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Published on: December 6, 2016
Paediatric obstructive sleep apnoea: can our identification of surgical candidates be evidence-based?
Insights
Paediatric obstructive sleep apnoea (POSA) lacks clear diagnostic criteria and evidence for its systemic impact. Further research is needed to understand POSA comorbidities and non-surgical management options.
Area of Science:
- Otolaryngology
- Pediatric Sleep Medicine
- Respiratory Medicine
Background:
- Pediatric obstructive sleep apnea (POSA) is prevalent among children and managed by ENT specialists.
- Significant variability exists in diagnostic criteria, comorbidity assessment, and surgical indications for POSA.
- Existing literature offers limited consensus on fundamental aspects of POSA management.
Purpose of the Study:
- To systematically review the evidence base for POSA definition.
- To assess the link between POSA and serious systemic illnesses.
- To identify comorbidities influencing POSA severity and explore non-surgical treatment options.
Main Methods:
- Systematic literature review addressing four key questions regarding POSA.
- Analysis of evidence for diagnostic criteria, systemic impact, comorbidities, and medical management.
- Evaluation of screening measure accuracy and definition clarity for sleep-disordered breathing.
Main Results:
- Considerable lack of evidence found for fundamental questions concerning POSA.
- Screening measures for POSA demonstrate low specificity and can miss mild cases.
- Definitions and severity estimations for sleep-disordered breathing lack clarity, often relying on arbitrary thresholds.
Conclusions:
- There is a significant need for more robust evidence in pediatric obstructive sleep apnea research.
- Future research should investigate the mechanisms linking POSA to neurocognitive, behavioral, metabolic, and cardiovascular comorbidities.
- The role and efficacy of non-surgical management strategies for POSA require further investigation.
Background:
Paediatric obstructive sleep apnoea is a common clinical condition managed by most ENT clinicians. However, despite the plethora of publications on the subject, there is wide variability, in the literature and in practice, on key aspects such as diagnostic criteria, the impact of co-morbidities and the indications for surgical correction.
Methods:
A systematic review is presented, addressing four key questions from the available literature: (1) what is the evidence base for any definition of paediatric obstructive sleep apnoea?; (2) does it cause serious systemic illness?; (3) what co-morbidities influence the severity of paediatric obstructive sleep apnoea?; and (4) is there a medical answer?
Results And Conclusion:
There is a considerable lack of evidence regarding most of these fundamental questions. Notably, screening measures show low specificity and can be insensitive to mild obstructive sleep apnoea. There is a surprising lack of clarity in the definition (let alone estimate of severity) of sleep-disordered breathing, relying on what may be arbitrary test thresholds. Areas of potential research might include investigation of the mechanisms through which obstructive sleep apnoea causes co-morbidities, whether neurocognitive, behavioural, metabolic or cardiovascular, and the role of non-surgical management.
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