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Adult criteria for obstructive sleep apnea do not identify children with serious obstruction
C L Rosen1, L D'Andrea, G G Haddad
1Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510.
Insights
Pediatric obstructive sleep apnea (OSA) lacks diagnostic criteria. Adult OSA criteria may not accurately identify serious upper airway obstruction in children, as shown by low apnea indices despite impaired gas exchange.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Pediatric Critical Care
Background:
- Obstructive sleep apnea (OSA) is recognized in children, but established diagnostic criteria are lacking.
- Current diagnostic criteria for adult OSA are well-defined and widely used.
Purpose of the Study:
- To evaluate the applicability of adult OSA diagnostic criteria, specifically the apnea index, in identifying pediatric patients with significant sleep-related upper airway obstruction.
- To assess polysomnographic findings in children with clinical signs of upper airway obstruction during sleep.
Main Methods:
- Polysomnography was conducted on 20 children (8 months to 16 years) exhibiting symptoms of upper airway obstruction and cyclic oxyhemoglobin saturation (SaO2) oscillations.
- Data collected included sleep state, SaO2, ECG, airflow, respiratory effort, and behavioral observations.
- Key measurements involved obstructive events, desaturations, and time spent with SaO2 below 90%.
Main Results:
- Children demonstrated impaired gas exchange with cyclic SaO2 decreases and elevated end-tidal CO2.
- An average of 175 episodes of SaO2 decrease (>5%) occurred, with a mean minimum SaO2 of 66%.
- The average apnea index was low at 1.9 events/hour, indicating adult criteria may underestimate severity in children.
Conclusions:
- The standard apnea index used for adults may not adequately identify the severity of sleep-related upper airway obstruction in children.
- Further research is needed to establish specific diagnostic criteria for pediatric OSA that reflect the unique pathophysiology in this age group.
Abstract:
Although obstructive sleep apnea (OSA) occurs in the pediatric population, diagnostic criteria have not been established. Since criteria for adult OSA are well established, we asked whether commonly used adult criteria, such as the apnea index (based on the number of obstructive apnea [OA] events per hour), would identify children with serious sleep-related upper airway obstruction. Polysomnographic data were analyzed from 20 children (ages 8 months to 16 yr) with clinical evidence of upper airway obstruction during sleep (loud snoring and labored breathing) and who had cyclic oscillations of oxyhemoglobin saturation (SaO2) during sleep. The overnight studies included sleep state (EEG, EOG, and EMG), SaO2, ECG, nasal (end-tidal CO2) and oral (thermistor) airflow, chest and abdominal movement (inductance plethysmography), and video camera and behavioral observations. Measurements included the number of obstructive events > or = 10 s, the number of desaturations (> or = 5% decrease lasting > or = 5 s), the number of desaturation episodes to < 90%, < 85%, and < 80% lasting > 5 s, and the percentage of sleep time with SaO2 values < 90%. Gas exchange was impaired as evidenced by cyclic decreases in SaO2 and elevated PETCO2 values (maximum value 58 +/- 6 mm Hg). The children experienced 175 +/- 168 (range 6 to 609) episodes of decreased SaO2 > 5%, with an average minimum SaO2 of 66 +/- 13% (range 30 to 85%). The average number of apnea events was only 1.9 +/- 3.2 events/h (range 0 to 10.4).(ABSTRACT TRUNCATED AT 250 WORDS)