Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art
Abstract
:1. Introduction
2. Risk Factors
2.1. Obesity
2.2. Adenoid and/or Tonsil Hypertrophy
2.3. Allergic Rhinitis
2.4. Craniofacial Abnormalities and Genetics
2.5. Inflammatory Factors and Biomarkers
3. Clinical Presentation
4. Diagnosis
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Abbreviations
AASM | American Association Sleep Medicine |
AHI | Apnea-Hypopnea index |
AT | Adenotonsillectomy |
AR | Allergic Rhinitis |
BMI | Body Mass Index |
CPAP | Continuous Positive Airway Pressure |
CRP | Reactive C- Protein |
DISE | Drug Induced Sleep Endoscopy |
ERS | European Respiratory Society |
ESS | Epworth Sleepiness Scale |
ICSD-3 | International Classification of Sleep Disorders |
ODI | Oxygen Desaturation Index |
OSA | Obstructive sleep apnea |
OSAS | Obstructive sleep apnea syndrome |
PSG | Polysomnography |
PSQ | Pediatric Sleep Questionnaire |
RDI | Respiratory Disease Index |
REM | Rapid Eye Movement |
RERAs | Respiratory Effort Related Arousal |
RSD | Respiratory Sleep Disorder |
SSSDR | Sleeping Sleepless Sleepy Disturbed Rest questionnaire |
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Study | Year | Type of Study | Patients Number | Age | Parameters Evaluated | Conclusions |
---|---|---|---|---|---|---|
Arens R et al. [18] | 2018 | Case-control study | 44 | 12.5 ± 2.8 | Anatomical findings in obese children affected by OSAS compared to the ones in obese children | Significant upper airway lymphoid hypertrophy in obese children with OSAS. Larger parapharyngeal fat in obese children with OSAS but not a direct association with severity of OSAS or with obesity |
Su M. et al. [21] | 2016 | Epidemiological study | 5930 | 3–11 | Age and sex; | No positive correlation between OSA and BMI |
AHI; | ||||||
Arousal index; | ||||||
BMI; | ||||||
Mallampati; | ||||||
AT hypertrophy; | ||||||
Nocturnal/daytime symptoms | ||||||
Xu Z. et al. [26] | 2008 | Case-control Study | 198 | 10.3 ± 2.1 | Age and sex; | Positive relation between OSAS and degree of obesity |
BMI; | ||||||
Waist circumference; | ||||||
Neck circumference; | ||||||
Waist-to-Height Ratio; | ||||||
Symptoms; | ||||||
AHI, Obstructive Apnea Index, Central Apnea, MinSaO2; | ||||||
AT hypertrophy | ||||||
Andersen I.G. et al. [30] | 2019 | Longitudinal study | 62 | 13.4 ± 3.1 | Age and sex; | AHI normalization in 44% of patients and positive correlation between BMI and AHI parameters |
BMI; | ||||||
AT hypertrophy; | ||||||
AHI; | ||||||
Sleep time (hours); | ||||||
ODI |
Grade | Description |
---|---|
0 | No tonsils seen |
I | In tonsillar fossa |
II | Visible beyond anterior pillars |
III | Extended ¾ of way to midline |
IV | Completely obstructing airway (kissing tonsils) |
Study | Year | Type of Study | Patients n° | Age | Parameters Evaluated | Conclusions |
---|---|---|---|---|---|---|
Kurnatowski P. et al. [33] | 2007 | Case–control study | 225 | 10–13 | Age and sex; | Negative emotional effect of adenotonsillar hypertrophy induced obstructive sleep disordered breathing |
Total sleep time; | ||||||
AHI, ODI; | ||||||
AT grade sec. Friedman; | ||||||
Spielberger test; | ||||||
Capra and Pastorelli scale | ||||||
Brietzke S.E. et al. [34] | 2006 | Meta-analysis (14 studies) | 28 (mean) | 4.9 (pooled mean age) | Age; | AT effective in reducing severity of OSAS in majority of patients |
Pre AT AHI; | ||||||
Post AT AHI; | ||||||
Success of AT; | ||||||
Kang K.T. et al. [38] | 2017 | Meta-analysis (4 studies) | 18.25 (mean) | 8.3 ± 1.1 (mean) | Age; | Effectiveness of lingual tonsillectomy for children with OSA caused by lingual tonsil hypertrophy |
BMI; | ||||||
Other comorbidities; | ||||||
CT, RMN, DISE; | ||||||
Preoperative AHI; | ||||||
Postoperative AHI | ||||||
Preoperative ODI; | ||||||
Postoperative ODI | ||||||
Lee C.F. et al. [41] | 2016 | Meta-analysis (11 studies) | 11 (mean) | 3.7 (mean) | Age; | Effectiveness in reducing AHI and MinSaO2, but complete resolution not achieved in most cases |
BMI; | ||||||
Preoperative AHI; | ||||||
Postoperative AHI | ||||||
Preoperative ODI; | ||||||
Postoperative ODI |
Study | Year | Type of Study | Patients n° | Age | Parameters Evaluated | Conclusions |
---|---|---|---|---|---|---|
Cao Y. et al. [51] | 2018 | Meta-analysis (44 studies) | 6086 total patients | 47.97 (adults) 7.73 (children) | Age and Sex; | Children with OSA suffering from a higher incidence of AR. OSA adults with AR do not have any influences on sleep parameters |
BMI; | ||||||
Neck circumference; | ||||||
AHI; | ||||||
ESS; | ||||||
AR prevalence | ||||||
Kheirandish-Gozal L. et al. [52] | 2014 | Retrospective review | 3071 | 2–14 | Age and Sex; | Effective alternative to adenotonsillectomy, particularly in younger and non-obese Children |
BMI; | ||||||
Pretreatment: AT grade; | ||||||
Mallampati; | ||||||
Total sleep time; | ||||||
AHI, ODI; | ||||||
Posttreatment: Pretreatment: AT grade; | ||||||
Mallampati; | ||||||
Total sleep time; | ||||||
AHI, ODI | ||||||
Kheirandish-Gozal L. et al. [53] | 2016 | Prospective randomized trial study | 92 | 2–10 | Age and Sex; | Beneficial effects (reduction of AHI and ODI) in 71% of children treated with montelukast. No changes in those treated with placebo. |
BMI; | ||||||
Pretreatment: AT grade; | ||||||
Mallampati; | ||||||
Total sleep time; | ||||||
AHI, ODI; | ||||||
Posttreatment: Pretreatment: AT grade; | ||||||
Mallampati; | ||||||
Total sleep time; | ||||||
AHI, ODI | ||||||
Brouillette R.T. et al. [54] | 2001 | Triple-blind randomized placebo-controlled trial | 25 | 1–10 | Age and Sex; | Decrease in AHI/ODI values in 12/13 of fluticasone group. No changes in placebo group |
Pretreatment: | ||||||
AHI, ODI; | ||||||
Total sleep time; | ||||||
AT grade; | ||||||
AR symptoms | ||||||
Posttreatment: AHI, ODI; | ||||||
Total sleep time; | ||||||
AT grade; | ||||||
AR symptoms |
Study | Year | Type of Study | Patients Number | Age | Parameters Evaluated | Conclusions |
---|---|---|---|---|---|---|
Follmar A. et al. [58] | 2014 | Retrospective cohort study | 118 | 1 day–15 years | RDI; | Multifactorial etiology of RSD in children affected by Prader–Willi Syndrome |
Laryngomalacia; | ||||||
macroglossia, | ||||||
AT hypertrophy; | ||||||
GERD. | ||||||
Onodera K. et al. [62] | 2005 | Case–control study | 30 | 3.8 ± 1.4 (20) 7.9 ± 3 (10) | Questionnaire items: | Significant presence of RSD in patients affected by achondroplasia (AP) |
Snoring; | ||||||
AHI; | ||||||
Mouth breathing; | ||||||
Occlusion; | ||||||
Height and weight; | ||||||
Ages of the eruption of deciduous teeth | ||||||
Pavone M. et al. [66] | 2015 | Retrospective study | 88 | 1–14.5 | Anthropometric data; | No correlations between MOAHI and age or BMI, positive correlations between MOAHI and Sp02 |
BMI; | ||||||
MOAHI, RDI, SpO2 | ||||||
Guilleminault C. et al. [67] | 2013 | Retrospective study | 34 patients | 26.55 | Clinical evaluation; | Commonly unrecognized abnormal breathing and its correlation with daytime fatigue and poor sleep in Ehlers–Danlos patients |
Rhinomanometry; | ||||||
AHI, RDI, Sa02 | ||||||
Kalaskar R et al. [69] | 2012 | Case report study | 1 | 11 years old boy | Anatomical finding; orthodontic conformation | Association between Ellis–van Creveld syndrome and OSA |
Cardiel Rios S.A. et al. [71] | 2016 | Case report study | 1 | 10 years old boy | Anatomical finding; orthodontic conformation | Association between Noonan syndrome, malocclusion and OSA |
Saxby C. et al. [74] | 2018 | Retrospective study | 65 | Not specified | Patients demographics; Type of midface advancement; | Positive outcomes after midface advancement in patients with craniosynostosis |
Preoperative: AHI, RDI, SaO2; | ||||||
Postoperative: AHI, RDI, SaO2; | ||||||
Blood pressure; | ||||||
Villa M.P. et al. [77] | 2002 | Randomized controlled study | 32 | 4–10 | Brouillette questionnaire; | Improved respiratory symptoms in patients who underwent oral appliance treatments |
physical examinations: | ||||||
AHI, RDI, SaO2 |
Study | Year | Type of Study | Patients n° | Age | Parameters Evaluated | Conclusions |
---|---|---|---|---|---|---|
Gozal D. et al. [59] | 2007 | Prospective study | 355 | 5–7 | AHI, RDI, SaO2; | Positive correlation between APOE epsilon4 allele and OSA and neurocognitive deficits |
Neurocognitive tests; | ||||||
Blood draw. | ||||||
Khalyfa A. et al. [60] | 2011 | Case–control study | 140 | <6 | ESS questionnaire; | Positive correlation between high TNF- α levels and OSAS |
AHI, RDI, SaO2M; | ||||||
Serum TNF- α | ||||||
Tam C.S. et al. [79] | 2006 | Case–control study | 113 | 7.3 ± 3.7 | C-reactive protein; | Significantly elevated IFN-gamma levels and elevated IL-8 levels |
Cytokines: IL-1beta, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, GM-CSF, IFN-gamma and TNF-alpha. | ||||||
Gozal et al. [80] | 2008 | Case–control study | 40 | 6.5 ± 0.7 | Age and sex; | Higher levels of IL-6 and IL-10 |
Ethnicity; | ||||||
BMI: | ||||||
AHI, RDI; | ||||||
IL-6, IL-10. | ||||||
Park C.S. et al. [85] | 2014 | Case–control study | 67 | 6 (3–16) | Age and sex; | High level of serum alpha amilase in severe OSAS children compared to moderate and mild ones and to the control group |
BMI; | ||||||
AHI, RDI; | ||||||
OSA-18 questionnaire; | ||||||
Alpha amilase levels. | ||||||
Gozal D. et al. [86] | 2009 | Case–control study | 60 | 6.6 ± 0.7 | Clinical questionnaires; | Consistent alterations in urinary concentrations of specific protein clusters in OSA patients |
Height and weight; | ||||||
BMI; | ||||||
AHI; RDI, SaO2; | ||||||
Urine collection |
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Gulotta, G.; Iannella, G.; Vicini, C.; Polimeni, A.; Greco, A.; de Vincentiis, M.; Visconti, I.C.; Meccariello, G.; Cammaroto, G.; De Vito, A.; et al. Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art. Int. J. Environ. Res. Public Health 2019, 16, 3235. https://doi.org/10.3390/ijerph16183235
Gulotta G, Iannella G, Vicini C, Polimeni A, Greco A, de Vincentiis M, Visconti IC, Meccariello G, Cammaroto G, De Vito A, et al. Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art. International Journal of Environmental Research and Public Health. 2019; 16(18):3235. https://doi.org/10.3390/ijerph16183235
Chicago/Turabian StyleGulotta, Giampiero, Giannicola Iannella, Claudio Vicini, Antonella Polimeni, Antonio Greco, Marco de Vincentiis, Irene Claudia Visconti, Giuseppe Meccariello, Giovanni Cammaroto, Andrea De Vito, and et al. 2019. "Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art" International Journal of Environmental Research and Public Health 16, no. 18: 3235. https://doi.org/10.3390/ijerph16183235