Outcomes of pediatric mild sleep-disordered breathing

Sleep-disordered breathing disorders (SDB) ranging from snoring to obstructive sleep apnea (OSA), are common in children and have long-term consequences. However, guidelines for mild OSA are unclear with possible early surgery, pharmacotherapy, or watchful waiting. The current study aimed to investigate the persistence of symptoms in children with polysomnographic (PSG) diagnosis of mild SDB and the different treatment strategies carried out.

Children diagnosed with mild SDB at two tertiary medical centers were contacted 1-2 years following PSG diagnosis of mild SDB and assessed for symptom persistence using the Pediatric Sleep Questionnaire (PSQ).

A total of 78 children (38 female) were enrolled. The mean age at PSG was 5.45 (±3.98) years, the baseline apnea-hypopnea index (AHI) 2-5/h. The PSQ was completed at a mean age of 7.37 (±4.11) years and was positive in 31 (40 %) children. Twenty-six (33 %) children were initially offered surgical treatment, two-thirds of whom went through with surgery. A positive PSQ was associated with the presence of any background morbidity (including asthma, trisomy 21, prematurity, developmental delay, attention deficit disorder, chronic lung disease, congenital heart disease, etc.), prematurity, the BMI, having had no change in complaints, and high respiratory rate on PSG (p ≤ 0.05) but not the type of intervention provided.

We identified a high rate of persistent SDB symptoms in children previously diagnosed with mild OSA, emphasizing the importance of continued follow-up of these children. Proactive follow-up should be considered in children with background morbidities, prematurity, higher BMI z scores, persistent complaints, or high respiratory rates on the PSG.