for the condition or experiencing at least one asthma attack during the last 12 months. Of the 25,610 participants, 1,830 people were defined as being asthmatics. Here’s what the researchers found when they compared asthma and sleep quality:

• The prevalence of insomnia symptoms was significantly higher among asthmatics than non-asthmatics

• For those with nasal congestion and asthma, insomnia symptoms were worse

• The risk of insomnia increased with the severity of asthma

• Asthmatics who had three or more symptoms were more than twice as likely to suffer from insomnia

• Nasal congestion, obesity, and smoking also increased the risk of insomnia

Insomnia is a common problem among asthmatics. The researchers concluded by saying that asthmatics should treat their symptoms, including nasal congestion, to make sure that they get a good night’s sleep. Other lifestyle factors, like smoking and obesity, will also increase your chances of suffering from insomnia if you’re an asthmatic.

Read article here.

Snoring Kids Should Be Screened for Sleep Apnea

It's nice to see media outlets covering this important health issue for children.  The AAP has rightfully updated an outdated guideline given the dangers of untreated sleep apnea. Dr. Susarla

AAP Issues New Guidelines for Kids’ Snoring

ABC News Medical Unit

A new set of practice guidelines released Monday by the American Academy of Pediatrics (AAP) may help parents and pediatricians uncover things that go snore in the night.

Pediatric sleep experts focused on children with a condition known as uncomplicated obstructive sleep apnea, which occurs when breathing is interrupted during sleep and is related to enlarged tonsils or obesity.  It is a condition the AAP says affects 1.2 to 5.7 percent of American children. They reviewed evidence from 350 study articles between 1999 and 2010 to create the following recommendations:

• Screening: All children and adolescents should be screened for snoring at their routine health visits.
• Sleep testing: Any children who have symptoms of obstructive sleep apnea, such as habitual snoring, disturbed sleep from intermittent pauses, snorts or gasps, or daytime behavioral problems, should be referred for a sleep study.
• Adenotonsillectomy: Any child with obstructive sleep apnea and enlarged tonsils should be referred to a surgeon to consider tonsil removal surgery.
• High risk: A child undergoing tonsil surgery is considered “high-risk” if he or she is under age 3, has severe sleep apnea on sleep testing, is obese or currently has an infection. These children should be closely monitored in the hospital after surgery for any complications.
• Re-evaluation: After surgery, snoring children should be reassessed to see if their sleep apnea has improved or if they will need any further treatments.
• CPAP: If symptoms do not improve after surgery or if a child is unable to get surgery for some reason, they should be considered for CPAP (continuous positive airway pressure), which is a breathing apparatus, often worn at night, that keeps airways open.
• Weight loss: Weight loss is recommended for any overweight or obese patient in addition to any other treatments.
• Intranasal steroids: Nasal sprays are recommended for patients with mild sleep apnea symptoms, whether in lieu of or after tonsil surgery.

The last set of guidelines for pediatric sleep apnea was released in 2002. The changes reflected in these new guidelines were made in light of research over the past 10 years that has suggested that delayed diagnosis of childhood sleep apnea “can result in severe complications if left untreated,” according to the American Academy of Pediatrics report. Examples include cognitive deficits, behavior problems, hypertension and heart problems, failure to thrive and inflammation throughout the body.

With these new guidelines, the AAP hopes that more cases of childhood sleep apnea will be diagnosed sooner and children will receive the proper treatments earlier to prevent these dangerous long-term effects.

“These new guidelines are extremely important,” says Dr. Vikas Jain, a sleep specialist at Integris Health in Oklahoma City.

“Pediatric sleep apnea is a rising problem among American children and leads to serious consequences,” he says. “The sooner we can diagnose a child with this condition, the sooner we can get these kids started on the right treatments to improve their quality of life and their overall health.”

Read article here.

CPAP for Sleep Apnea Reverses Neurobehavioral Problems in Children

Thanks to Dr. Susarla for posting this article! Dr. Rotenberg

Sleep apnea in children results in problems in the way kids function during the day.  For children that need it, this study confirms that CPAP use can REVERSE issues of daytime sleepiness, behavioral problems, and attention deficits.  A CPAP desensitization service that addresses the difficulties of getting started can make the process easier.  Dr. S 

Effects of Positive Airway Pressure Therapy on Neurobehavioral Outcomes in Children with Obstructive Sleep Apnea

Marcus, Carole L; Radcliffe, Jerilynn; Konstantinopoulou, Sofia; Beck, Suzanne E;Cornaglia, Mary Anne; et al. American Journal of Respiratory and Critical Care Medicine185. 9(May 1, 2012): 998-1003.

Abstract (summary)

Rationale: Positive airway pressure therapy is frequently used to treat obstructive sleep apnea in children. However, it is not known whether positive airway pressure therapy results in improvements in the neurobehavioral abnormalities associated with childhood sleep apnea. Objectives: We hypothesized that positive airway pressure therapy would be associated with improvements in attention, sleepiness, behavior, and quality of life, and that changes would be associated with therapy adherence. Methods: Neurobehavioral assessments were performed at baseline and after 3 months of positive airway pressure therapy in a heterogeneous group of 52 children and adolescents. Measurements and Main Results: Adherence varied widely (mean use, 170 ± 145 [SD] minutes per night). Positive airway pressure therapy was associated with significant improvements in attention deficits (P < 0.001); sleepiness on the Epworth Sleepiness Scale (P < 0.001); behavior (P < 0.001); and caregiver- (P = 0.005) and child- (P < 0.001) reported quality of life. There was a significant correlation between the decrease in Epworth Sleepiness Scale at 3 months and adherence (r = 0.411; P = 0.006), but not between other behavioral outcomes and adherence. Behavioral factors also improved in the subset of children with developmental delays. Conclusions: These results indicate that, despite suboptimal adherence use, there was significant improvement in neurobehavioral function in children after 3 months of positive airway pressure therapy, even in developmentally delayed children. The implications for improved family, social, and school function are substantial. Clinical trial registered with www.clinicaltrials.gov (NCT 00458406).

Read full paper here