Changes in dentofacial morphology after adeno-/tonsillectomy in young children with obstructive sleep apnoea--a 5-year follow-up study. (41/168)

The aim of this study was to compare a number of dentofacial variables and airway space in children suffering from obstructive sleep apnoea (OSA) syndrome with the corresponding variables in control children exhibiting a normal breathing pattern, to study the development of these variables prospectively over a 5-year-period following treatment for OSA, and to compare the recorded changes with the corresponding changes occurring in the controls. The subjects were 17 children (10 boys and 7 girls, mean age 5.6 years) diagnosed with OSA syndrome. The treatment for the OSA was adeno-/tonsillectomy. The control group comprised 17 age- and gender-matched children (mean age 5.8 years) without breathing problems. Lateral cephalograms were taken of the OSA children at baseline and then at 1, 3, and 5 years post-treatment. The control records comprised registrations at baseline and then after 1 and 5 years. In comparison with the controls, the OSA children exhibited a more posteriorly inclined mandible (P < 0.05), a more anteriorly inclined maxilla (P < 0.001), a greater lower anterior face height (P < 0.01), a shorter anterior cranial base (P < 0.01), retroclined upper and lower incisors (P < 0.05 and P < 0.01, respectively), reduced airway space (P < 0.05 and P < 0.01), and a less pronounced nose (P < 0.05). At 5 years post-treatment, there were no statistically significant differences between the groups except for the lengths of the anterior cranial base and the nose which were still shorter (P < 0.05) in the patient group. OSA in young children has an unfavourable effect on the development of several dental and facial components. However, if OSA is diagnosed and treated at an early age, an almost complete normalization of dentofacial morphology may be achieved.  (+info)

Subjective sleepiness and polysomnographic correlates in children scheduled for adenotonsillectomy vs other surgical care. (42/168)

STUDY OBJECTIVE: To compare a validated subjective measure of childhood sleepiness to an objective determination, assess the frequency of problematic sleepiness among children with suspected sleep-disordered breathing (SDB), and examine what standard or investigational polysomnographic measures of SDB predict subjective sleepiness. DESIGN: Prospective, cross-sectional. SETTING: University-based sleep disorders laboratory. PARTICIPANTS: Washtenaw County Adenotonsillectomy Cohort. INTERVENTION: Polysomnography followed by Multiple Sleep Latency Tests (MSLTs) in 103 children aged 5 to 12 years old: 77 were scheduled for clinically indicated adenotonsillectomy, usually for suspected SDB, and 26 for unrelated surgical care. Parents completed the previously validated, 4-item Pediatric Sleep Questionnaire-Sleepiness Subscale (PSQ-SS). RESULTS: Thirty-three (43%) of the children scheduled for adenotonsillectomy had high PSQ-SS scores, in comparison with only 3 (12%) of the controls (p = .004). The PSQ-SS scores correlated inversely with mean sleep latencies on the MSLTs (rho = -0.23, p = .006). The obstructive apnea index, apnea-hypopnea index, and respiratory disturbance index (which included respiratory event-related arousals identified by esophageal pressure monitoring) each correlated similarly with PSQ-SS scores, as did investigational quantification of esophageal pressures and respiratory cycle-related electroencephalographic changes (each rho approximately 0.30, p < .02). A stepwise regression identified sigma-frequency respiratory cycle-related electroencephalographic changes as the strongest independent predictor of subjective sleepiness among all subjects and particularly among those without obstructive sleep apnea. CONCLUSIONS: Sleepiness is a frequent problem among children with suspected SDB. Subjective sleepiness (PSQ-SS) reflects MSLT results to a limited extent, as in adults. Standard polysomnographic measures of SDB predict subjective sleepiness, but respiratory cycle-related electroencephalographic changes may offer additional clinical utility.  (+info)

Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. (43/168)

OBJECTIVE: Findings from published studies suggest that the postoperative recovery process is more painful, slower, and more complicated in adult patients who had high levels of preoperative anxiety. To date, no similar investigation has ever been conducted in young children. METHODS: We recruited 241 children aged 5 to 12 years scheduled to undergo elective outpatient tonsillectomy and adenoidectomy. Before surgery, we assessed child and parental situational anxiety and temperament. After surgery, all subjects were admitted to a research unit in which postoperative pain and analgesic consumption were assessed every 3 hours. After 24 hours in the hospital, children were discharged and followed up at home for the next 14 days. Pain management at home was standardized. RESULTS: Parental assessment of pain in their child showed that anxious children experienced significantly more pain both during the hospital stay and over the first 3 days at home. During home recovery, anxious children also consumed, on average, significantly more codeine and acetaminophen compared with the children who were not anxious. Anxious children also had a higher incidence of emergence delirium compared with the children who were not anxious (9.7% vs 1.5%) and had a higher incidence of postoperative anxiety and sleep problems. CONCLUSIONS: Preoperative anxiety in young children undergoing surgery is associated with a more painful postoperative recovery and a higher incidence of sleep and other problems.  (+info)

Hyperactivity and attention deficit syndrome in obstructive sleep apnea syndrome: is there improvement with surgical management? (44/168)

Neuropsychological disorders are frequently associated with obstructive ventilatory disorders (OVD). AIM: To analyze the incidence of neuropsychological disorders in Brazilian children with OVD, using a screening questionnaire and to compare the answers given before and after surgery. PATIENTS AND METHODS: We studied 30 children with clinical diagnosis of OVD. The children were divided into 3 groups: group I, children aged 4 to 7; group II, from 8 to 10; and group III, children over 11. The applied questionnaires were answered by the parents or tutors, and comprised 30 questions, 10 for each disorder: attention deficit, hyperactivity and impulsivity. The children were diagnosed with one of the disorders when presented 3 or more positive answers. The follow up interview occurred 6 months after adenotonsillectomy. RESULTS: There was a predominance of male gender (60.6%) over female gender (39.4%). Group II presented the highest number of significant changes, with reductions raging from 87.5% to 33.3% of patients with attention deficit, 75% to 50% of the hyperactive patients, and 50% to 33% of the impulsive patients. CONCLUSION: There was neuropsychological improvement after the surgery, which occurred mainly in the children from group II. More interaction among health professionals is necessary when diagnosing and following up similar cases.  (+info)

Quality of life in children with sleep-disordered breathing: evaluation by OSA-18. (45/168)

Sleep-disordered breathing (SDB) is prevalent. There is evidence of their effect on quality of life. AIM: To assess the quality of life in children with SDB before and after adenoidectomy or adenotonsillectomy. METHODS: A prospective before and after interventional study, with a component for assessment. A consecutive sample of children referred to adenoidectomy or adenotonsillectomy was recruited from the otolaryngology clinic; guardians answered a specific survey for the evaluation of quality of life in children with SDB, the OSA-18, before and at least 30 days after surgery. Nasofibroscopic and otolaryngological exams and a semi-structured survey on the childs social and clinical profile were done on both appointments. RESULTS: 48 children with a mean age of 5.93 years (SD=2.43) were evaluated. The mean number of schooling years for guardians was 8.29 years (SD=3.14). The most frequent symptoms were: agitated sleep, apnea and snoring. The total mean score of the initial OSA-18 was 82.83 (major impact); following surgery, the total mean score was 34.15. The differences in the total scores and in the domains between the initial OSA-18 and post-surgery scores were all significant (p<0.00). CONCLUSION: SDB has a relevant impact on quality of life, and patients show dramatic improvements after surgical treatment.  (+info)

Plasma C-reactive protein in nonobese children with obstructive sleep apnea before and after adenotonsillectomy. (46/168)

STUDY OBJECTIVE: Sleep-disordered breathing (SDB) is a prevalent condition in children and is associated with increased cardiovascular morbidity. Circulating levels of C-reactive protein (CRP), a proinflammatory protein, are associated with increased risk for atherosclerosis. Plasma CRP levels in snoring children have yielded conflicting results, such that it remains unclear whether OSA is mechanistically involved in such elevations of CRP. METHODS: Consecutive nonobese children with polysomnographically demonstrated obstructive sleep apnea underwent blood draws in the morning after their corresponding sleep studies on 2 occasions, namely at diagnosis of obstructive sleep apnea and 10 to 14 weeks after adenotonsillectomy. High-sensitivity CRP serum concentrations were determined within 2 to 3 hours after collection, using a particle-enhanced turbidimetric immunoassay technique. RESULTS: Twenty children with obstructive sleep apnea (mean age 7.3 +/- 1.9 years; 55% boys; relative body mass index: 88% +/- 12.0%) with a mean apnea-hypopnea index at diagnosis of 15.6 +/- 2.9 events per hour of total sleep time and nadir SaO2 of 82.3% +/- 2.5% were included. Mean initial CRP levels at obstructive sleep apnea diagnosis were 0.67 +/- 0.21 mg/dL and decreased to 0.23 +/- 0.07 mg/dL after adenotonsillectomy (p < .05), along with significant decreases in measured apnea-hypopnea index (2.2 +/- 0.8 events/h of total sleep time; p < .01) and improved oxygenation (mean nadir SaO2 values: 88.6% +/- 1.9%; p < .01). CONCLUSIONS: Obstructive sleep apnea is frequently associated with increases in CRP levels that are reversible upon treatment. Thus, obstructive sleep apnea induces a systemic inflammatory response in children, which, if left untreated, may potentially lead to cardiovascular morbidity.  (+info)

Sialometaplasia of the soft palate in a 2-year-old girl. (47/168)

A case of sialometaplasia of the soft palate is reported in a 2-year-old girl 3 months after she had an adenoidectomy. Dental practitioners should be aware of the possible causes of intraoral swellings in both children and adults. The appearance of some conditions in children may differ from their characteristic appearance in adults. Necrotizing sialometaplasia may appear as an aggressive-looking lesion in an adult, possibly resembling squamous cell carcinoma. In the young patient reported here, frank necrosis was not evident from clinical or histological examination. Necrosis may not be part of the presentation of sialometaplasia in such young children.  (+info)

The effect of adenotonsillectomy on oxygen saturation in children with sleep disordered breathing. (48/168)

OBJECTIVE: To evaluate the effect of adenotonsillectomy on oxygen saturation measured through nocturnal pulse oximetry in children with sleep disordered breathing. METHODS: A pre- and post-intervention study was carried out using nocturnal pulse oximetry. The study involved 31 children who were suspected of having sleep disordered breathing and had been referred for adenotonsillectomy. RESULTS: A total of 27 children completed the study. The mean age was 5.2 +/- 1.8 years, and 18 (66.7%) of them were male. Upon physical examination, 23 (85.2%) of the children presented class III or class IV hyperplasia of the palatine tonsils. There was significant improvement in the post-operative period over the pre-operative period in terms of the oxygen desaturation rate (OR = 0.65; 95% CI: 0.5-1.3 vs. OR = 1.63; 95% CI: 1.1-2.4; p < 0.001). CONCLUSION: Adenotonsillectomy significantly improved oxygen saturation, as measured through nocturnal pulse oximetry, in children with sleep disordered breathing.  (+info)