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Predicting the effect of treatment in paediatric OSA by clinical examination and functional respiratory imaging
Monique Slaats1,2, Wim Vos3, Cedric Van Holsbeke3
1Department of Paediatrics, Antwerp University Hospital, Edegem, Belgium.
Insights
Functional Respiratory Imaging (FRI) and clinical scores can predict obstructive sleep apnea (OSA) treatment outcomes in children. A less constricted airway, indicated by FRI and tonsil size, predicts a less favorable response to surgery.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Medical Imaging
Background:
- Obstructive sleep apnea (OSA) is common in children.
- Predicting treatment success for OSA in normal-weight children is crucial.
- Current methods may not fully capture airway dynamics.
Purpose of the Study:
- To evaluate if Functional Respiratory Imaging (FRI) and clinical examination predict treatment outcomes in normal-weight children with OSA.
- To compare the predictive value of FRI versus clinical assessment for OSA treatment success.
Main Methods:
- Prospective study of normal-weight children diagnosed with OSA.
- Utilized polysomnography, ultra-low dose CT scans for upper airway (UA) analysis, and FRI with computational fluid dynamics.
- Drug-induced sleep endoscopy (DISE) guided surgical decisions; post-operative polysomnography assessed outcomes.
Main Results:
- Ninety-one children (mean age 5.0 years) were included.
- Severe OSA correlated with smaller adenoid-tonsil overlap volume.
- Persistent OSA occurred in 19/60 patients; lower UA conductance and higher tonsil score predicted successful treatment.
Conclusions:
- Airway constriction, assessed by FRI and tonsil score, predicts less favorable outcomes after adenotonsillectomy.
- FRI and DISE show promise for characterizing the upper airway in pediatric OSA.
- Further research is needed to refine FRI's role in predicting OSA treatment response.
Objective:
The aim of this study was to investigate whether functional respiratory imaging (FRI) or clinical examination could predict treatment outcome for obstructive sleep apnea (OSA) in normal-weight, non-syndromic children.
Methods:
Normal weight children diagnosed with OSA by polysomnography were prospectively included. All children got a thorough evaluation and an ultra-low dose computed tomography scan of the upper airway (UA). A 3-D reconstruction was built combined with computational fluid dynamics for FRI. Decisions on the need and type of surgery were based upon findings during drug-induced sleep endoscopy. A second polysomnography was performed 3-12 months after surgery.
Results:
Ninety-one children were included: 62 boys, 5.0 ± 2.7 years, and BMI z-score of -0.1 ± 1.2. Children with more severe OSA had a smaller volume of the overlap region between the adenoids and tonsils. Nineteen out of 60 patients had persistent OSA (oAHI >2/h). A lower conductance in the UA and a higher tonsil score predicted successful treatment.
Conclusions:
A less constricted airway, as characterized by both FRI and a lower tonsil score, was associated with a less favorable response to (adeno) tonsillectomy. Further studies after treatment using FRI and DISE are warranted to further characterize the UA of these subjects.
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