Monday, July 25, 2016

Which Children Are Particularly AT-Risk For Sleep Apnea? Its not just tonsils and obesity...

Online mode from wiki on sleep apnea in infants children  - not a patient
I would add the following:
  • Epilepsy
  • Brain Injury
  • Hypermobility Syndromes
  • Asthma
  • Polycystic Ovarian Syndrome
  • Failure to Thrive

Otherwise Healthy Kids
RISK FACTORS — Adenotonsillar hypertrophy and obesity are the major risk factors for obstructive sleep apnea (OSA) in otherwise healthy children. 
  • Adenotonsillar hypertrophy — Adenotonsillar hypertrophy is a widely recognized risk factor for OSA in children. The size and location of the tonsils and adenoids are influenced by genetic factors, infection, and inflammation. Although tonsils that appear large on anterior oral exam may contribute to a reduction in the airway size, there is not a clear linear correlation of increased size of tonsils and adenoids with greater severity of OSA; thus, even tonsils within the tonsillar pillars (graded as a 1+) may be clinically significant and cause obstruction in the airway during sleep. 
  • Obesity — Obesity is an important risk factor for OSA at all ages but is particularly prominent among adolescents. In a prospective study, OSA was diagnosed in 4 percent of adolescents (16 to 19 years of age), and most of these had not had OSA or habitual snoring during mid-childhood [11]. The strongest risk factors for OSA during adolescence were obesity, male sex, and a history of adenotonsillectomy. The importance of obesity as a predictor of OSA during adolescence is underscored by a separate study of 37 adolescents with moderate to severe obesity (BMI >97th percentile), among whom 45 percent had OSA on polysomnogram (defined as apnea-hypopnea index [AHI] >1.5)

Medically Complex Kids - Above Risk Factors PLUS (There are MANY MANY kids in this category) 
.... Medical, neurological, or dental conditions that reduce upper airway size, affect the neural control of the upper airway, or impact the collapsibility of the upper airway are also risk factors. Individuals presenting with OSA during infancy are particularly likely to have an underlying anatomic or genetic anomaly:
Cerebral palsy
Down syndrome / Trisomy 21
Craniofacial anomalies (eg, retrognathia, micrognathia, midface hypoplasia)
History of low birth weight / preemies 
Muscular dystrophy or other neuromuscular disorders
Mucopolysaccharidoses (eg, Hunter syndrome and Hurler syndrome)
Prader-Willi syndrome
Orthodontic problems (e.g, high narrow hard palate, overlapping incisors, cross bite)

Family history of OSA / sleep apnea
Children with any of these conditions should be followed closely for signs and symptoms of OSA. Objective assessment with polysomnogram is recommended in children with complex medical conditions who present with signs and symptoms of obstructive sleep apnea.

Dr R Additions
  • Epilepsy
  • Brain Injury
  • Hypermobility Syndromes
  • Asthma
  • Polycystic Ovarian Syndrome
  • ...

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