Wednesday, January 14, 2015

Obstructive sleep apnea in childhood and adolescence

There is limited study data about the natural course of obstructive sleep apnea (OSA) in children. This study looked at OSA incidence and remission from middle childhood (ages 8-11 years) through late adolescence (ages 16-19 years). It also studied if risk factors for OSA that were present in middle childhood remained in adolescence. This was a retrospective study from a larger sleep and health study.

Of note, OSA in children is typically defined as full or partial collapse of the airway at least 1 time an hour. In this study, the authors used a more conservative measure of 5 or more airway collapses per hour. The results showed OSA was present in 4.7% of middle childhood aged kids and in 4.3% of adolescents. And only 8.7% of those with OSA in middle childhood still had OSA in adolescence - meaning almost 91% of cases of OSA resolved between middle childhood and adolescence. And of those whose OSA had remitted by adolescence, only 24% had had tonsillectomy, the treatment of choice for OSA in children. So in 3 out of 4 cases, the OSA went away on it's own, without surgical intervention. Of the children without OSA, only 4% went on to be diagnosed with OSA in adolescence.

Unlike OSA, habitual snoring was much more persistent from middle childhood to adolescence. Half of the snorers in middle childhood were still snoring in adolescence, yet most of them did not go on to develop OSA as adolescents. However, when the study authors lowered the threshold for diagnosing OSA, 32% of middle childhood snorers went on to develop OSA in adolescence.

Risk factors for middle childhood OSA were African American race, preterm status, and neighborhood distress. However, these were not risk factors for OSA in adolescents. Instead, the risk factors were male sex and history of tonsillectomy or adenoidectomy. Finally, adolescents with OSA had a higher body-mass index (marker for obesity) compared to adolescents and middle childhood kids without OSA. The authors speculated that the changing risk factors may reflect the fact that upper airway changes occur from middle childhood to adolescence, especially regression of tonsils. Thus, other factors like male gender and obesity would be more important in adolescents. The authors go on to explain that the risk factor of prior tonsillectomy in adolescents with OSA may be due to other risk factors that reflect a predisposition for upper airway collapse in sleep.

The authors concluded that screening for OSA could be age specific given the different risk factors present at the different ages. Also, the cutoff values for OSA may need to be altered given the child's age - using a more liberal cutoff for younger children and a more conservative one for older children. This is already being done at many sleep centers, where the sleep physician can use adult criteria or pediatric criteria cutoff values for children aged 13 and older.

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