Application of the Portuguese version of the Obstructive Sleep Apnea-18 survey to children

Despite the significant prevalence of obstructive sleep apnea syndrome (OSAS) in children, the diagnosis and treatment of this condition is still challenging due to the difficulties inherent to objectively assessing the disease's severity.ObjectiveTo verify whether the Portuguese version of the Obstructive Sleep Apnea-18 (OSA-18) survey is as valid as its original version in English.MethodProspective study. The OSA-18 was translated into Portuguese, culturally adapted, and tested in the Portuguese population. The caregivers of 51 children (aged from 2 to 12 years) diagnosed with OSAS answered the OSA-18-pv survey. Statistical analysis was used to assess the psychometric properties of the survey.ResultsReliability analysis yielded a Cronbach's alpha of 0.821, confirming the survey's consistency. Converging validity was assessed using Pearson's correlation coefficient, which revealed a statistically significant correlation between individual data and total results. The survey can be easily and quickly answered (7.26 min). The outcomes of the OSA-18-pv showed that quality of life was poor in 14 children with OSAS (28%), moderate in 22 (43%), and high in 15 (29%).Conclusionthe OSA-18-pv is a valid tool and can be used to assess the impact on the quality of life of Portuguese children with OSAS.     

Quality of life in children with Robin Sequence

IntroductionParents may play an important role during the management of children with Robin Sequence (RS). However, so far only one study has been done on both parent-reported health-related quality of life (HRQoL) and obstructive sleep apnea (OSA) symptoms in children with RS.MethodsOverall, 63 children with RS, aged 1 and 18, were included in this cross-sectional study. Fifty-three parents of children with RS with a median age of 8.9 [IQR 5.1–12.7] completed questionnaires on HRQoL (OSA-18) and symptoms of OSA (the Brouillette score) in their child with RS. Ten children between 12 and 18 years filled out the self-reported HRQoL questionnaire OSA-12.ResultsAt cross-section, 10 children still had respiratory problems. Overall, parents of children with RS reported a lower HRQoL in their child compared with parents in the general population. Parents of children with RS who still had respiratory problems, i.e. OSA or airway support, reported significantly worse OSA-18 scores compared with parents of RS children without OSA. Children with RS themselves (n = 10) reported less physical suffering and less emotional distress on the OSA-12 compared with children in the norm population. Parental perceptions of OSA-related symptoms were accurate, except for the incidence of snoring. In assessing snoring, the multidimensional OSA-18 sleep domain was more informative.ConclusionsParents of children with RS reported a lower HRQoL in their child compared with parents in the general population. Parental perceptions of health and HRQoL in children with RS might have an additional value to recognize and treat respiratory problems.     

Helicobacter pylori seroprevalence in children with sleep-disordered breathing

ObjectiveChronic Helicobacter pylori (HP) infection is considered to be a factor involved in obstructive sleep apnea syndrome (OSAS). This cross-sectional study examined the seroprevalence of HP in children with sleep-disordered breathing (SDB) in respect to OSAS severity and in reference to other common pediatric medical conditions.MethodsOvernight polysomnography with pH-metry (PSG) was performed at a Sleep Laboratory (in the years 2008–2011). OSAS severity was determined based on Obstructive Apnea Index (OAI). Subjects were classified into primary snoring group (OAI < 1/hours), mild - moderate OSAS (OAI: 1–5/hour), and severe OSAS (OAI: ≥5/hour). HP IgG was tested by an enzyme-linked immunosorbent assay in the SDB (n = 115) and reference (n = 387) groups [reference group consisted of 4 subgroups based on ICD-10 diagnoses encompassing conditions affecting the skin, respiratory system, food hypersensitivity, and gastrointestinal tract]. Analyses were performed by nonparametric statistical tests.ResultsHP seropositivity was 10.4% (12/115) in the SDB group and 11.6% (45/387) in the reference group. HP positive and negative subjects did not differ in PSG, acid gastro-esophageal reflux index nor in age, sex, nutritional status (BMI-z score), and hematological indices in the SDB group. Seropositivity was found in 16.7% of the primary snoring group, 10.2% of mild-moderate OSAS, and in 11.1% of severe OSAS (chi² p = 0.832).ConclusionsChildren with SDB are not more predisposed to a chronic HP infection than children with other common chronic pediatric conditions. HP seropositivity does not influence OSAS severity but possible infection should none-the-less be considered on a case-by-case basis.     

Quality of life after adenotonsillectomy for children with sleep-disordered breathing: A linear mixed model analysis

Objective

To study changes in quality of life (QoL) after adenotonsillectomy (T&A) in children with sleep-disordered breathing (SDB), and to elucidate discrepancies in QoL improvements after T&A in children of different gender, age, adiposity status, and disease severity.

Materials and methods

Children aged 2–18 years were recruited. All children had SDB-related symptoms and underwent preoperative full-night polysomnography (PSG). Caregivers completed the first obstructive sleep apnea 18-items questionnaire (OSA-18) prior to T&A and the second OSA-18 survey within 3 months after surgery. Disease severity was defined as primary snoring (apnea/hypopnea index, AHI < 1), mild obstructive sleep apnea (OSA) (5 > AHI ≥1), and moderate-to-severe OSA (AHI ≥ 5). Discrepancies in OSA-18 score changes after T&A for different groups were assessed using the linear mixed model.

Results

In total, 144 children were enrolled (mean age, 7.0 ± 3.6 years; 76% boy). The OSA-18 total score changes after surgery were not significantly different by gender (boys vs. girls), age group (≥6 years vs. <6 years), or adiposity (obese vs. non-obese). The OSA-18 total score changes after surgery differed by disease severity (primary snoring vs. moderate-to-severe OSA, P = 0.004; mild OSA vs. moderate-to-severe OSA, P = 0.003). Children with moderate-to-severe OSA had greater improvement in OSA-18 total score after surgery than those with mild OSA or primary snoring.

Conclusions

Children with SDB had QoL improvement after T&A, as documented by OSA-18 score changes. The QoL improvement after T&A for SDB children increased as disease severity increased, and the improvement was not affected by gender, age, or adiposity.     

腺样体扁桃体切除术对睡眠呼吸紊乱患儿生活质量的影响

目的：评价阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿行扁桃体和（或）腺样体切除手术治疗前后生活质量的改善程度,并与有睡眠呼吸紊乱（SDB）症状但整夜PSG阴性的患儿进行比较;同时分析PSG与疾病特异性生活质量调查结果之间的相关性。方法：SDB患儿术前1～2周内行整夜PSG监测,根据结果分为PSG阳性组和阴性组,术后6～9个月内进行随访。使用儿童OSAHS疾病特异性生活质量调查量表（OSA-18）对患儿术前及术后的生活质量进行评估,比较2组患儿术后生活质量改善情况。对PSG确诊的OSAHS患儿,分析术前整夜PSG与OSA-18指标之间的相关性。结果：共51例患儿入选,其中28例整夜PSG结果达到OSAHS诊断标准（阳性组）,另23例为PSG阴性组。2组的临床资料具有可比性。术前OSA-18评分在2组之间的差异无统计学意义。术后2组患儿的OSA-18总分及各维度评分较术前均明显降低（均P〈0．01）,且术前、术后评分的变化值2组比较差异无统计学意义（P〉0．05）。在PSG确诊的OSAHS患儿,术前AHI与OSA-18量表中睡眠障碍、身体症状和对监护人影响3个维度的评分有明显相关性（均P〈0．01）,而与总分及其他2个维度无显著相关（均P〉0．05）。结论：对整夜PSG确诊的OSAHS患儿,扁桃体和（或）腺样体切除术后整夜PSG指标显著改善伴随生活质量明显提高,但没有发现术前OSA-18量表评分与整夜PSG检测指标之间有显著相关性。对有睡眠呼吸紊乱症状而其他方面健康的患儿,即使整夜PSG阴性,也能从手术治疗中受益。     

Cross-cultural adaptation and validation of the Greek OSA-18 questionnaire in children undergoing polysomnography

ObjectiveTranslations of validated questionnaires help to compare different countries/cultures populations and establish protocols for global health. OSA-18 is a validated disease-specific questionnaire for pediatric Obstructive Sleep Apnea (OSA). Our aim was to validate OSA-18 in Greek and correlate it with polysomnography results and OSA severity.Study designProspective instrument validation study.Subjects and methodsOSA-18 was translated in Greek and back into English. Children undergoing polysomnography due to snoring were recruited prospectively. OSA-18 was completed by parents during the initial clinic visit (test), in the evening prior to the sleep study (retest), and 3 months postoperatively for subjects who underwent adenotonsillectomy. Internal consistency and test–retest reliability were evaluated. Validity was assessed by exploring correlations between OSA-18 and AHI, by comparing OSA-18 of OSA and non-OSA groups, and by calculating questionnaire's sensitivity and specificity for detecting OSA. Total scores of non-OSA, mild, moderate and severe OSA subgroups were compared. In OSA children who underwent adenotonsillectomy, preoperative and postoperative total scores were compared to assess responsiveness.ResultsTest–retest questionnaires were fully completed for 141 children. OSA-18 in Greek had good internal consistency (Cronbach's alpha 0.951 for test and 0.947 for retest) and test–retest reliability (Pearson's correlation coefficients between test and retest scores: 0.850–0.946; P < 0.05). Total and subscale OSA-18 scores and AHI were significantly correlated (Spearman's correlation coefficients: 0.376–0.633; P < 0.01), while children with OSA had higher total OSA-18 score than those without OSA [median (interquartile range): 61 (35) vs. 38 (22), respectively; P < 0.001)]. Sensitivity was 53.4%, suggesting poor validity compared to polysomnography. All OSA severity subgroups had significant higher score than non-OSA. OSA-18 scores postoperatively were significantly lower compared to preoperatively (22.91 ± 5.49 vs. 67.13 ± 15.27, respectively; P < 0.001), indicating good responsiveness.ConclusionGreek OSA-18 is an instrument with satisfactory internal consistency, reliability, and responsiveness, but it is a poor predictor of OSA severity.     

Predicting the outcome after adenoidectomy-alone for adenoid hypertrophy causing sleep disordered breathing

PurposeBy using preoperative parameters age, body mass index, nasopharyngeal obstruction as assessed using flexible videonasopharyngoscopy, and quality of life scores in patients undergoing adenoidectomy-alone because of adenoid hypertrophy causing sleep disordered breathing, we aimed to examine the relationship between the change in quality of life scores, and preoperative parameters and to develop a tool to predict the change.Materials and methodsPatients who were scheduled for adenoidectomy-alone in a 12-month period were included. Flexible videnonasopharyngoscopy of the nasopharynx was performed. Nasopharyngeal obstruction was measured by using Image J software. Preoperative quality of life was evaluated using OSA-18 quality of life survey. OSA-18 survey has 5 subcategories consisting of sleep disturbance (O1), physical suffering (O2), emotional distress (O3), daytime problems (O4), caregiver concerns (O5). A question about the overall quality of life(O6) was added. Postoperative OSA-18 domain scores were obtained at the 3-month-follow-up. Preoperative OSA-18 subscores were compared to postoperative subscores. Linear regression analysis to predict the proportional change in OSA-18 subscores was performed.ResultsOur study group consisted of 94 cases. Mean postoperative O1, O2,O3, O4 and O5 scores were significantly lower compared to the preoperative scores. Mean postoperative O6 score was significantly higher. Linear regression analysis was carried out for predicting change in O1(r2 = 0.686; p = 0.006), O5(r2 = 0.711; p = 0.003) and O6(r2 = 0.757; p = 0.001).ConclusionChange in quality of life scores for sleep disturbance, physical suffering and general quality of life may be predicted by using preoperative parameters.     

Long term change in quality of life after adenotonsillectomy for pediatric obstructive sleep disorders

BACKGROUND: To study short-term and long-term changes in quality of life (QOL) in children before and after adenotonsillectomy (T and A) for obstructive sleep disorders (OSDs). MATERIALS AND METHODS: Prospective study of 20 children underwent T and A for OSDs at the University hospital of Ulm/Germany. Caregivers were asked to complete the Brouillette-Score (BS) and OSA-18 survey, validated instruments for detecting symptoms and QOL change in children with OSDs, at the initial office visit prior to surgery (BS/1 and OSA-18/1) within 7.5 +/- 1.14 weeks after surgery (BS/2 and OSA-18/2), and 14.8 +/- 1.98 months after surgery (BS/3 and OSA-18/3). The BS comprises 3 items including: difficulty breathing during sleep, apnea observed by the caregivers and snoring. The OSA-18 survey comprises 18 items in 5 domains of sleep disturbance, physical suffering, emotional distress, daytime problems, and caregiver concerns. Scores from the preoperative and postoperative surveys were compared using the paired T-test and SPEARMAN-RANK test. RESULTS: 13 children were male (65 %). The mean age at the time of inclusion in the study was 6.2 +/- 1.63 years, mean preoperative body mass index (BMI) was 17.4 +/- 1.24 kg/m(2). Brouillette-Score: The mean Brouillette-Score before T and A (2.72) was significantly higher ( P = or < .001) than in the short-term (- 2.19) and in the long-term. (- 3.54). OSA-18 SURVEY: The mean total score for OSA-18/1 (83.4) was significantly higher ( P = or < .001) than the mean total score for OSA-18/2 (29.8) and OSA-18/3 (25.6). The overall correlation between BS and OSA-18 was R = .887 ( P = or < .001). CONCLUSION: Children with suspicious OSDs demonstrate significant short term and long-term improvement in the Brouillette-Score and OSA-18 survey. Caregivers perceive a long-term improvement for a minimum of one year in QOL after T and A for OSDs, although these improvements are not uniform across all domains of the OSA-18 survey. Use of the Brouillette-Score and the OSA-18 survey should decrease the need for polysomnographic monitoring and facilitate selection of children for T and A, whereas the OSA-18 questionnaire permits the more differentiated finding.     

Factors affecting quality of life of pediatric outpatients with symptoms suggestive of sleep-disordered breathing

OBJECTIVE: To determine the relationship between causative factors of sleep-disordered breathing (SDB) and quality of life (QOL) of children who presented with SDB. METHODS: Prospective cross-sectional study was done. Pediatric outpatients with SDB were recruited. Patients with craniofacial, neurologic or syndromic anomalies and previous adenotonsillectomy were excluded. Data collected were clinical history, physical examination and lateral skull X-ray, along with QOL survey by using obstructive sleep apnea-18 (OSA-18) questionnaires. We assessed the association between clinical signs, the size of the tonsils and the adenoids, overweight/obesity and the OSA-18 scores to see the impact of these factors on QOL. RESULTS: Fifty-one children were enrolled. Mean age was 6.4+/-2.6 years. The most common clinical findings was mouth breathing (41.2%). Tonsillar hypertrophy (> or =3+) was found in 62.7 and 52.9% had adenoid-nasopharyngeal ratio greater than 70%. Overweight/obesity were found in 35.3% of the patients. OSA-18 scores ranged from 22 to 85. Tonsillar hypertrophy was significantly related to QOL (p<0.05). Adenoid hypertrophy had trends towards impact on QOL (p=0.094). Mouth breathing correlated well with QOL (p<0.01). Overweight/obesity and QOL had no statistically significant correlation. CONCLUSION: Tonsillar hypertrophy and mouth breathing were the clinical findings that affected most to the QOL of the children with SDB. Adenoid hypertrophy had trends towards the impact on QOL, although not statistically significant.     

Assessment of adenotonsillar size and caregiver-reported sleep symptoms among 3–6 year old children undergoing adenotonsillectomy

IntroductionAdenotonsillectomy remains the accepted first-line treatment for obstructive sleep apnea syndrome (OSAS) in children. Tonsillar size may be especially relevant in risk stratification as it may impact symptoms of sleep disordered breathing (SDB). This study assesses correlations among subjective tonsillar grading, measured tonsillar size, and degree of adenoid obstruction in patients age 3–6 years with caregiver-reported symptoms.MethodsChildren 3–6 years old undergoing adenotonsillectomy for OSAS were enrolled prospectively. The subjective tonsillar grade and degree of adenoid obstruction were recorded on physical examination by the otolaryngologist, and the objective tonsillar size was obtained from pathology reports. Spearman's rho was used to assess agreement among measures of tonsillar size and adenoid obstruction; and to correlate these measures with caregiver-reported SDB symptoms obtained from a pre-operative standardized questionnaire.ResultsThe cohort included 103 boys and 97 girls of median age 4.8 (interquartile range [IQR]: 3.9, 5.9) years. Median subjective tonsillar grade was 3+ (IQR: 3+, 4+) while median tonsillar size was 2.7 cm (IQR: 2.5, 3) and median adenoid obstruction was 60% (IQR: 50%, 80%). The subjective tonsillar grade and measured tonsillar size were strongly correlated (ρ = 0.31, p < 0.001), whereas adenoid obstruction was uncorrelated with either subjective tonsillar grade (ρ = 0.01, p = 0.860) or measured size (ρ = −0.05, p = 0.497). Tonsillar grade was positively correlated with 3 common caregiver-reported SDB symptoms (loud snoring, trouble breathing at night, and daytime sleepiness). Objective tonsillar size was positively correlated only with difficulty organizing tasks or activities, and adenoid obstruction was positively correlated only with stopping breathing during sleep.ConclusionSubjective tonsillar grading by the otolaryngologist achieved better correlation than measured tonsillar size or degree of adenoid obstruction with caregiver-reported SDB symptoms in children 3–6 years of age undergoing adenotonsillectomy.     

儿童阻塞性睡眠呼吸暂停低通气综合征筛查评分标准的探讨

目的:探讨采用儿童睡眠呼吸生活质量问卷、体格检查及电子鼻咽镜检查结果筛查儿童OSAHS的可行性。方法:对2009年以睡眠打鼾为主诉来我院儿童睡眠中心行PSG监测的患儿527例进行OSA-18问卷调查、体格检查以及电子鼻咽镜检查。以PSG监测结果作为诊断OSAHS的标准,将入组患儿分为OSAHS组和非OSAHS组,并将该2组患儿的临床资料进行统计学分析。结果:2组间年龄、扁桃体大小评分、腺样体大小评分、OSA-18总评分、OSA-18问题1(响亮的鼾声)评分、OSA-18问题3(睡眠中有气喘或窒息)评分、OSA-18问题16(担心孩子夜间不能得到足够氧气)评分之间差异有统计学意义(P<0.05)。用Logistic回归(Backward:LR法)建立Y的回归方程并做ROC曲线分析。Y的界限值为0.735,即Y>0.735,则患有OSAHS的可能性增加,其敏感度为62.7%,特异度为79.4%。结论:以OSA-18问卷调查、体格检查及电子鼻咽镜的检查结果对患儿进行临床评估,以此对儿童OSAHS进行初步筛查的方法是可行的。     

Obstructive sleep apnea syndrome (OSAS) in mouth breathing children

It is well known that mouth breathing is associated with adenotonsillar hypertrophy - which is the main cause of obstructive sleep apnea among children. Despite the importance of this matter, there are only a handful of studies showing the relationship between OSAS and mouth breathing.Aimto determine the prevalence of obstructive sleep disorders in mouth breathing children and study its correlation with otorhinolaryngological findings.Study designRetrospective cohort study.MethodData analysis from 248 medical charts of mouth breathing children seen at the Pediatric Otolaryngologic Division of a large medical institution between the years of 2000 and 2006. All patients had nasofibroscopy and or Cavum radiographs and polysomnographic exams. According to the Apnea index, patients were classified as primary snorers (AI<1); and as OSAS (≥1).ResultsFrom 248 patients included in the study, 144 (58%) were primary snorers and 104 (42%) had OSAS. The most prevalent otorhinolaryngological findings were adenotonsillar hypertrophy (n=152; 61.2%), tonsilar hypertrophy (n=17; 6.8%), adenoid hypertrophy (n=37; 14.9%), rhinitis (n=155; 62.5%) and secretory otitis (n=36; 14.5%).Conclusionsprimary snoring and OSAS are frequent findings in mouth breathing children. The most frequent otorhinolaryngological disorder in children with OSAS is adenotonsillar hypertrophy with or without rhinitis.     

Adenotonsillectomy for obstructive sleep apnea in children: outcome evaluated by pre- and postoperative polysomnography

OBJECTIVE: To evaluate the outcome of adenotonsillectomy for obstructive sleep apnea (OSA) in children using objective data from polysomnography supplemented by subjective proxy reports from the OSA-18 quality of life instrument. STUDY DESIGN: Prospective cohort study. METHODS: Children 3 to 14 years of age with OSA diagnosed principally on the basis of polysomnography as having an obstructive apnea/hypopnea index (AHI) of 5 or greater underwent adenotonsillectomy. OSA was classified as mild (AHI > or = 5 < 10), moderate (AHI > or = 10 < 20), or severe (AHI > or =20). Children enrolled in the study also had postoperative polysomnography 3 to 6 months after surgery. Caregivers completed the OSA-18 survey before surgery and within 6 months after surgery. Pearson correlation was used to compare the pre- and postoperative AHI values with the pre- and postoperative OSA-18 total scores. SAS procedures (SAS Corp., Cary, NC) were used for statistical analyses. A P value less than or equal to .05 was considered significant. RESULTS: The study population included 79 healthy children, 40 of who were male. The mean age was 6.3 (range, 3.0-14.0) years. Only tonsillar size was correlated significantly with a high preoperative AHI. For all children, the preoperative AHI value was higher than the postoperative value. The mean preoperative AHI for the study population was 27.5, whereas the mean postoperative AHI was 3.5. This change was highly significant (P < .001). The percentage of children with normal polysomnography parameters after adenotonsillectomy ranged from 71% to 90% as a function of the criteria used to define OSA. It was highest when an obstructive apnea index less than 1 was used and lowest when an AHI less than 1 was used to define resolution of OSA. Overnight respiratory parameters after adenotonsillectomy were normal for all children with mild OSA. Three (12%) children with moderate preoperative OSA, and 13 (36%) children with severe preoperative OSA had persistent OSA after adenotonsillectomy. Resolution of OSA occurred in all children with a preoperative AHI less than or equal to 10 and in 73% of children with a preoperative AHI greater than 10. The mean total OSA-18 score and the mean scores for all domains showed significant improvement after surgery (P < .001). The preoperative AHI values had a fair correlation with the preoperative total OSA-18 scores (r = 0.28), but postoperative AHI values had a poor correlation with the postoperative total OSA-18 scores (r = 0.16). Caregivers reported snoring some, most, or all of the time in 22 (28%) children; this group included all children with persistent OSA. CONCLUSIONS: Adenotonsillectomy for OSA results in a dramatic improvement in respiratory parameters as measured by polysomnography in the majority of healthy children. Quality of life also improves significantly after adenotonsillectomy for OSA in children. However, the correlation between improvements in respiratory parameters and improvements in quality of life is poor. Severe preoperative OSA is associated with persistence of OSA after adenotonsillectomy. Postoperative reports of symptoms such as snoring and witnessed apneas correlate well with persistence of OSA after adenotonsillectomy.     

腺样体扁桃体切除术对阻塞性睡眠呼吸暂停低通气综合征儿童生活质量的影响

目的　探讨腺样体扁桃体和（或）切除术对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿生活质量的影响。方法　对OSAHS患儿行疾病特异性生活质量调查表（OSA-18）,分析术前、术后结果差异,评估生活质量变化。结果　246例患儿临床症状均缓解,OSA-18总分由（64.80±8.95）降至（30.11±4.49）,差异具有统计学意义（P <0.01）。生活质量改善总体有效率达99.60%,睡眠障碍、全身症状、对监护人的影响显著改善。结论　腺样体和（或）扁桃体切除术能够直接解除呼吸道梗阻,提高患儿睡眠质量、生活质量,可作为儿童OSAHS的主要治疗手段。     

Monitoring microvascular free flaps with tissue oxygen measurement and pet

Snoring occurs as a major symptom in patients with sleep disordered breathing (SDB). The aetiology of snoring remains still unclear despite various attempts to localize snoring. The correlation between different snoring sounds and the severity of SDB has not yet been investigated in a larger population. The aim of this study was to record and analyse snoring sounds and to correlate the obtained data with clinical and polysomnographical parameters. Sixty male patients with suspected SDB and reported snoring underwent a clinical examination and night time polysomnography. The parallel digitally recorded snoring sounds were analysed by fast fourier transformation (FFT). Peak intensity was determined from the power spectrum. The periodicity of snoring was classified into rhythmic and non-rhythmic snoring according to the presence of air flow interruptions due to obstructive apneas. Patients with primary snoring revealed peak intensities between 100 and 300 Hz. Patients with an obstructive sleep apnea syndrome (OSAS) revealed peak intensities above 1,000 Hz. Polysomnographical data (AHI, mean and minimum SpO₂) as well as body mass index (BMI) correlated with peak intensity of the power spectrum. None of the parameters of the clinical examination correlated with peak intensity. Frequency analysis of snoring sounds provides a useful diagnostic tool to distinguish between different patterns of snoring and respective SDB. The topodiagnosis of snoring is not possible by means of frequency analysis or clinical examination alone. Acoustical analysis of snoring sounds seems a promising additional diagnostic tool to verify different types of SDB in snoring patients.     

Respiratory complications after diode-laser-assisted tonsillotomy

Children with certain risk factors, such as comorbidities or severe obstructive sleep apnea syndrome (OSAS) are known to require extended postoperative monitoring after adenotonsillectomy. However, there are no recommendations available for diode-laser-assisted tonsillotomy. A retrospective chart review of 96 children who underwent diode-laser-assisted tonsillotomy (07/2011–06/2013) was performed. Data for general and sleep apnea history, power of the applied diode-laser (λ = 940 nm), anesthesia parameters, the presence of postoperative respiratory complications and postoperative healing were evaluated. After initially uncomplicated diode-laser-assisted tonsillotomy, an adjustment of post-anesthesia care was necessary in 16 of 96 patients due to respiratory failure. Respiratory complications were more frequent in younger children (3.1 vs. 4.0 years, p = 0.049, 95 % CI ?1.7952 to ?0.0048) and in children who suffered from nocturnal apneas (OR = 5.00, p < 0.01, 95 % CI 1.4780–16.9152) or who suffered from relevant comorbidities (OR = 4.84, p < 0.01, 95 % CI 1.5202–15.4091). Moreover, a diode-laser power higher than 13 W could be identified as a risk factor for the occurrence of a postoperative oropharyngeal edema (OR = 3.45, p < 0.01, 95 % CI 1.3924–8.5602). Postoperative respiratory complications should not be underestimated in children with sleep-disordered breathing (SDB). Therefore, children with SDB, children with comorbidities or children younger than 3 years should be considered “at risk” and children with confirmed moderate to severe OSAS should be referred to a PICU following diode-laser-assisted tonsillotomy. We recommend a reduced diode-laser power (<13 W) to reduce oropharyngeal edema.     

便携式睡眠监测仪应用于儿童OSAHS诊断的临床分析

摘要：目的初步探讨便携式睡眠监测仪（PM）在儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）中的临床诊断价值。方法随机选择门诊收治的以经常性睡眠打鼾为主诉的儿童患者36例，其中男23例，女13例；年龄4~13岁，平均年龄（7.0±2.6）岁，应用PM与多导睡眠监测仪（PSG）对患儿进行整夜同步睡眠呼吸监测，同时完成儿童OSAHS疾病特异性生活质量调查表（OSA 18），分析PM灵敏度及特异性，对比分析两种睡眠监测仪临床各参数的相关性，以及OSA 18问卷与AHI相关性。结果以PSG监测结果为标准，在儿童OSAHS 监测诊断中，根据严重程度分为单纯鼾症2例，轻度5例，中度12例，重度17例；PM分析单纯鼾症1例，轻度6例，中度10例，重度19例，PM的灵敏度为97.1%，特异度为100.0%，准确率为97.2%；两种睡眠监测仪的睡眠呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSaO2）及平均血氧饱和度（MSaO2）有相关性，OSA 18问卷与PM及PSG监测的AHI呈正相关性（r=0.875、0.874，P均<0.05）。结论PM辅以OSA 18问卷调查在儿童OSAHS中具有较高的临床诊断价值，且PM与PSG各项指标相关性良好，操作简便，值得临床推广应用。     

Orofacial motor functions in pediatric obstructive sleep apnea and implications for myofunctional therapy

ObjectivesThe purposes of this study were (1) to identify possible differences in muscular and orofacial functions between children with obstructive sleep apnea (OSA) and with primary snoring (PS); (2) to examine the standardized difference between normal values of myofunctional scores and those of subjects with OSA or PS; and (3) to identify the features associated with OSA.MethodsParticipants were 39 children (mean age 8 ± 1.2 years) of which, 27 had a diagnosis of OSA and 12 had PS. All participants were examined by an otorhinolaryngologist and underwent overnight polysomnography. Orofacial characteristics were determined through a validated protocol of orofacial myofunctional evaluation with scores (OMES), surface electromyography of masticatory muscles, and measurements of maximal lip and tongue strength. Reference values in the OMES were included to quantify the standardized difference (effect size = ES) relative to the groups studied and in the regression analysis.ResultsThe OSA group had lower scores in breathing and deglutition, more unbalanced masticatory muscle activities than PS group (P < 0.05), but both groups had similar reductions in orofacial strength. OSA had a large ES (Cohen's d > 0.8) in all analysed OMES scores, while PS group showed small and medium differences in breathing and mastication scores, respectively. The mobility of the stomatognathic components score was the most important to contribute for group status (57%, P < 0.0001) in the regression analysis.ConclusionChildren with tonsillar hypertrophy and OSA had relevant impairments in orofacial functions and lesser muscular coordination than children with PS.     

Safety and long-term efficacy of tonsillectomy versus subtotal tonsillectomy in children with sleep disordered breathing

Objectivesto compare safety and long-term symptoms after TE compared to Subtotal Tonsillectomy (STT).MethodsA retrospective review data of 412 patients, one to twelve years old that underwent either TE or STT, as treatment for sleep disorder breathing, at two different medical centers. Symptoms were assessed by a questionnaire 3–5 years post-surgery. Additionally, data regarding immediate post-operative symptoms and complications were also collected.ResultsLong-term symptoms score was significantly lower in the TE group: 1.585 (±1.719) compared to 1.967 (±1.815) in the STT group (p = 0.033); 51.3% of patients in the ST group presented long-term SDB symptoms, compared to 40.6% in the TE group (p = 0.035); The main difference between the groups was snoring as 49% of the STT group suffered from snoring, versus 28.9% in the TE group (p < 0.001).ConclusionsTE showed an advantage over STT in resolving snoring in the long term.     

Identification and evaluation of obstructive sleep apnea in children before adenotonsillectomy using evaluative surveys

Sleep-disordered breathing (SDB) caused by enlarged tonsils and adnoids is common in early childhood. SDB without alterations in alveolar ventilation or sleep architecture is called primary snoring and affects up to 3-12 % of young children. In contrast, SDB with associated apneas or hypopneas affects between 0.7-3 % and is called obstructive sleep apnea syndrome (OSAS). OSAS and primary snoring should be distinguished with polysomnography (PSG). Despite the large number of patients undergoing tonsillectomy and adenoidectomy, the ability to assess patients-based preoperative diagnosis and surgical outcomes polysomnographically is limited. As a consequence it remains difficult which children will or will not benefit from surgical intervention. In the context of OSAS diagnosis, a discriminative survey is desired, one that cold classify differences before surgery as small, moderate or large. A promising office based surrogate measure are disease-specific quality-of-life surveys. Change within patients can be measured using an evaluative survey, administered before and after an intervention.