Egambaram Senthilvel

To assess the screening awareness of obstructive sleep apnea in children with Down syndrome among Primary Care and Pediatric Sub-Specialty Clinicians. A 15-question cross-sectional survey was conducted to determine the current awareness of OSA screening in DS children among primary care and pediatric subspecialty clinicians in the state of Kentucky. A Fisher's Exact test was performed to determine if the proportions of respondents differed significantly among different clinicians. A total of 97 responses were included. 73% of the clinicians specialized in pediatrics, 23% in family medicine, and 3% in ENT. Of the respondents, 50% were physician attendings, 27% were residents, and 23% were nurse practitioners or physician assistants. Although 94% of the respondents were aware that the prevalence of OSA in children with DS is higher than normally developing children, only 26% were aware of AAP guidelines and only 29.6% knew the age-specific threshold for screening regardless of symptoms. A significant difference existed between the type of clinicians who agreed that all DS children should undergo OSA screening regardless of symptoms: 85.4% of attending physicians, 57.7% of residents, and 81.8% of nurse practitioners (p < 0.03). In terms of specialty, 84% in pediatrics, 50% in medicine/pediatrics, and 59% in family medicine (p < 0.003). AAP screening guidelines for awareness of OSA in DS children vary among clinicians, their practice, and their specialty in Kentucky. Given the clinical implications of OSA, clinicians can utilize this study to identify knowledge gaps to address the barriers to screening guidelines education.

Introduction: Children with spinal muscular atrophy (SMA) are at high risk for sleep-disordered breathing (SDB). This study compared polysomnogram (PSG) findings in children with SMA versus healthy controls and differences by functional status. Methods: In this single-center retrospective study, 17 children with confirmed SMA underwent an overnight PSG and were compared with 17 controls matched by age, sex, body mass index (BMI), and apnea–hypopnea index (AHI). Obstructive sleep apnea (OSA) severity was defined by obstructive AHI (OAHI): normal (<1/hr), mild (1–4.9), moderate (5–9.9), and severe (≥10). Results: Thirty-four PSGs were analyzed. Mean age was 4.0 (SMA) vs. 4.7 years (controls); 70.6% were female. OSA distribution was similar in both groups (47% none, 29% mild, 17% moderate, and 5% severe). Compared to controls, the SMA group had lower total sleep time (386.5 vs. 421.5 min, p=0.022), less N1 sleep (3.5 vs. 18.5 min, p=0.006), and reduced non-rapid eye movement (non-REM) sleep (255.3 vs. 333.2 min, p=0.004). Mean non-REM carbon dioxide (CO₂) was lower (39.5 vs. 42.3 mmHg, p=0.011), while mean heart rate (HR) was higher (100.8 vs. 87.1 bpm, p=0.017) in the SMA group. Central apnea (CA) time differed by functional status (non-sitters 3.8 seconds, sitters 2.9 seconds, and walkers 5.5 seconds; p=0.021). Periodic limb movement index (PLMI) was the highest in walkers (7.1 vs. 0.0 in other groups; p=0.02). Conclusion: Over half of the children with SMA exhibited SDB. Compared with AHI-matched controls, they showed reduced TST, lower non-REM CO₂, and PSG differences across functional statuses.

Objective: To assess the prevalence of obstructive sleep apnea (OSA) in a cohort of children with craniofacial syndromes (CFS) within a single institution, and to describe their polysomnographic (PSG) characteristics and the overall management of OSA in this cohort. Design: A single-center retrospective study. Electronic healthcare records were used to access information regarding medical history, surgical history, and PSG details of patients with CFS. Setting: This study took place at a tertiary care center affiliated with a school of medicine. Patient, Participants: Patients with CFS under the age of 18 years with PSG data were assessed. Interventions: No intervention was performed as it was retrospective study. Main Outcome Measures: Obstructive sleep apnea prevalence among children with CFS. Results: A total of 46 patients were included in this study. In our study, 69.6% of the children with CFS had OSA, with 39.1% of them classified as severe. We performed mandibular distraction osteogenesis (MDO) to treat 26.5% of patients with OSA. The prevalence of OSA was 93.8% among a total of 16 Pierre Robin Sequence (PRS) patients. MDO substantially decreased apnea-hypopnea index (AHI), rapid eye movement AHI, and EtCO2 in PRS patients while simultaneously increasing SpO2 and total sleep time. Conclusions: Obstructive sleep apnea is more prevalent in children with CFS than was previously recognized, and MDO is the most frequently employed treatment. Pierre Robin Sequence is the most prevalent pediatric CFS associated with OSA. Mandibular distraction osteogenesis significantly improves OSA and sleep quality in PRS patients.

Purpose We aimed to evaluate the characteristics of sleep disordered breathing (SDB) in a cohort of pediatric patients with achondroplasia and to describe magnetic resonance imaging (MRI) findings and management strategies. Methods A single center retrospective study that included a cohort of pediatric achondroplasia patients and age, gender, and AHI-matched normally developed controls. Medical records and PSGs were reviewed for both cohorts and additionally MRI findings and SDB management strategies were evaluated in the achondroplasia cohort. Results A total of 15 subjects were included in the achondroplasia cohort and they were matched to 15 normally developed subjects included in the control group. 60% were found to have an AHI in the moderate-to-severe range, and 86.7% subjects were found to have apnea that was predominately obstructive in nature. There were no significant differences found in sleep efficiency, wake after sleep onset, arousal index, time spent in each sleep stage, or oxygen desaturation nadir between the two groups. In the achondroplasia group, MRI findings demonstrated foramen magnum stenosis in 33.3% (5 patients), 2 of whom had subsequent decompression surgery. Within this cohort, 3 patients underwent adenotonsillectomy and 4 patients received positive airway pressure therapy. Conclusion There were no significant differences found between sleep architecture and arousal index between children with achondroplasia and normally developed control subjects. This supports the belief that general management strategies for pediatric SDB, including adenotonsillectomy and continuous positive airway pressure, may be beneficial in this population. However, due to the increased risk of foramen magnum stenosis in this population, evaluation of SDB should also include neuroimaging when clinically warranted.

Purpose To assess OSA prevalence, comorbidities, and the influence of sleep stages and body positions on respiratory events distribution in toddlers aged 12–24 months. Methods A single center retrospective study that included toddlers aged 12–24 months old who underwent overnight PSG. OSA severity was categorized by obstructive apnea-hypopnea index (OAHI) as mild (1–4.9 events/h), moderate (5–9.9 events/h), and severe (≥ 10 events/h). Results 283 PSG data were included with a median age of 18 months (IQR 16–20.25) for the OSA group (168/283) and 19 months (IQR 16–22) for the non-OSA group (115/283) (p = 0.047). OSA prevalence was 68.5% (42.3% mild, 18.5% moderate, and 39% severe). 38.1% of children had no comorbidities, 24.4% had a history of prematurity and 11.3% had Down syndrome. Multivariate binominal regression analysis showed that children with history of prematurity (p = 0.017) and Down syndrome (p = 0.043) had higher odds of having OSA. The mean SaO₂ in REM sleep was lower, and the mean time spent with oxygen saturation below 90% was higher in children with neuromuscular disease compared to those with other comorbidities. In toddlers without comorbidities, the median REM OAHI was 29.8 events/h (IQR: 58.48), whereas the median non-REM OAHI was 4.1 events/h (IQR: 10.4 p < 0.001). Supine OAHI was 7.9 (IQR: 24.9), and off supine OAHI was 10.5 (IQR: 18.1, p = 0.407). Conclusion In toddlers aged 12–24 months, history of prematurity and Down syndrome were significantly associated with OSA. Obstructive respiratory events occurred predominantly in REM sleep, and no significant positional relations were noted.

Purpose This study aimed to evaluate polysomnographic (PSG) outcomes of tonsillectomy and adenoidectomy (T&A) in children with Down Syndrome (DS) and OSA, and the difference in PSG outcomes of T&A between children with DS and age- and gender-matched normally developing (non-DS) children. Methods This was a single center retrospective study that included children with DS and OSA who underwent T&A and had pre-operative and post-operative PSG. The baseline and the differences of pre- and post-operative PSG variables were compared with those of an age- and gender-matched group of non-DS children. Results Forty-eight children with DS were included in the study; the median age was 5 years (IQR 5.5), 58% were males, and the median BMI was 18.2 (IQR 3.3). There was statistically significant improvement noted between pre-operative and post-operative OAHI 17.9 ± 26.7 vs. 9.1 ± 13.6 (p = 0.022) and non-REM AHI 13.9 ± 19.7 vs. 6.9 ± 14.2 (p = 0.027). However, there were no significant changes in sleep architecture, oxygen desaturation nadir, or CO2 levels. 54.2% of the DS children continued to have moderate to severe OSA after T&A. Univariate logistic regression showed that for every 1% increase in oxygen desaturation nadir, the odds of having residual moderate or severe OSA decreased by 28% (p = 0.002) compared to the cured and mild OSA groups. There was no significant pre- and post-operative differences in PSG variables noted in 16 children with DS compared to age- and gender-matched non-DS children. Conclusion Despite the overall significant reduction of OAHI in children with DS and OSA who underwent T&A, there was a residual moderate to severe OSA in about half of the included children. Oxygen desaturation nadir was a predicting factor for persistent moderate to severe OSA. There were no significant pre- and post-operative PSG differences in between DS children compared to non-DS children.

Neuroendocrine hyperplasia of infancy is a rare form of pediatric interstitial lung disease presenting with hypoxemia, tachypnea, retractions, and persistent pulmonary crackles in the first year of life. As these children frequently require supplemental oxygen therapy and demonstrate nighttime hypoxemia, there is a concern for an increased prevalence of sleep-disordered breathing in this population, including obstructive sleep apnea. As untreated sleep-disordered breathing is associated with adverse developmental outcomes for children, it is essential to promptly diagnose and treat. However, treatment of obstructive sleep apnea is often challenging in children. In this report, we describe a case of a child diagnosed with neuroendocrine hyperplasia of infancy at 12 months of age who was subsequently found to have severe obstructive sleep apnea that persisted despite adenotonsillectomy. As continuous positive airway pressure was not well tolerated, the patient was initiated on a high-flow nasal cannula at nighttime, which resulted in improvement of his sleep apnea and daytime functioning with better adherence to treatment. Our case illustrates the importance of screening for sleep-disordered breathing in patients with neuroendocrine hyperplasia of infancy, as well as the utility of a high-flow nasal cannula as a novel, effective treatment for pediatric obstructive sleep apnea.

Introduction Recurrent/residual adenoidal hypertrophy after adenotonsillectomy in children can result in obstructive sleep apnea (OSA). We aimed to assess the polysomnographic (PSG) outcomes of revision adenoidectomy in children with recurrent/residual adenoidal hypertrophy and OSA. Methods This was a single-center retrospective study that included children with sleep studies that confirmed OSA and known history of adenotonsillectomy who were diagnosed with adenoidal hypertrophy and subsequently underwent revision adenoidectomy. Pre- and postoperative PSG variables of revision adenoidectomy were included in the analysis. Results A total of 20 children were included in the study. The cohort included 13 males and 7 females with a mean age of 7.8 years (± 3.6 years). The mean BMI z score was 1.96 [1.31, 2.43]. The median duration from adenotonsillectomy performance was 2.3 years [1.4, 4.0]. Overall, revision adenoidectomy resulted in significant improvements in multiple respiratory parameters, including AHI 6.6 [1.4, 13. 7] vs 14.8 [7.4, 20.7], p = 0.02; oxygen desaturations nadir 88.0 [84.0, 93.0] vs 80.0 [72.2, 88.9], p = 0.01; supine AHI 8.6 [1.5, 14.3] vs 17.6 [8.3, 30.2], p = 0.02; and arousal index 12.2 [9.6, 15.7] vs 18.9 [13.4, 24.9], p = 0.04. Conclusions Children with recurrent/residual adenoidal hypertrophy after adenotonsillectomy who undergo revision adenoidectomy experience improvements in respiratory event, gas exchange, and arousal index.

Purpose Children with Down Syndrome (DS) have a high prevalence of obstructive sleep apnea (OSA). We aimed to assess OSA prevalence in a single center cohort of children with DS, identify associated risk factors of obstructive respiratory events, and examine the influence of different sleep stages and body positions on respiratory events distribution. Methods Single center retrospective study that included children with DS who underwent overnight polysomnogram (PSG). OSA severity was categorized by obstructive apnea–hypopnea index (OAHI) as mild (1.5–4.9 events/h), moderate (5–9.9 events/h), and severe (≥ 10 events/h). A logistic regression analysis was used to examine the association between OSA-related risk factors in normal and abnormal OAHI category and in REM and Non-REM predominant AHI groups. Results PSG data were available for 192 children with a median age of 5 years (IQR 7). OSA prevalence was 82.3% (27.1% mild, 19.8% moderate, and 35.4% severe). A logistic regression model identified BMI and being an African American as significant predictors for OAHI severity. In children with OSA, the median OAHI was 7.6 and obstructive respiratory events were more common in REM sleep and in the supine position. The median REM OAHI was 20 events/h (IQR: 24.4), whereas the median Non-REM OAHI was 5.2 events/h (IQR: 12.6 p < 0.0001). Similarly, supine OAHI was 11.6 (IQR: 19.3) and off supine OAHI was 6.6 (IQR: 11.6, p = 0.0004). Age was a significant predictor (p = 0.012) for Non-REM predominant OSA which was present in 15.2% of children with OSA. Conclusion Children with DS have a high prevalence of OSA. Higher BMI and being an African American were significant associated risk factors for higher OAHI. Obstructive respiratory events in children with DS occur predominantly in REM sleep and in the supine position. Non-REM predominant distribution of respiratory events was noted in older children with DS.