Snoring and Obstructive Sleep Apnea in Children

An Evidence-Based, Multidisciplinary Approach

1st Edition - November 11, 2023
Editors: Amal Isaiah, Ron B. Mitchell
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 9 9 6 5 3 - 2
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 9 9 6 5 4 - 9

Snoring and Obstructive Sleep Apnea in Children: An Evidence-Based, Multidisciplinary Approach provides researchers and practitioners with a complete and comprehensive source of… Read more

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Snoring and Obstructive Sleep Apnea in Children: An Evidence-Based, Multidisciplinary Approach provides researchers and practitioners with a complete and comprehensive source of information on the epidemiology, pathophysiology, diagnosis, management and controversies concerning sleep disordered breathing in infants. Written by an interdisciplinary team of authors, chapters consolidate information on the evaluation and management of pediatric sleep disordered breathing (SDB) currently fragmented across different specialties.

Principles of surgery for SDB as well as non-medical approaches, such as continuous positive airway pressure (CPAP) are covered, and a section dedicated to controversies in pediatric SDB discusses clinical cases and future trends for the treatment of snoring and obstructive sleep apnea in children.

Cover image
Title page
Table of Contents
Copyright
Dedication
List of contributors
Preface
Section 1: Epidemiology and pathophysiology
Chapter 1. Anatomy of the upper airway
Abstract
1.1 Introduction
1.2 Nasal airway
1.3 Nasopharynx
1.4 Oral cavity
1.5 Oropharynx
1.6 Hypopharynx
1.7 Conclusion
References
Chapter 2. Regulation of the upper airway during sleep
Abstract
2.1 Introduction
2.2 Central respiratory control of the upper airway
2.3 Anatomy of the upper airway
2.4 Physiology of the upper airway during sleep
2.5 Neuromuscular compensation
2.6 Ventilatory control
2.7 Sleep state effect
2.8 Arousal
References
Chapter 3. Socioeconomic disparities in pediatric sleep disordered breathing
Abstract
3.1 Introduction
3.2 Disparities in prevalence of sleep disordered breathing
3.3 Disparities in access to care and treatment
3.4 Disparities in treatment outcomes
3.5 Disparities in complications after treatment
3.6 Interpersonal communication and mitigation strategies in sleep disordered breathing disparities
3.7 Conclusions
References
Chapter 4. Cerebral oxygenation in pediatric obstructive sleep apnea
Abstract
4.1 Introduction
4.2 Measuring cerebral hemodynamics
4.3 Relationship between sleep disordered breathing and cerebral hemodynamics
4.4 Conclusion
Abbreviations
References
Chapter 5. Genetics of pediatric obstructive sleep apnea
Abstract
5.1 Introduction
5.2 Genetic risks associated with obstructive sleep apnea
5.3 Methods to explore genetic factors in pediatric obstructive sleep apnea
5.4 Conclusion
References
Chapter 6. Neurobehavioral outcomes of pediatric obstructive sleep apnea
Abstract
6.1 Introduction
6.2 Imaging-based studies in pediatric obstructive sleep apnea
6.3 Neurobehavioral sequelae of obstructive sleep apnea
6.4 Conclusion
References
Chapter 7. Quality of life outcomes of pediatric obstructive sleep apnea
Abstract
7.1 Introduction
7.2 Quality of life assessment instruments
7.3 Conclusion
References
Chapter 8. Cardiovascular complications of pediatric obstructive sleep apnea
Abstract
8.1 Introduction
8.2 Pathophysiological mechanisms linking pediatric obstructive sleep apnea to CVD
8.3 Conclusions
References
Chapter 9. Pediatric obstructive sleep apnea: high-risk groups
Abstract
9.1 Introduction
9.2 Obesity
9.3 Prematurity
9.4 Down syndrome
9.5 Craniofacial conditions
9.6 Conclusion
References
Chapter 10. Growth and development in pediatric obstructive sleep apnea
Abstract
10.1 Impact on behavior
10.2 Impact on attention
10.3 Impact on memory
10.4 Impact on speech and language development
10.5 Impact on academic performance
10.6 Impact on growth and physical parameters
10.7 Impact on blood pressure
10.8 Impact on systemic inflammation
10.9 Potential mechanisms of obstructive sleep apnea-induced growth and developmental dysfunction
10.10 Weight gain and catch-up growth after adenotonsillectomy
10.11 Conclusions
References
Section 2: Evaluation
Chapter 11. Symptoms and signs of upper airway obstruction
Abstract
11.1 Introduction
11.2 Clinical presentation of upper airway obstruction
11.3 Summary
References
Chapter 12. Polysomnography for evaluation of upper airway obstruction
Abstract
12.1 Introduction
12.2 Indications for PSG
12.3 Monitoring during PSG
12.4 Types of respiratory events
12.5 Reporting of respiratory events
12.6 How to decipher a sleep study interpretation
12.7 Special situations
References
Chapter 13. Imaging upper airway obstruction in obstructive sleep apnea
Abstract
13.1 Introduction
13.2 Anatomical and functional considerations
13.3 Imaging techniques
13.4 Imaging the normal airway
13.5 Imaging the obstructed airway
13.6 Special imaging considerations
13.7 Clinical applications of advanced imaging
13.8 Future directions
References
Chapter 14. Pediatric drug-induced sleep endoscopy
Abstract
14.1 Introduction
14.2 Indications for drug-induced sleep endoscopy
14.3 Drug-induced sleep endoscopy technique: anesthesia and room setup considerations
14.4 Structures to examine during drug-induced sleep endoscopy
14.5 Describing drug-induced sleep endoscopy findings
14.6 Outcomes
14.7 Future directions
14.8 Conclusions
References
Chapter 15. Questionnaires for pediatric obstructive sleep apnea
Abstract
15.1 Introduction
15.2 Scope of questionnaires
15.3 Conclusion
References
Chapter 16. Technology applications for detection of upper airway obstruction
Abstract
16.1 Introduction
16.2 Need for portable technology for detection of upper airway obstruction
16.3 Types of portable technology applications for stratification of sleep-disordered breathing
16.4 Conclusion
References
Section 3: Management
Chapter 17. Adenotonsillectomy
Abstract
17.1 Introduction
17.2 Anatomy
17.3 Indications
17.4 Perioperative considerations for adenotonsillectomy
17.5 Tonsillectomy methods
17.6 Adenoidectomy methods
17.7 Special considerations
17.8 Complications
17.9 Conclusion
References
Chapter 18. Surgical management of obstructive sleep apnea following adenotonsillectomy
Abstract
18.1 Introduction
18.2 Adjuvant surgical procedures
18.3 Conclusion
References
Chapter 19. Maxillofacial procedures
Abstract
19.1 Introduction
19.2 Mandibular distraction osteogenesis
19.3 Rapid maxillary expansion
19.4 Midface distraction osteogenesis
19.5 Frontofacial monobloc advancement
19.6 Maxillomandibular advancement
19.7 Conclusion
References
Chapter 20. Positional therapy for pediatric obstructive sleep apnea
Abstract
20.1 Introduction
20.2 Prevalence of positional obstructive sleep apnea in the pediatric population
20.3 Positional obstructive sleep apnea: anatomical and physiological mechanisms
20.4 Diagnosis of positional obstructive sleep apnea
20.5 Treatment of positional obstructive sleep apnea
20.6 Future directions
References
Chapter 21. Orofacial myofunctional therapy for pediatric sleep disordered breathing
Abstract
21.1 Introduction
21.2 Craniofacial growth and sleep disordered breathing
21.3 Orofacial myofunctional evaluation
21.4 Orofacial myofunctional exercises
21.5 Obstructive sleep disordered breathing and orofacial myofunctional therapy
21.6 Recent evidence
21.7 Conclusion
References
Chapter 22. Antiinflammatory therapy for pediatric obstructive sleep apnea
Abstract
22.1 Introduction
22.2 Types of medical therapy for pediatric obstructive sleep apnea syndrome
22.3 Conclusion
References
Chapter 23. Positive airway pressure therapy for pediatric obstructive sleep apnea
Abstract
23.1 Introduction
23.2 Why should obstructive sleep apnea be treated?
23.3 When is nighttime respiratory support indicated?
23.4 What are the different modes of positive airway pressure therapy?
23.5 How to choose the appropriate positive airway pressure therapy setting?
23.6 What are the benefits of positive airway pressure therapy?
23.7 How often should the child follow up?
23.8 How to measure treatment adherence and efficacy
23.9 What are the facilitators and barriers to adherence?
23.10 Equipment troubleshooting and maintenance
23.11 Symptoms commonly reported by children using positive airway pressure
23.12 When is a repeat titration polysomnogram indicated?
23.13 Conclusion
References
Chapter 24. Clinical guidelines for the management of pediatric obstructive sleep apnea
Abstract
24.1 Introduction
24.2 Screening for pediatric obstructive sleep apnea
24.3 Diagnostic workup
24.4 Treatment
24.5 Conclusion
References
Chapter 25. Comorbid asthma in children with pediatric obstructive sleep apnea
Abstract
25.1 Introduction
25.2 Effects of asthma on sleep
25.3 Effects of obstructive sleep apnea on sleep
25.4 Asthma as a comorbid condition in obstructive sleep apnea
25.5 A practical approach to the care of children with asthma and obstructive sleep apnea
25.6 Conclusion
References
Section 4: Special cases/controversies
Chapter 26. Obstructive sleep apnea in infancy: evaluation and management
Abstract
26.1 Upper airway obstruction in infants
26.2 Epidemiology and prevalence
26.3 Etiology and pathogenesis
26.4 Diagnosis
26.5 Treatment
26.6 Conclusion
References
Chapter 27. Obstructive sleep apnea and attention deficit hyperactivity disorder
Abstract
27.1 Introduction
27.2 Obstructive sleep apnea in children with attention deficit hyperactivity disorder
27.3 Attention deficit hyperactivity disorder in children with obstructive sleep apnea
27.4 Potential mechanisms for the link between attention deficit hyperactivity disorder and obstructive sleep apnea
27.5 Age and gender influences
27.6 Treatment implications
27.7 Conclusion
References
Chapter 28. Home sleep studies
Abstract
28.1 Introduction
28.2 Categories of diagnostic sleep equipment
28.3 Biological parameters and home sleep apnea tests sensors
28.4 Level III devices
28.5 Level IV devices
28.6 Portable monitoring in children with comorbidities
28.7 Summary
References
Chapter 29. Severe, very severe, and extreme obstructive sleep apnea: principles of management
Abstract
29.1 Introduction
29.2 Pathogenesis of pediatric obstructive sleep apnea
29.3 Treatment modalities for very severe and extreme obstructive sleep apnea
29.4 Adenotonsillectomy
29.5 Postadenotonsillectomy care
29.6 Identifying sites of obstruction postadenotonsillectomy
29.7 Initiation of positive airway pressure therapy
29.8 Additional sites of obstruction
29.9 Special considerations for children with very severe to extreme obstructive sleep apnea
29.10 Impact of obstructive sleep apnea
29.11 Conclusion
References
Chapter 30. Sleep-related hypoxemia in children
Abstract
30.1 Definition
30.2 Control of breathing
30.3 Physiology and pathophysiology
30.4 Relevance of detecting sleep-related hypoxemia
30.5 Diagnostic criteria
30.6 Diagnostic tools
30.7 Technical considerations while assessing oxygen saturation
30.8 Special circumstances
30.9 Differential diagnoses
30.10 Management
References
Chapter 31. Obstructive sleep apnea in children with Down syndrome
Abstract
31.1 Introduction
31.2 Prevalence of obstructive sleep apnea in Down syndrome
31.3 Clinical features and pathophysiology of Down syndrome
31.4 Investigations
31.5 Consequences of obstructive sleep apnea
31.6 Nonsurgical management
31.7 Surgical management
31.8 Conclusion
References
Chapter 32. Obstructive sleep apnea in adolescents
Abstract
32.1 Introduction
32.2 Definitions
32.3 Pathophysiology of obstructive sleep apnea in adolescents
32.4 Treatment
32.5 Conclusions
References
Chapter 33. Hypoglossal nerve stimulation
Abstract
33.1 Introduction
33.2 Hypoglossal nerve stimulation in Down syndrome patients
33.3 Anatomical considerations related to the hypoglossal nerve
33.4 Surgical technique and pediatric modifications to hypoglossal nerve stimulation for obstructive sleep apnea
References
Chapter 34. Future directions
Abstract
34.1 Introduction
34.2 Telemedicine for diagnosis and treatment
34.3 Imaging
34.4 Treatment of obstructive sleep apnea in children without comorbidities
34.5 Obstructive sleep apnea–related outcomes
34.6 Precision medicine for the treatment of obstructive sleep apnea in medically complex children
34.7 Long-term obstructive sleep apnea and obstructive sleep apnea–related outcomes evolutions over time in children with and without treatment require longitudinal, prospective studies
34.8 From individual to family and society
34.9 Genotype–phenotype interactions in pediatric obstructive sleep apnea
34.10 Conclusions
References
Index

Amal Isaiah

Dr. Isaiah earned a medical degree in India with multiple honors and was awarded a Rhodes Scholarship to complete a DPhil (PhD) in Neuroscience at the University of Oxford. During doctoral training, he studied brain plasticity using electrophysiological, statistical, computational, and behavioral techniques. Following postdoctoral training (University of Maryland), residency in otolaryngology (University of Maryland), and a clinical fellowship in pediatric otolaryngology (UT Southwestern/Children’s Dallas), he joined the faculty at University of Maryland in 2016, rising to a full Professor in 2023. He has published widely in the domains of sleep disordered breathing (SDB), brain development, and statistical modeling and leads a laboratory funded by the National Institutes of Health (NIH). Dr. Isaiah is interested in technology development and has a portfolio of multiple patents related to upper airway obstruction

Affiliations and expertise

Professor, Otorhinolaryngology - Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, United States

Ron B. Mitchell

Dr. Mitchell earned his medical degree at the University of Southampton in England. He completed residencies in general surgery and otolaryngology at the Royal College of Surgeons of England and then received advanced training in pediatric otolaryngology through a fellowship at Le Bonheur Children’s Hospital in Memphis. In addition to his roles at UT Southwestern, he serves as head of the Sleep Disorders Center at Children’s Medical Center. Dr. Mitchell is the past president of the American Society of Pediatric Otolaryngology and is actively involved in his profession’s national leadership, chairing multiple committees, including a recent task force of the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) that published Clinical Practice Guideline: Tonsillectomy in Children (Update). A highly respected educator, he has delivered lectures on pediatric otolaryngology and pediatric sleep medicine across the United States and in Israel, Panama, Argentina, Brazil, and Mexico.

Affiliations and expertise

Professor and Vice Chairman, Department of Otolaryngology - Head and Neck Surgery, Chief of Pediatric Otolaryngology, UT Southwestern and Children's Medical Center Dallas, TX, United States