Materiały źródłowe

• #1 Pediatric Obstructive Sleep Apnea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557610/

  Obstructive sleep apnea (OSA) is an essential topic in pediatrics that is frequently overlooked, especially in the context of children with neurodevelopmental delay. The American Thoracic Society and the American Academy of Pediatrics define obstructive sleep apnea in children as a sleep-related breathing disorder with intermittent upper airway obstruction that disrupts normal sleep patterns. This activity highlights the role of the interprofessional team in the diagnosis and treatment of this condition. […] Pediatric obstructive sleep apnea (OSA) is a childhood disorder in which there is upper airway dysfunction causing complete or partial airway obstruction during sleep leading to decreased oxygen saturation or arousals from sleep. It can have dramatic effects on childhood behavior, neurodevelopment, metabolism, and overall health. Early recognition, evaluation, and treatment are important to prevent long-term consequences.

• #2 Pediatric obstructive sleep apnea – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/symptoms-causes/syc-20376196

  Pediatric obstructive sleep apnea is a condition in which a child’s breathing is partly or completely blocked during sleep. Breathing can briefly stop and start again many times a night. The condition happens when the upper airway narrows or is blocked during sleep. […] It’s important for healthcare professionals to find and treat pediatric obstructive sleep apnea as soon as possible. Early treatment helps prevent other health conditions called complications. These can affect children’s growth, learning, behavior and heart health. The first treatment may be surgery to remove enlarged tonsils and adenoids. But some children may get better using medical devices or taking medicines. […] See your child’s healthcare professional if your child has any symptoms of obstructive sleep apnea, including frequent snoring.

• #3 Recognising paediatric obstructive sleep apnoea in primary care: diagnosis and management | British Journal of General Practice

  https://bjgp.org/content/67/659/282

  Obstructive sleep apnoea (OSA) is part of a spectrum of sleep-disordered breathing diseases. This ranges from benign simple snoring, affecting up to 12% of children, to severe upper airways resistance and OSA, which affects 12% of children. Paediatric OSA can be associated with serious consequences including cor pulmonale, right ventricular hypertrophy, and systemic hypertension, if left untreated. […] The majority of paediatric OSA is caused by adenotonsillar hypertrophy in children with no pre-existing medical conditions; this is known as uncomplicated OSA. Complicated OSA refers to a subgroup of children with medical conditions predisposing to OSA; obesity is an important predisposing condition. Traditionally, paediatric OSA occurs among pre-school children, although there is an emerging peak in middle childhood and adolescence attributed to the rising obesity epidemic. OSA affects boys and girls in equal numbers.

• #4 How to Treat Sleep Apnea in Children | Cedars-Sinai

  https://www.cedars-sinai.org/blog/pediatric-obstructive-sleep-apnea.html

  Sleep apnea can occur at any age, but is most common between ages 2 and 8 during the period of peak tonsil growth. […] However, obesity is a risk factor for sleep apnea in children. […] The first occurs when there’s not enough space in the back of the throat for air to flow easily into their windpipe to get into their lungs. […] Mild sleep apnea (which can be caused by allergies or enlarged tonsils or adenoids) can be treated with an oral medication, such as montelukast or different types of nasal steroid or antihistamine sprays. […] For children who have moderate to severe sleep apnea, the gold standard of treatment is to remove part or all of the tonsils and the adenoids. […] Continuous positive airway pressure (CPAP) machines can also be a treatment option for patients who have already gotten a tonsillectomy and adenoidectomy but still have significant sleep apnea. […] Some children who have mild sleep apnea may be medically managed and may not necessarily need surgical therapy. Children who tend to have moderate and severe sleep apnea, however, often don’t get better until they have surgical treatment (removing part or all of the tonsils and adenoids).

• #5 Pediatric obstructive sleep apnea – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/symptoms-causes/syc-20376196

  Without treatment, pediatric obstructive sleep apnea can lead to other health conditions called complications. Rarely, pediatric obstructive sleep apnea can cause infants and young children not to grow as much as those who don’t have the condition. Children who don’t receive treatment also may have a higher risk of later complications such as: High blood pressure. High cholesterol. A higher than typical blood sugar level that raises the risk of diabetes. Other heart and blood vessel conditions. […] But in most children, treatment can help manage complications.

• #6 Obstructive Sleep Apnea in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0301/p1147.html

  Obstructive sleep-disordered breathing is common in children. From 3 percent to 12 percent of children snore, while obstructive sleep apnea syndrome affects 1 percent to 10 percent of children. […] Consequences of untreated obstructive sleep apnea include failure to thrive, enuresis, attention-deficit disorder, behavior problems, poor academic performance, and cardiopulmonary disease. […] Treatment includes the use of continuous positive airway pressure and weight loss in obese children. […] Adenotonsillectomy is curative in most patients. […] Children with craniofacial syndromes, neuromuscular diseases, medical comorbidities, or severe obstructive sleep apnea, and those younger than three years are at increased risk of developing postoperative complications and should be monitored overnight in the hospital.

• #7 Pediatric Obstructive Sleep Apnea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557610/

  Diagnosis of sleep apnea is made by measuring the apneic events during sleep. The diagnostic criteria are detailed in the evaluation section. The four main features that contribute to OSA are obesity, lymphoid hyperplasia, craniofacial abnormalities, and neuromuscular dysfunction. […] Many different treatment options are depending on the severity of the OSA. These include both surgical and non-surgical interventions. A therapeutic trial of leukotriene inhibitors (montelukast) may be appropriate for pediatric patients who are diagnosed with mild to moderate OSA. […] Continuous positive airway pressure (CPAP) is another potential treatment option. While this is the first-line treatment in adults, there are limitations to the use of PAP in children. […] If left untreated, pediatric OSA can have serious morbidities and long-term complications. Sustained hypoxia can increase pulmonary vasoconstriction and lead to pulmonary hypertension and right heart failure at an early age. Cognitive dysfunction, impaired learning, and poor school performance are associated with undiagnosed and untreated pediatric OSA. […] Before diagnosis, parents should be educated at well-child checks to be vigilant about signs and symptoms of pediatric OSA, including loud nightly snoring, frequent nighttime awakenings, secondary nocturnal enuresis, and behavioral changes in their children.

• #8 Pediatric Obstructive Sleep Apnea – Conditions and Treatments | Children’s National Hospital

  https://www.childrensnational.org/get-care/health-library/obstructive-sleep-apnea

  Obstructive sleep apnea is when a child briefly stops breathing while sleeping. It often occurs because of a blockage in the airway. The most common cause is large tonsils and adenoids in the upper airway. […] The treatment for obstructive sleep apnea is based on the cause. It may include: Surgery to remove the enlarged tonsils and adenoids. Your child’s healthcare provider will discuss the risks and benefits with you. Weight loss. If your child is overweight, losing weight may ease symptoms. Continuous positive airway pressure (CPAP). While sleeping, your child wears a special mask that delivers a steady stream of air to keep his or her airway open. Some children may have trouble getting used to the mask. Rapid maxillary expansion. This is a device put in place by an orthodontist. The device widens the palate and nasal passages. Inhaled steroids. These medicines may help children with mild or moderate obstructive sleep apnea caused by enlarged tonsils. Staying away from secondhand smoke, indoor pollutants and allergens. This is important for children who also have nasal congestion. […] Children’s National experts in pediatric sleep medicine can help diagnose and treat sleep disorders in children. Learn more about diagnostic testing, therapeutic intervention and treatment for sleep disorders.

• #9 Obstructive Sleep Apnea (OSA) in Children – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sleep-apnea/obstructive-sleep-apnea-osa-in-children

  Obstructive sleep apnea (OSA) is episodes of partial or complete closure of the upper airway that occur during sleep and lead to breathing cessation. Symptoms include snoring and sometimes restless sleep, nocturnal sweating, morning headache, and problems concentrating. Complications of OSA may include learning or behavioral disturbances, growth disturbance, cor pulmonale, and pulmonary hypertension. Diagnosis is by polysomnography. Treatment is usually adenotonsillectomy. […] The prevalence of obstructive sleep apnea in children is about 2%. The condition is underdiagnosed and can lead to serious sequelae. […] Risk factors for obstructive sleep apnea in children include the following: Obesity (the most common cause), Enlarged tonsils or adenoids, Allergic rhinitis (ie, causing significant nasal congestion), Craniofacial abnormalities (eg, micrognathia, retrognathia, midfacial hypoplasia, excessively angled skull base), Certain medications (eg, sedatives, opioids), Mucopolysaccharidoses, Disorders causing hypotonia or hypertonia (eg, Down syndrome, cerebral palsy, muscular dystrophies), Possibly genetic factors (eg, congenital central hypoventilation disorders that can include both obstructive and central sleep apneas, and Prader-Willi syndrome and others).

• #10 Pediatric Obstructive Sleep Apnea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557610/

  Diagnosis of sleep apnea is made by measuring the apneic events during sleep. The diagnostic criteria are detailed in the evaluation section. The four main features that contribute to OSA are obesity, lymphoid hyperplasia, craniofacial abnormalities, and neuromuscular dysfunction. […] Many different treatment options are depending on the severity of the OSA. These include both surgical and non-surgical interventions. A therapeutic trial of leukotriene inhibitors (montelukast) may be appropriate for pediatric patients who are diagnosed with mild to moderate OSA. […] Continuous positive airway pressure (CPAP) is another potential treatment option. While this is the first-line treatment in adults, there are limitations to the use of PAP in children. […] If left untreated, pediatric OSA can have serious morbidities and long-term complications. Sustained hypoxia can increase pulmonary vasoconstriction and lead to pulmonary hypertension and right heart failure at an early age. Cognitive dysfunction, impaired learning, and poor school performance are associated with undiagnosed and untreated pediatric OSA. […] Before diagnosis, parents should be educated at well-child checks to be vigilant about signs and symptoms of pediatric OSA, including loud nightly snoring, frequent nighttime awakenings, secondary nocturnal enuresis, and behavioral changes in their children.

• #11 Childhood Sleep Apnea, Pediatric Obstructive Sleep Apnea (OSA)

  https://my.clevelandclinic.org/health/diseases/14312-obstructive-sleep-apnea-in-children

  Childhood sleep apnea is a condition in which there are brief pauses in your childs breathing pattern during sleep. The most common type is obstructive sleep apnea, where an airway blockage causes it. Childhood sleep apnea can change your childs sleeping pattern, which affects their behavior during the daytime. […] Childhood obstructive sleep apnea is most common between the ages of 2 and 6 years old. […] While its most common for a child to experience mild symptoms of sleep apnea, untreated childhood sleep apnea could be dangerous and lead to the following complications: Growth and development challenges. Loss of bladder control (enuresis). Cardiopulmonary disease (heart and lung conditions). Attention-deficit/hyperactivity disorder (ADHD). Changes to your childs sleep pattern may affect your childs behavior, emotional capacity and academic performance.

• #12 Childhood Sleep Apnea: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1004104-overview

  Obstructive sleep apnea (OSA) in children is characterized by episodic upper airway obstruction that occurs during sleep. The airway obstruction may be complete or partial. […] The clinical presentation of a child with obstructive sleep apnea (OSA) is nonspecific and requires increased awareness by the primary care physician. OSA symptoms in children can include the following: Abnormal breathing during sleep, Frequent awakenings or restlessness, Frequent nightmares, Enuresis, Difficulty awakening, Excessive daytime sleepiness, Hyperactivity/behavior problems, Daytime mouth breathing, Poor or irregular sleep patterns. […] Complications of OSA in children can generally be divided into the 4 following immediate consequences of upper airway obstruction during sleep: Sleep fragmentation, Increased work of breathing, Alveolar hypoventilation, Intermittent hypoxemia.

• #13 Pediatric Sleep Disordered Breathing / Obstructive Sleep Apnea |

  https://www.bmc.org/patient-care/conditions-we-treat/db/pediatric-sleep-disordered-breathing-obstructive-sleep-apnea

  Sleep-disordered breathing (SDB) is a general term for breathing difficulties occurring during sleep. SDB can range from frequent loud snoring to Obstructive Sleep Apnea (OSA) a condition involving repeated episodes of partial or complete blockage of the airway during sleep. […] Approximately 10 percent of children snore regularly and about 2-4 % of the pediatric population has OSA. Recent studies indicate that mild SDB or snoring may cause many of the same problems as OSA in children. […] The most obvious symptom of sleep disordered breathing is loud snoring that is present on most nights. The snoring can be interrupted by complete blockage of breathing with gasping and snorting noises and associated with awakenings from sleep. […] Due to a lack of good quality sleep, a child with sleep disordered breathing may be irritable, sleepy during the day, or have difficulty concentrating in school. Busy or hyperactive behavior may also be observed. Bed-wetting is also frequently seen in children with sleep apnea.

• #14 How to Treat Sleep Apnea in Children | Cedars-Sinai

  https://www.cedars-sinai.org/blog/pediatric-obstructive-sleep-apnea.html

  If your child sounds like an elderly person snoring or a freight train when they sleep, they might have pediatric obstructive sleep apnea. […] Obstructive sleep apnea is estimated to affect about 1% to 4% of children. […] Children with sleep apnea will often have a loud snore (not a soft, cute one) or may gasp for air or stop breathing for a brief time while sleeping. […] Because sleep apnea can present in a number of ways, it’s important for parents to pay attention to behavioral changes and not solely focus on breathing during sleep. […] If you think your child might have sleep apnea, reach out to your pediatrician. […] Dr. Reddy says parents of children who snore loudly and/or stop breathing may want to make an audio recording of their child’s sleep pattern for their doctor, who may refer them to a pediatric ENT.

• #15 Childhood Sleep Apnea: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1004104-overview

  Obstructive sleep apnea (OSA) in children is characterized by episodic upper airway obstruction that occurs during sleep. The airway obstruction may be complete or partial. […] The clinical presentation of a child with obstructive sleep apnea (OSA) is nonspecific and requires increased awareness by the primary care physician. OSA symptoms in children can include the following: Abnormal breathing during sleep, Frequent awakenings or restlessness, Frequent nightmares, Enuresis, Difficulty awakening, Excessive daytime sleepiness, Hyperactivity/behavior problems, Daytime mouth breathing, Poor or irregular sleep patterns. […] Complications of OSA in children can generally be divided into the 4 following immediate consequences of upper airway obstruction during sleep: Sleep fragmentation, Increased work of breathing, Alveolar hypoventilation, Intermittent hypoxemia.

• #16 Obstructive Sleep Apnea | Children’s Hospital Colorado

  https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/obstructive-sleep-apnea/

  Obstructive sleep apnea (OSA) is defined as pauses in breathing that frequently occur with snoring or gasping. […] OSA can cause a child’s oxygen levels to drop because of disrupted breathing. […] Sleep-disordered breathing (SDB) is a term that is used to describe all types of breathing problems that cause decreased airflow. […] The most common associations of obstructive sleep apnea in children are large tonsils and adenoids. […] Some kids with large tonsils and adenoids don’t have OSA, so the tonsils don’t „cause” OSA, but they contribute to it. […] Other causes of OSA include obesity, craniofacial abnormalities and decreased muscle tone that can occur in children with complex medical conditions. […] OSA occurs in 1% to 5% of all children. […] Because OSA may disturb sleep patterns, these children may also show continued sleepiness after waking in the morning, and tiredness and attention problems throughout the day.

• #17 Obstructive Sleep Apnea in Pediatric Patients | RT

  https://respiratory-therapy.com/disorders-diseases/sleep-medicine/obstructive-sleep-apnea-in-pediatric-patients/

  Early recognition, accurate diagnosis, and appropriate treatment help to alleviate much of the childhood morbidity associated with obstructive sleep apnea. […] Diagnosis of OSA requires a careful and detailed history and physical examination. Polysomnography is required to determine the nature of the problem, the magnitude of the physiologic disturbance, and (ultimately) the significance of the problem for the child. […] Earlier recognition, accurate diagnosis, and appropriate treatment all should alleviate much of the childhood morbidity associated with these conditions. […] OSA occurs when airflow is absent in the presence of chest-wall movement. In children, more than one obstructive apnea of any length per hour of sleep should be considered abnormal. […] The clinical consequences of OSA are the direct result of the disorders two fundamental abnormalities.

• #18 Pediatric obstructive sleep apnea – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/diagnosis-treatment/drc-20376199

  Diagnosis involves the steps that a healthcare professional takes to find out if your child has pediatric obstructive sleep apnea. A healthcare professional reviews your child’s symptoms and health history and does a physical exam. Your child’s healthcare professional likely will look at your child’s head, neck, nose, mouth and tongue. […] Our caring team of Mayo Clinic experts can help you with your pediatric obstructive sleep apnea-related health concerns. […] Your child’s healthcare professional works with you to find the right treatment for your child’s pediatric obstructive sleep apnea. Most often, the first treatment for the condition is surgery to remove enlarged tonsils and adenoids. This is called adenotonsillectomy (ad-uh-no-ton-sil-EK-tuh-me). […] The right treatment plan for your child depends on your child’s sleep apnea symptoms and risk factors. For most children, treatment includes adenotonsillectomy, but your child’s healthcare professional may recommend other treatments if this surgery isn’t right for your child. Other treatments also may be needed if the surgery doesn’t fully treat your child’s obstructive sleep apnea.

• #19 Pediatric Obstructive Sleep Apnea Diagnosis and Treatment: What You Need to Know – Pediatrics Nationwide

  https://pediatricsnationwide.org/2024/12/18/pediatric-obstructive-sleep-apnea-diagnosis-and-treatment-what-you-need-to-know/

  Pediatric obstructive sleep apnea, a common condition in children, is definitively diagnosed with sleep studies and can be treated through various modalities, depending on disease severity. […] A pediatric sleep study, or pediatric polysomnography, is critical to definitively diagnosing OSA and evaluating treatment success, Dr. Kalra explains. […] Medical, dental and surgical approaches are available to treat OSA, but each case requires a personalized approach. […] Overall, tailoring the treatment to the individual characteristics of the patient through shared decision-making with families can help achieve the best treatment outcomes, he concluded.

• #20 Obstructive Sleep Apnea in Pediatric Patients | RT

  https://respiratory-therapy.com/disorders-diseases/sleep-medicine/obstructive-sleep-apnea-in-pediatric-patients/

  Early recognition, accurate diagnosis, and appropriate treatment help to alleviate much of the childhood morbidity associated with obstructive sleep apnea. […] Diagnosis of OSA requires a careful and detailed history and physical examination. Polysomnography is required to determine the nature of the problem, the magnitude of the physiologic disturbance, and (ultimately) the significance of the problem for the child. […] Earlier recognition, accurate diagnosis, and appropriate treatment all should alleviate much of the childhood morbidity associated with these conditions. […] OSA occurs when airflow is absent in the presence of chest-wall movement. In children, more than one obstructive apnea of any length per hour of sleep should be considered abnormal. […] The clinical consequences of OSA are the direct result of the disorders two fundamental abnormalities.

• #21 Diagnostic and Therapeutic Approach to Children and Adolescents with Obstructive Sleep Apnea Syndrome (OSA): Recommendations in Emilia-Romagna Region, Italy

  https://www.mdpi.com/2075-1729/12/5/739

  Obstructive sleep apnoea syndrome (OSA) in paediatrics is a rather frequent pathology caused by pathophysiological alterations leading to partial and prolonged obstruction (hypoventilation) and/or intermittent partial (hypopnoea) or complete (apnoea) obstruction of the upper airways. […] Unfortunately, there are few data on shared diagnostic-therapeutic pathways that address OSA with a multidisciplinary approach in paediatric age. This document summarizes recommendations from the Emilia-Romagna Region, Italy, developed in order to provide the most appropriate tools for a multidisciplinary approach in the diagnosis, treatment and care of paediatric patients with OSA. […] The relationship between the paediatrician of the patient and her/his parents must see a synergy of behaviour between the various players in order to avoid uncertainty about the diagnostic and therapeutic decisions as well as the follow-up phase.

• #22 Sleep Apnea: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/obstructive-sleep-apnea-osa/?srsltid=AfmBOopJQLRm7L-cz2vuPxpCeO5QAyV3ad4ZzX3psVhbRHGIy-6tFD07

  Assess signs and symptoms: […] Respiratory status […] Oxygen saturation […] Vital signs […] Sleep quality […] Daytime fatigue […] Snoring […] […] Screen individuals with daytime fatigue or other risk factors for OSA. […] Ineffective breathing pattern related to sleep apnea evidenced by: […] Periods of apnea during sleep […] Decreased oxygen saturation […] Shallow breathing […] Impaired gas exchange related to altered oxygen supply secondary to sleep apnea evidenced by: […] Decreased oxygen saturation […] Periods of apnea during sleep […] Sleep deprivation related to OSA evidenced by: […] Interrupted sleep […] Irritability […] Complaints of not feeling rested […] […] Monitor skin and mucous membrane color for cyanosis […] Assess vital signs, especially respiratory rate and oxygen saturation during sleep

• #23 Sleep Apnea: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/obstructive-sleep-apnea-osa/?srsltid=AfmBOopJQLRm7L-cz2vuPxpCeO5QAyV3ad4ZzX3psVhbRHGIy-6tFD07

  Auscultate lungs for abnormal breath sounds […] Provide PAP and supplemental oxygen as ordered […] Refer to a sleep specialist […] Assist with repositioning to elevate the head of the bed and discourage supine position […] Administer medication as ordered […] Use pulse oximeter and apnea monitor during sleep […] […] Maintains effective breathing pattern and adequate oxygenation […] Reports restful sleep […] Demonstrates effective coping […] Uses and maintains sleep equipment as recommended […] […] Condition, treatment, and expected outcomes […] Avoid sedative and alcohol use […] Importance of treatment compliance […] Sleep hygiene, weight loss, and side sleeping […] Recommended follow-up with healthcare providers […] Immediate medical care for acute elevations in blood pressure, chest pain, or shortness of breath

• #24 Sleep Apnea: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/obstructive-sleep-apnea-osa/?srsltid=AfmBOopJQLRm7L-cz2vuPxpCeO5QAyV3ad4ZzX3psVhbRHGIy-6tFD07

  Assess signs and symptoms: […] Respiratory status […] Oxygen saturation […] Vital signs […] Sleep quality […] Daytime fatigue […] Snoring […] […] Screen individuals with daytime fatigue or other risk factors for OSA. […] Ineffective breathing pattern related to sleep apnea evidenced by: […] Periods of apnea during sleep […] Decreased oxygen saturation […] Shallow breathing […] Impaired gas exchange related to altered oxygen supply secondary to sleep apnea evidenced by: […] Decreased oxygen saturation […] Periods of apnea during sleep […] Sleep deprivation related to OSA evidenced by: […] Interrupted sleep […] Irritability […] Complaints of not feeling rested […] […] Monitor skin and mucous membrane color for cyanosis […] Assess vital signs, especially respiratory rate and oxygen saturation during sleep

• #25 Sleep Apnea: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/obstructive-sleep-apnea-osa/?srsltid=AfmBOopJQLRm7L-cz2vuPxpCeO5QAyV3ad4ZzX3psVhbRHGIy-6tFD07

  Assess signs and symptoms: […] Respiratory status […] Oxygen saturation […] Vital signs […] Sleep quality […] Daytime fatigue […] Snoring […] […] Screen individuals with daytime fatigue or other risk factors for OSA. […] Ineffective breathing pattern related to sleep apnea evidenced by: […] Periods of apnea during sleep […] Decreased oxygen saturation […] Shallow breathing […] Impaired gas exchange related to altered oxygen supply secondary to sleep apnea evidenced by: […] Decreased oxygen saturation […] Periods of apnea during sleep […] Sleep deprivation related to OSA evidenced by: […] Interrupted sleep […] Irritability […] Complaints of not feeling rested […] […] Monitor skin and mucous membrane color for cyanosis […] Assess vital signs, especially respiratory rate and oxygen saturation during sleep

• #26 Sleep Apnea: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/obstructive-sleep-apnea-osa/?srsltid=AfmBOopJQLRm7L-cz2vuPxpCeO5QAyV3ad4ZzX3psVhbRHGIy-6tFD07

  Assess signs and symptoms: […] Respiratory status […] Oxygen saturation […] Vital signs […] Sleep quality […] Daytime fatigue […] Snoring […] […] Screen individuals with daytime fatigue or other risk factors for OSA. […] Ineffective breathing pattern related to sleep apnea evidenced by: […] Periods of apnea during sleep […] Decreased oxygen saturation […] Shallow breathing […] Impaired gas exchange related to altered oxygen supply secondary to sleep apnea evidenced by: […] Decreased oxygen saturation […] Periods of apnea during sleep […] Sleep deprivation related to OSA evidenced by: […] Interrupted sleep […] Irritability […] Complaints of not feeling rested […] […] Monitor skin and mucous membrane color for cyanosis […] Assess vital signs, especially respiratory rate and oxygen saturation during sleep

• #27 2 Apnea Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/apnea-nursing-care-plans/

  Use this nursing care plan and management guide to help care for patients with apnea. Learn about the nursing assessment, nursing interventions, goals and nursing diagnosis for apnea in this guide. […] Nursing care plan for sleep apnea is directed at supporting the infants cardiopulmonary status, improvement in gas exchange and breathing pattern, attainment of an optimal level of parental coping, knowledge of the treatment program and home care, and absence of complications. […] The following are the nursing priorities for patients with apnea: Airway management and maintenance, Monitor and assess respiratory function, Administration of appropriate interventions and therapies, such as continuous positive airway pressure (CPAP) or mechanical ventilation if necessary, Educate and support for the patient and their caregivers regarding apnea management and prevention, Collaborate with the healthcare team to address underlying causes of apnea and optimize overall patient care.

• #28 2 Apnea Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/apnea-nursing-care-plans/

  Therapeutic interventions and nursing actions for patients with apnea may include: Assess the frequency and pattern of breathing; Observe the presence of apnea and changes in the heart rate, Assess skin, nail beds, skin, and mucous membranes for pallor or cyanosis, Place the infant on an apnea monitor and pulse oximeter, Assess respiratory rate, depth, and ease, periods of apnea, Assess the infant for skin color and perfusion, Assess for changes in consciousness, the presence of irritability and somnolence, Monitor ABG levels and oxygen saturation, Monitor chest-Xray studies for further evaluation, Position the infants head and neck in a neutral position, Avoid prolonged suctioning; Discourage taking rectal temperatures and tube feedings, Provide tactile stimulation by applying a gentle rub on the soles of the feet or chest wall, Administer methylxanthines (e.g., theophylline, caffeine) as prescribed, Administer continuous nasal airflow or CPAP via a nasal mask, or a face mask, Prepare the infant for assisted mechanical ventilation as indicated, Educate the parents on the use of apnea monitor and allow for a return demonstration of the application.

• #29 2 Apnea Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/apnea-nursing-care-plans/

  Therapeutic interventions and nursing actions for patients with apnea may include: Assess the frequency and pattern of breathing; Observe the presence of apnea and changes in the heart rate, Assess skin, nail beds, skin, and mucous membranes for pallor or cyanosis, Place the infant on an apnea monitor and pulse oximeter, Assess respiratory rate, depth, and ease, periods of apnea, Assess the infant for skin color and perfusion, Assess for changes in consciousness, the presence of irritability and somnolence, Monitor ABG levels and oxygen saturation, Monitor chest-Xray studies for further evaluation, Position the infants head and neck in a neutral position, Avoid prolonged suctioning; Discourage taking rectal temperatures and tube feedings, Provide tactile stimulation by applying a gentle rub on the soles of the feet or chest wall, Administer methylxanthines (e.g., theophylline, caffeine) as prescribed, Administer continuous nasal airflow or CPAP via a nasal mask, or a face mask, Prepare the infant for assisted mechanical ventilation as indicated, Educate the parents on the use of apnea monitor and allow for a return demonstration of the application.

• #30 Sleep Apnea: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/obstructive-sleep-apnea-osa/?srsltid=AfmBOopJQLRm7L-cz2vuPxpCeO5QAyV3ad4ZzX3psVhbRHGIy-6tFD07

  Auscultate lungs for abnormal breath sounds […] Provide PAP and supplemental oxygen as ordered […] Refer to a sleep specialist […] Assist with repositioning to elevate the head of the bed and discourage supine position […] Administer medication as ordered […] Use pulse oximeter and apnea monitor during sleep […] […] Maintains effective breathing pattern and adequate oxygenation […] Reports restful sleep […] Demonstrates effective coping […] Uses and maintains sleep equipment as recommended […] […] Condition, treatment, and expected outcomes […] Avoid sedative and alcohol use […] Importance of treatment compliance […] Sleep hygiene, weight loss, and side sleeping […] Recommended follow-up with healthcare providers […] Immediate medical care for acute elevations in blood pressure, chest pain, or shortness of breath

• #31 2 Apnea Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/apnea-nursing-care-plans/

  Compromised family coping for patients with apnea may occur due to the significant impact that the infants condition can have on the familys daily routine and emotional well-being. […] Assess family anxiety level and erratic behaviors (anger, tension, disorganization) perception of a crisis situation, Assess the familys previous coping methods and perceived effectiveness, Assist the family to identify and use 3 techniques to cope with and solve problems and gain control over the situation, Assess the history of apnea, sudden infant death syndrome (SIDS), and life-threatening events of infants in the family, Assess for the presence of apneic episodes, bradycardia, cyanosis, gastroesophageal reflux, upper respiratory infection, and poor feeding with choking during feedings, Assess parents ability to take part in apnea monitoring and to learn CPR as an intervention in case of an episode, Encourage verbalization of feelings and provide accurate information about infant apnea, Educate parents that over-protective behaviors may affect infant growth and development, Reinforce appropriate coping behaviors, Reinforce the need to sustain the health of family members and social contacts, Encourage parents to verbalize feelings about unmet needs and the ability to meet and develop self-expectations, Provide a calm, supportive, and positive environment; encourage and commend positive parental behaviors, Encourage touching and play activities between parents and infants, Provide parents with step-by-step procedures in written or picture form about apnea monitoring and resuscitation, Teach parents about safety issues of home apnea monitoring, Demonstrate for parents, and allow for return demonstration on how to attach electrodes to the belt and monitor, apply belt to infants chest, turn to monitor on, set the monitor, test the monitor alarms, remove and care of monitor after use, Instruct other significant others and support persons to care for the child with a home monitor, including CPR, Demonstrate for parents and allow for return demonstration of CPR on infant model.

• #32 Sleep Apnea: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/obstructive-sleep-apnea-osa/?srsltid=AfmBOopJQLRm7L-cz2vuPxpCeO5QAyV3ad4ZzX3psVhbRHGIy-6tFD07

  Auscultate lungs for abnormal breath sounds […] Provide PAP and supplemental oxygen as ordered […] Refer to a sleep specialist […] Assist with repositioning to elevate the head of the bed and discourage supine position […] Administer medication as ordered […] Use pulse oximeter and apnea monitor during sleep […] […] Maintains effective breathing pattern and adequate oxygenation […] Reports restful sleep […] Demonstrates effective coping […] Uses and maintains sleep equipment as recommended […] […] Condition, treatment, and expected outcomes […] Avoid sedative and alcohol use […] Importance of treatment compliance […] Sleep hygiene, weight loss, and side sleeping […] Recommended follow-up with healthcare providers […] Immediate medical care for acute elevations in blood pressure, chest pain, or shortness of breath

• #33 Pediatric obstructive sleep apnea – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/diagnosis-treatment/drc-20376199

  Diagnosis involves the steps that a healthcare professional takes to find out if your child has pediatric obstructive sleep apnea. A healthcare professional reviews your child’s symptoms and health history and does a physical exam. Your child’s healthcare professional likely will look at your child’s head, neck, nose, mouth and tongue. […] Our caring team of Mayo Clinic experts can help you with your pediatric obstructive sleep apnea-related health concerns. […] Your child’s healthcare professional works with you to find the right treatment for your child’s pediatric obstructive sleep apnea. Most often, the first treatment for the condition is surgery to remove enlarged tonsils and adenoids. This is called adenotonsillectomy (ad-uh-no-ton-sil-EK-tuh-me). […] The right treatment plan for your child depends on your child’s sleep apnea symptoms and risk factors. For most children, treatment includes adenotonsillectomy, but your child’s healthcare professional may recommend other treatments if this surgery isn’t right for your child. Other treatments also may be needed if the surgery doesn’t fully treat your child’s obstructive sleep apnea.

• #34 Treatment of obstructive sleep apnea in children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3004500/

  Obstructive sleep apnea (OSA) in children is a frequent disease for which optimal diagnostic methods are still being defined. Treatment of OSA in children should include providing space, improving craniofacial growth, resolving all symptoms, and preventing the development of the disease in the adult years. […] Surgery in young children should be performed as early as possible to prevent the resulting morphologic changes and neurobehavioral, cardiovascular, endocrine, and metabolic complications. Close postoperative follow-up to monitor for residual disease is equally important. […] Multidisciplinary evaluation of the anatomic abnormalities in children with OSA leads to better overall treatment outcome. […] Treatment of OSA should include providing space for ventilation, improvement of cranio-facial growth, improvement all symptoms, and preventing the development of adult OSA.

• #35 Position Statement: Treatment of Obstructive Sleep Apnea – American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)

  https://www.entnet.org/resource/position-statement-treatment-of-obstructive-sleep-apnea/

  Pediatric OSA […] Surgical management, specifically adenotonsillectomy, is the recommended first line treatment for moderate to severe OSA in children. Children with mild OSA may be managed with watchful waiting, medical therapy with anti-inflammatory medications, or adenotonsillectomy. Children with persistent OSA following adenotonsillectomy may be managed with additional surgical therapy such as lingual tonsillectomy or continuous positive airway pressure (CPAP). Drug induced sleep endoscopy (DISE) is useful to determine the best management strategy in children with persistent OSA.

• #36 Adenotonsillectomy for obstructive sleep apnea in children – UpToDate

  https://www.uptodate.com/contents/adenotonsillectomy-for-obstructive-sleep-apnea-in-children

  Obstructive sleep apnea (OSA) is common in the pediatric population. If untreated, the disease has been associated with a wide range of cardiovascular and cognitive morbidities. Surgical removal of the tonsils and adenoids is considered the first-line treatment for OSA in otherwise healthy children over two years of age with adenotonsillar hypertrophy, as recommended in guidelines from the American Academy of Pediatrics (AAP) and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). […] Adenotonsillectomy is one of the most common surgical procedures performed on children in the United States, with approximately 300,000 ambulatory procedures performed annually in children 15 years or younger. In a survey of practice patterns by otolaryngologists in the United States, non-mutually exclusive indications for surgery included obstructed breathing of any type in 59 percent of cases, recurrent infections in 42 percent, and OSA in 39 percent of children, which indicates that obstructed breathing rivals recurrent infection as the most common surgical indication for adenotonsillectomy.

• #37 Pediatric Sleep-disordered Breathing – ENT Health

  https://www.enthealth.org/conditions/pediatric-sleep-disordered-breathing/

  Many children with OSA show both short- and long-term improvement in their sleep and behavior after TA. […] Recent studies have shown that some children have persistent SDB after TA. A post-operative sleep study may be necessary, especially in children with persistent symptoms or increased risk factors for persistent apnea after TA such as obesity, craniofacial anomalies or neuromuscular problems. Additional treatments such as weight loss, the use of continuous positive airway pressure (CPAP), or additional surgical procedures may sometimes be required.

• #38 Diagnostic and Therapeutic Approach to Children and Adolescents with Obstructive Sleep Apnea Syndrome (OSA): Recommendations in Emilia-Romagna Region, Italy

  https://www.mdpi.com/2075-1729/12/5/739

  The minimum age for performing adenoidectomy is three months, and for AT six months. Other organic alterations have the possibility of surgical correction, for example coanal atresia, laryngomalacia, labiopalatoschisis and craniofacial malformations (mid-facial hypoplasia and mandibular-retrognathic hypoplasia). […] In these cases, laser supraglottoplasty, endoscopic correction of coanal atresia, tracheostomy, or maxillofacial surgery are effective and must be planned and performed in a multidisciplinary and dedicated care setting. […] The application of uniform and shared protocols aims to improve clinical practice, through the standardization of diagnostic procedures and therapeutic approaches.

• #39 Pediatric obstructive sleep apnea – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/diagnosis-treatment/drc-20376199

  Some kids get better without sleep apnea treatments. It’s possible for some children with mild to moderate obstructive sleep apnea to outgrow the condition. A healthcare professional may recommend closely watching a child for up to six months to see if the symptoms get better. This is called watchful waiting. […] Topical nasal steroids might ease sleep apnea symptoms for some children with mild obstructive sleep apnea. […] Your child’s healthcare professional may recommend use of devices such as positive airway pressure therapy. […] Adenotonsillectomy to remove the tonsils and adenoids might improve obstructive sleep apnea by opening the airway. It’s often a treatment option for children with moderate to severe obstructive sleep apnea. […] You can take the following steps at home to help your child with pediatric obstructive sleep apnea: Stay away from airway irritants and allergens.

• #40 Pediatric Obstructive Sleep Apnea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557610/

  Diagnosis of sleep apnea is made by measuring the apneic events during sleep. The diagnostic criteria are detailed in the evaluation section. The four main features that contribute to OSA are obesity, lymphoid hyperplasia, craniofacial abnormalities, and neuromuscular dysfunction. […] Many different treatment options are depending on the severity of the OSA. These include both surgical and non-surgical interventions. A therapeutic trial of leukotriene inhibitors (montelukast) may be appropriate for pediatric patients who are diagnosed with mild to moderate OSA. […] Continuous positive airway pressure (CPAP) is another potential treatment option. While this is the first-line treatment in adults, there are limitations to the use of PAP in children. […] If left untreated, pediatric OSA can have serious morbidities and long-term complications. Sustained hypoxia can increase pulmonary vasoconstriction and lead to pulmonary hypertension and right heart failure at an early age. Cognitive dysfunction, impaired learning, and poor school performance are associated with undiagnosed and untreated pediatric OSA. […] Before diagnosis, parents should be educated at well-child checks to be vigilant about signs and symptoms of pediatric OSA, including loud nightly snoring, frequent nighttime awakenings, secondary nocturnal enuresis, and behavioral changes in their children.

• #41 How to Treat Sleep Apnea in Children | Cedars-Sinai

  https://www.cedars-sinai.org/blog/pediatric-obstructive-sleep-apnea.html

  Sleep apnea can occur at any age, but is most common between ages 2 and 8 during the period of peak tonsil growth. […] However, obesity is a risk factor for sleep apnea in children. […] The first occurs when there’s not enough space in the back of the throat for air to flow easily into their windpipe to get into their lungs. […] Mild sleep apnea (which can be caused by allergies or enlarged tonsils or adenoids) can be treated with an oral medication, such as montelukast or different types of nasal steroid or antihistamine sprays. […] For children who have moderate to severe sleep apnea, the gold standard of treatment is to remove part or all of the tonsils and the adenoids. […] Continuous positive airway pressure (CPAP) machines can also be a treatment option for patients who have already gotten a tonsillectomy and adenoidectomy but still have significant sleep apnea. […] Some children who have mild sleep apnea may be medically managed and may not necessarily need surgical therapy. Children who tend to have moderate and severe sleep apnea, however, often don’t get better until they have surgical treatment (removing part or all of the tonsils and adenoids).

• #42 Management of obstructive sleep apnea in children – UpToDate

  https://www.uptodate.com/contents/management-of-obstructive-sleep-apnea-in-children

  An overview of surgical and medical management of children with confirmed OSA is reviewed here. The diagnostic evaluation of suspected OSA in children is described separately. […] More detailed information about specific treatments for OSA in children is available from the following topic reviews: […] – (See „Adenotonsillectomy for obstructive sleep apnea in children.”) […] – (See „Continuous positive airway pressure (CPAP) for pediatric obstructive sleep apnea.”)

• #43 Obstructive Sleep Apnea (OSA) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/obstructive-sleep-apnea-osa

  If your child snores or has trouble breathing at night, he or she may not just be a noisy sleeper. It could be a sign of obstructive sleep apnea (OSA), a condition in which breathing is repeatedly blocked during sleep. OSA affects about 2 to 5 percent of children and teenagers. […] OSA can cause children to be tired, irritable, or hyperactive during the day and to perform below their potential at school. […] If you think your child might have OSA, talk with your primary care provider. He or she may refer you to a sleep specialist for a full evaluation and sleep study. […] Getting care for obstructive sleep apnea can have far-reaching positive effects on your child’s overall health. […] If your child has been diagnosed with OSA, there are many effective treatments. These may include: Weight loss for children who are overweight; Nasal steroids and other medications to reduce nasal congestion, particularly in children who have allergies or asthma; Oral (dental) appliances to open the airway; Using a continuous or bi-level positive airway pressure (CPAP or BiPAP) machine to keep the airway open during sleep; Muscle retraining of the upper airway (myofunctional therapy); Surgery to remove the tonsils or adenoids (tonsillectomy or adenoidectomy) or to correct any abnormalities in facial structure.

• #44 Childhood Sleep Apnea, Pediatric Obstructive Sleep Apnea (OSA)

  https://my.clevelandclinic.org/health/diseases/14312-obstructive-sleep-apnea-in-children

  Childhood sleep apnea treatment varies based on the cause and severity. Their healthcare provider will focus on clearing your childs airways. Treatment options could include: Surgery: Surgery may be necessary to remove enlarged tonsils or adenoids or repair structural abnormalities of your childs head and neck to create more room in their airway. Lifestyle modifications: Regular exercise can naturally open your childs airways. In addition, changes to your childs diet can may help them reach or maintain a healthy BMI (body mass index) for their age. Medications: Medications can help keep your childs airways clear or open them up. Your childs provider may make medication recommendations based on the cause of their sleep apnea. For example, medications for allergies include antihistamines, fluticasone (Flonase) and montelukast (Singulair). A nasal decongestant can help if your child has an upper respiratory infection. Continuous positive airway pressure (CPAP): CPAP involves wearing a mask over your nose during sleep. The mask attaches to a small, portable machine that blows air through the nasal passages and into your airway. The air pressure keeps your childs airway open so they can breathe normally during sleep.

• #45 Childhood Sleep Apnea: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1004104-overview

  Although OSA has multiple etiologies in children, once the diagnosis has been established and its severity assessed, adenotonsillectomy is usually the first line of treatment. […] Adenotonsillectomy should be implemented along with weight normalization in obese children. Caloric intake limitation and dietary counseling are necessary if obesity complicates OSA. […] CPAP is the mainstay of therapy for most adults with OSA, as well as a large number of children and adolescents. However, it is often difficult for children to adhere to the therapy regimen. […] Patients receiving continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea must understand that they need to use their machines every night and each time they nap. […] Educate families of children and adolescents who have obesity and obstructive apnea about nutrition and weight loss.

• #46 Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

  https://www.mdpi.com/2077-0383/9/3/888

  In addition to anti-inflammatory therapy, non-invasive positive airway pressure (PAP) therapy has clearly been the most frequently selected treatment option for children who present with moderate to severe OSA after T&A. […] Although there are clear benefits to PAP therapy, some problems and concerns deserve mention besides suboptimal adherence. […] Drug-induced sleep endoscopy (DISE) permits assessment of the upper airway using a flexible fiberoptic endoscope introduced via the nose during spontaneous breathing while the patient is under conscious sedation. […] Recent renewed interest in the implementation of myofunctional re-education as an approach aimed to reduce the frequency or severity of residual OSA in children. […] Overall, it would appear that RME may have a role in carefully selected patients, more specifically in those presenting obvious malocclusion (i.e., high, narrow palate associated with deep bite, retrusive bite or crossbite) and OSA. […] As our current understanding of the short-term and potentially long-term morbidities of pediatric OSA continues to evolve, our objectives for an increasingly effective and permanent resolution of the disease are being intensively sought.

• #47

  https://journals.lww.com/prcm/fulltext/2017/01020/the_asian_paediatric_pulmonology_society__apps_.2.aspx

  Postoperative complications were reported to be higher in those aged below 3 years, presence of cardiac complications, congenital craniofacial anomalies, neuromuscular disorders, and severe obesity. […] Reevaluation with PSG several months after TandA is recommended to evaluate for residual OSAS. […] The management of residual OSAS after TandA is dependent on the severity of the residual OSAS. […] Orthodontic treatment (e.g., rapid maxillary expansion [RME], mandibular advancement devices [MAD]) may be an effective treatment option for childhood OSAS in a selected group of patients. […] PAP therapy has been found to be effective in improving polysomnographic parameters in pediatric patients with OSAS. […] Adherence is the major barrier to PAP as an effective therapy for childhood OSAS. […] Orofacial myofunctional therapy (OMT) is potentially an option for the treatment of OSAS. […] This is the first position statement on the management of childhood OSA in Asia, which would serve as a guideline for doctors in this area so that a more uniform approach can be adopted for this disease.

• #48

  https://journals.lww.com/prcm/fulltext/2017/01020/the_asian_paediatric_pulmonology_society__apps_.2.aspx

  Postoperative complications were reported to be higher in those aged below 3 years, presence of cardiac complications, congenital craniofacial anomalies, neuromuscular disorders, and severe obesity. […] Reevaluation with PSG several months after TandA is recommended to evaluate for residual OSAS. […] The management of residual OSAS after TandA is dependent on the severity of the residual OSAS. […] Orthodontic treatment (e.g., rapid maxillary expansion [RME], mandibular advancement devices [MAD]) may be an effective treatment option for childhood OSAS in a selected group of patients. […] PAP therapy has been found to be effective in improving polysomnographic parameters in pediatric patients with OSAS. […] Adherence is the major barrier to PAP as an effective therapy for childhood OSAS. […] Orofacial myofunctional therapy (OMT) is potentially an option for the treatment of OSAS. […] This is the first position statement on the management of childhood OSA in Asia, which would serve as a guideline for doctors in this area so that a more uniform approach can be adopted for this disease.

• #49 Monitoring and Nursing for Children with Obstructive Sleep Apnea Syndrome in the Recovery Room After General Anesthesia

  https://brieflands.com/articles/ijp-96030

  Preschool children with obstructive sleep apnea-hypopnea syndrome (OSAHS) experience a potentially lethal sleep disorder disease. Early surgical resection of OSAHS is critical for children’s growth and development. Tonsil adenoidectomy is an essential treatment technique for OSAHS. However, laryngeal trauma caused by surgery leads to agitation due to pain during recovery, accompanied by other symptoms such as unstable vital signs and postoperative anxiety. […] Therefore, exploring a better-personalized care method is essential for reducing the incidence of respiratory complications during anesthesia recovery in children with OSAHS and the smooth recovery of the child. […] The study aimed to investigate the respiratory complications and agitation of childhood OSAHS in the anesthesia recovery period after surgery and suitable nursing care methods. […] Personalized nursing care during postoperative anesthesia recovery can reduce the incidence of agitation and respiratory obstruction, lower blood pressure and heart rate, and accelerate postoperative recovery in children with OSAHS. Our study discovered a suitable nursing method for OSAHS children after general anesthesia to improve patients recovery and reduce economic costs.

• #50 Monitoring and Nursing for Children with Obstructive Sleep Apnea Syndrome in the Recovery Room After General Anesthesia

  https://brieflands.com/articles/ijp-96030

  Postoperative agitation is one of the common complications of general anesthesia, which increases the risk of re-bleeding in the operation area, affects the surgical effect, and even causes life-threatening respiratory paralysis and obstruction. […] Therefore, it is especially important to pay close attention to children’s agitation and respiratory complications during the postoperative recovery period. However, there are a few studies on the treatment and nursing of postoperative agitation and respiratory complications in children with OSAHS. […] In this study, we aimed to investigate the respiratory complications and agitation during anesthesia recovery in children with OSAHS and explored the better-personalized nursing methods to ensure that children smoothly go through the recovery period. […] The agitation incidence of children in the recovery room was significantly lower in Group B than in Group A in the different periods (all P 0.05).

• #51 Monitoring and Nursing for Children with Obstructive Sleep Apnea Syndrome in the Recovery Room After General Anesthesia

  https://brieflands.com/articles/ijp-96030

  The rate of respiratory obstruction was significantly lower in the personalized nursing group (Group B) than in the routine nursing group (Group A) at 15 min, 30 min, and 45 min in the recovery room (all P 0.05). […] Therefore, the close observation of vital signs and timely treatment of postoperative respiratory obstruction and bleeding can help ensure the safety of children with OSAHS. […] In conclusion, personalized nursing during postoperative anesthesia recovery in children with OSAHS can improve the incidence of agitation, reduce the rate of respiratory obstruction, and lower blood pressure and heart rates.

• #52 Monitoring and Nursing for Children with Obstructive Sleep Apnea Syndrome in the Recovery Room After General Anesthesia

  https://brieflands.com/articles/ijp-96030

  The rate of respiratory obstruction was significantly lower in the personalized nursing group (Group B) than in the routine nursing group (Group A) at 15 min, 30 min, and 45 min in the recovery room (all P 0.05). […] Therefore, the close observation of vital signs and timely treatment of postoperative respiratory obstruction and bleeding can help ensure the safety of children with OSAHS. […] In conclusion, personalized nursing during postoperative anesthesia recovery in children with OSAHS can improve the incidence of agitation, reduce the rate of respiratory obstruction, and lower blood pressure and heart rates.

• #53 Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

  https://www.mdpi.com/2077-0383/9/3/888

  In addition to anti-inflammatory therapy, non-invasive positive airway pressure (PAP) therapy has clearly been the most frequently selected treatment option for children who present with moderate to severe OSA after T&A. […] Although there are clear benefits to PAP therapy, some problems and concerns deserve mention besides suboptimal adherence. […] Drug-induced sleep endoscopy (DISE) permits assessment of the upper airway using a flexible fiberoptic endoscope introduced via the nose during spontaneous breathing while the patient is under conscious sedation. […] Recent renewed interest in the implementation of myofunctional re-education as an approach aimed to reduce the frequency or severity of residual OSA in children. […] Overall, it would appear that RME may have a role in carefully selected patients, more specifically in those presenting obvious malocclusion (i.e., high, narrow palate associated with deep bite, retrusive bite or crossbite) and OSA. […] As our current understanding of the short-term and potentially long-term morbidities of pediatric OSA continues to evolve, our objectives for an increasingly effective and permanent resolution of the disease are being intensively sought.

• #54 Sleep Apnea: Nursing Diagnoses & Care Plans | NurseTogether

  https://www.nursetogether.com/sleep-apnea-nursing-diagnosis-care-plan/

  Patient education about appropriate lifestyle modifications and equipment use is essential in managing sleep apnea. […] The patient with a history of asthma, diabetes, CHF, and hypertension is at an increased risk for sleep apnea. Ensure these conditions are properly managed. […] Exercise, weight loss, quitting smoking, and avoiding alcohol at bedtime are necessary modifications to improve sleep apnea. […] Patients with sleep apnea experience ineffective breathing patterns as the airways can become obstructed and collapse during sleep, leading to breathing problems and affecting oxygen consumption. […] Though CPAP is more effective, oral devices may be easier for some patients. These devices open the throat and bring the jaw forward to relieve obstruction.

• #55 Complex Obstructive Sleep Apnea Program – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/services/complex-obstructive-sleep-apnea.html

  Obstructive sleep apneaobstructed breathing during sleepcan greatly impact your childs quality of life. […] In our Complex Obstructive Sleep Apnea Program, we care for a unique group of children with severe or persistent obstructive sleep apnea due to a complex health condition, such as Down syndrome, craniofacial abnormality, neuromuscular disorders, or obesity. […] We also evaluate and treat children who have received care for sleep apnea in the past and continue to have their daily life impacted by the disease. […] When obstructive sleep apnea is not resolved by removing large tonsils or adenoids, or by sleeping with a continuous positive airway pressure (CPAP) machine, your child could benefit from our innovative care that goes beyond typical treatments. […] Our ultimate goal is to resolve your childs obstructive sleep apnea and improve their overall health, well-being, and energy.

• #56 Obstructive sleep apnea is common in kids and may impact blood pressure, heart health | American Heart Association

  https://newsroom.heart.org/news/obstructive-sleep-apnea-is-common-in-kids-and-may-impact-blood-pressure-heart-health

  Children and adolescents with OSA may also have higher blood pressure. […] The statement suggests that children and adolescents with OSA have their blood pressure measured over a full 24-hour period to capture waking and sleeping measurements given the likelihood for higher nighttime blood pressure. […] Continuous positive airway pressure (CPAP), a treatment for OSA, can significantly lower triglyceride levels and improve HDL levels. Treating OSA may also improve the factors of metabolic syndrome, at least in the short term. […] Obesity is a significant risk factor for sleep disturbances and obstructive sleep apnea, and the severity of sleep apnea may be improved by weight loss interventions, which then improves metabolic syndrome factors such as insulin sensitivity. […] We need to increase awareness about how the rising prevalence of obesity may be impacting sleep quality in kids and recognize sleep-disordered breathing as something that could contribute to risks for hypertension and later cardiovascular disease.

• #57 Complex Obstructive Sleep Apnea Program – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/services/complex-obstructive-sleep-apnea.html

  In our Complex Obstructive Sleep Apnea Program, we look for more rare and complex causes for obstructive sleep apnea, including tongue collapse, airway collapse, supraglottic collapse (larynx closing on its own), septal deviation, craniofacial growth abnormalities, maxillary and/or mandibular underdevelopment, and other uncommon reasons. […] In this way, we offer solutions to families whose children have been treated for sleep apnea without success. […] With our obesity specialist expert, we also offer the latest approved treatments for obesity, to help decrease associated obstructive sleep apnea. […] We use advanced surgical methods and innovative technology to provide just the right care for your child. […] Our state-of-the-art intensive care unit empowers us to safely undertake complex surgeries, and we offer cutting-edge diagnostics to pinpoint the cause of your childs complex sleep apnea.

• #58 Pediatric Obstructive Sleep Apnea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557610/

  Diagnosis of sleep apnea is made by measuring the apneic events during sleep. The diagnostic criteria are detailed in the evaluation section. The four main features that contribute to OSA are obesity, lymphoid hyperplasia, craniofacial abnormalities, and neuromuscular dysfunction. […] Many different treatment options are depending on the severity of the OSA. These include both surgical and non-surgical interventions. A therapeutic trial of leukotriene inhibitors (montelukast) may be appropriate for pediatric patients who are diagnosed with mild to moderate OSA. […] Continuous positive airway pressure (CPAP) is another potential treatment option. While this is the first-line treatment in adults, there are limitations to the use of PAP in children. […] If left untreated, pediatric OSA can have serious morbidities and long-term complications. Sustained hypoxia can increase pulmonary vasoconstriction and lead to pulmonary hypertension and right heart failure at an early age. Cognitive dysfunction, impaired learning, and poor school performance are associated with undiagnosed and untreated pediatric OSA. […] Before diagnosis, parents should be educated at well-child checks to be vigilant about signs and symptoms of pediatric OSA, including loud nightly snoring, frequent nighttime awakenings, secondary nocturnal enuresis, and behavioral changes in their children.

• #59 Sleep Apnea: Nursing Diagnoses & Care Plans | NurseTogether

  https://www.nursetogether.com/sleep-apnea-nursing-diagnosis-care-plan/

  Sleep apnea is a sleep disorder characterized by the repeated cessation and resumption of breathing during sleep, preventing the body from getting adequate oxygen. […] Obstructive sleep apnea (OSA) is the most common type and occurs when the upper airways become obstructed while sleeping, reducing or completely stopping air intake. […] Treatment and management of sleep apnea will depend on the severity of the condition. Mild cases will only require lifestyle modifications, including losing weight, treating nasal allergies, and smoking cessation. Moderate to severe sleep apnea will require treatments like continuous positive airway pressure (CPAP), airway pressure devices, supplemental oxygenation, or wearing an oral device to keep the throat open. […] Nurses support their patients with sleep apnea by providing interventions and patient education to maintain cardiopulmonary status, improve breathing patterns and gas exchange, and improve quality of life.

• #60 Why Your Kid May Be Snoring at Night | Children’s Healthcare of Atlanta

  https://www.choa.org/parent-resources/surgery/sleep-apnea-in-kids-and-teens

  Kids and teens who have been diagnosed with sleep apnea often experience a wide range of symptoms that parents should keep an eye (or ear) out for, including being super sleepy during the day or even having behavior issues at school. […] These are possible signs of sleep apnea, which is a sleep disorder in which children and teens have a pause in their breathing while sleeping. They may also gasp for air or experience restless sleep. […] The criteria for diagnosing sleep apnea in children and teens is different than in adults. If a child has more than one interruption in their breathing each hour, thats considered obstructive sleep apnea. […] Obstructive sleep apnea, which is when there is tissue blocking a childs airway during sleep, essentially causing the body to have to make adjustments.

• #61 2 Apnea Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/apnea-nursing-care-plans/

  Compromised family coping for patients with apnea may occur due to the significant impact that the infants condition can have on the familys daily routine and emotional well-being. […] Assess family anxiety level and erratic behaviors (anger, tension, disorganization) perception of a crisis situation, Assess the familys previous coping methods and perceived effectiveness, Assist the family to identify and use 3 techniques to cope with and solve problems and gain control over the situation, Assess the history of apnea, sudden infant death syndrome (SIDS), and life-threatening events of infants in the family, Assess for the presence of apneic episodes, bradycardia, cyanosis, gastroesophageal reflux, upper respiratory infection, and poor feeding with choking during feedings, Assess parents ability to take part in apnea monitoring and to learn CPR as an intervention in case of an episode, Encourage verbalization of feelings and provide accurate information about infant apnea, Educate parents that over-protective behaviors may affect infant growth and development, Reinforce appropriate coping behaviors, Reinforce the need to sustain the health of family members and social contacts, Encourage parents to verbalize feelings about unmet needs and the ability to meet and develop self-expectations, Provide a calm, supportive, and positive environment; encourage and commend positive parental behaviors, Encourage touching and play activities between parents and infants, Provide parents with step-by-step procedures in written or picture form about apnea monitoring and resuscitation, Teach parents about safety issues of home apnea monitoring, Demonstrate for parents, and allow for return demonstration on how to attach electrodes to the belt and monitor, apply belt to infants chest, turn to monitor on, set the monitor, test the monitor alarms, remove and care of monitor after use, Instruct other significant others and support persons to care for the child with a home monitor, including CPR, Demonstrate for parents and allow for return demonstration of CPR on infant model.

• #62 Childhood Sleep Apnea: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1004104-overview

  Although OSA has multiple etiologies in children, once the diagnosis has been established and its severity assessed, adenotonsillectomy is usually the first line of treatment. […] Adenotonsillectomy should be implemented along with weight normalization in obese children. Caloric intake limitation and dietary counseling are necessary if obesity complicates OSA. […] CPAP is the mainstay of therapy for most adults with OSA, as well as a large number of children and adolescents. However, it is often difficult for children to adhere to the therapy regimen. […] Patients receiving continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea must understand that they need to use their machines every night and each time they nap. […] Educate families of children and adolescents who have obesity and obstructive apnea about nutrition and weight loss.

• #63 2 Apnea Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/apnea-nursing-care-plans/

  Compromised family coping for patients with apnea may occur due to the significant impact that the infants condition can have on the familys daily routine and emotional well-being. […] Assess family anxiety level and erratic behaviors (anger, tension, disorganization) perception of a crisis situation, Assess the familys previous coping methods and perceived effectiveness, Assist the family to identify and use 3 techniques to cope with and solve problems and gain control over the situation, Assess the history of apnea, sudden infant death syndrome (SIDS), and life-threatening events of infants in the family, Assess for the presence of apneic episodes, bradycardia, cyanosis, gastroesophageal reflux, upper respiratory infection, and poor feeding with choking during feedings, Assess parents ability to take part in apnea monitoring and to learn CPR as an intervention in case of an episode, Encourage verbalization of feelings and provide accurate information about infant apnea, Educate parents that over-protective behaviors may affect infant growth and development, Reinforce appropriate coping behaviors, Reinforce the need to sustain the health of family members and social contacts, Encourage parents to verbalize feelings about unmet needs and the ability to meet and develop self-expectations, Provide a calm, supportive, and positive environment; encourage and commend positive parental behaviors, Encourage touching and play activities between parents and infants, Provide parents with step-by-step procedures in written or picture form about apnea monitoring and resuscitation, Teach parents about safety issues of home apnea monitoring, Demonstrate for parents, and allow for return demonstration on how to attach electrodes to the belt and monitor, apply belt to infants chest, turn to monitor on, set the monitor, test the monitor alarms, remove and care of monitor after use, Instruct other significant others and support persons to care for the child with a home monitor, including CPR, Demonstrate for parents and allow for return demonstration of CPR on infant model.

• #64 Treatment of obstructive sleep apnea in children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3004500/

  TA should be considered a first-line therapy. For the majority of children with OSA, TA improved upper airway obstructive sign and symptoms, quality of life, and behavioral and cognition problems, and decreased polysomnographic abnormality. However, recent published data on the success rates of TA in curing pediatric OSAS are highly variable. Close postoperative follow-up to monitor for residual disease is equally important. Parents should be informed about the weight gain after TA, and reduction of body weight is considered primarily for obese children. Management with ongoing CPAP therapy and/or other surgical interventions and anti-inflammatory therapies are also considered. Initially for severe cases, multidisciplinary team approach is recommended to plan the optimal therapy.

• #65 Pediatric Sleep Disordered Breathing / Obstructive Sleep Apnea |

  https://www.bmc.org/patient-care/conditions-we-treat/db/pediatric-sleep-disordered-breathing-obstructive-sleep-apnea

  Sleep disordered breathing in children should be considered if frequent loud snoring, gasping, snorting, and thrashing in bed or unexplained bedwetting is observed. […] If you notice that your child has any of those symptoms, have them checked by an otolaryngologist (ear, nose and throat doctor). […] Surgical removal of the tonsils and adenoids (TA) is generally considered the first line treatment for pediatric sleep disordered breathing if the symptoms are significant and the tonsils and adenoids are enlarged. […] Many children with sleep apnea show both short and long- term improvement in their sleep and behavior after TA. […] If the SDB symptoms are mild or intermittent, academic performance and behavior is not an issue, the tonsils are small, or the child is near puberty, it may be recommended that a child with SDB be watched conservatively and treated surgically only if symptoms worsen. […] A post-operative PSG may be necessary after surgical intervention, especially in children with persistent symptoms or increased risk factors for persistent apnea after TA such as obesity, craniofacial anomalies or neuromuscular problems. Additional treatments such as weight loss, the use of Continuous Positive Airway Pressure (CPAP) or additional surgical procedures may sometimes be required.

• #66 Pediatric obstructive sleep apnea – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/symptoms-causes/syc-20376196

  Without treatment, pediatric obstructive sleep apnea can lead to other health conditions called complications. Rarely, pediatric obstructive sleep apnea can cause infants and young children not to grow as much as those who don’t have the condition. Children who don’t receive treatment also may have a higher risk of later complications such as: High blood pressure. High cholesterol. A higher than typical blood sugar level that raises the risk of diabetes. Other heart and blood vessel conditions. […] But in most children, treatment can help manage complications.

• #67 Reduced Regional Grey Matter Volumes in Pediatric Obstructive Sleep Apnea | Scientific Reports

  https://www.nature.com/articles/srep44566

  Pediatric OSA is associated with cognitive risk. […] One of the major consequences of pediatric OSA consists in the increased risk for severity-dependent cognitive and behavioral deficits, and poor school performance. […] In the majority of published intervention studies, effective OSA treatment has led to either significant improvements or to restoration of cognitive performance. […] The neurocognitive consequences of OSA in children have been extensively evaluated with divergent findings, whereby at any level of OSA severity, not every child will necessarily manifest the presence of cognitive deficits. […] These findings have prompted the assumption that both genetic and environmental factors contribute to this variance. […] In summary, children with moderate to severe OSA exhibit extensive regionally demarcated grey matter losses compared to healthy children. […] The mechanisms underlying such extensive MRI changes, the exact nature of the grey matter reductions and their potential reversibility remain virtually unexplored, and should prompt intensive future research efforts in this direction.

• #68 Pediatric Sleep Disordered Breathing / Obstructive Sleep Apnea |

  https://www.bmc.org/patient-care/conditions-we-treat/db/pediatric-sleep-disordered-breathing-obstructive-sleep-apnea

  A common physical cause of airway narrowing contributing to SDB is enlarged tonsils and adenoids. Overweight children are at increased risk for SDB because fat deposits around the neck and throat can also narrow the airway. […] Children with abnormalities involving the lower jaw or tongue or neuromuscular deficits such or cerebral palsy have a higher risk of developing sleep disordered breathing. […] Potential consequences of untreated pediatric sleep disordered breathing […] Children with SDB may become moody, inattentive, and disruptive both at home and at school. Sleep disordered breathing can also be a contributing factor to attention deficit disorders in some children. […] SDB can cause increased nighttime urine production, which may lead to bedwetting. […] Children with SDB may not produce enough growth hormone, resulting in abnormally slow growth and development. […] OSA can be associated with an increased risk of high blood pressure or other heart and lung problems.

• #69 Obstructive sleep apnea is common in kids and may impact blood pressure, heart health | American Heart Association

  https://newsroom.heart.org/news/obstructive-sleep-apnea-is-common-in-kids-and-may-impact-blood-pressure-heart-health

  Children and adolescents with OSA may also have higher blood pressure. […] The statement suggests that children and adolescents with OSA have their blood pressure measured over a full 24-hour period to capture waking and sleeping measurements given the likelihood for higher nighttime blood pressure. […] Continuous positive airway pressure (CPAP), a treatment for OSA, can significantly lower triglyceride levels and improve HDL levels. Treating OSA may also improve the factors of metabolic syndrome, at least in the short term. […] Obesity is a significant risk factor for sleep disturbances and obstructive sleep apnea, and the severity of sleep apnea may be improved by weight loss interventions, which then improves metabolic syndrome factors such as insulin sensitivity. […] We need to increase awareness about how the rising prevalence of obesity may be impacting sleep quality in kids and recognize sleep-disordered breathing as something that could contribute to risks for hypertension and later cardiovascular disease.

• #70 Pediatric obstructive sleep apnea – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/symptoms-causes/syc-20376196

  Without treatment, pediatric obstructive sleep apnea can lead to other health conditions called complications. Rarely, pediatric obstructive sleep apnea can cause infants and young children not to grow as much as those who don’t have the condition. Children who don’t receive treatment also may have a higher risk of later complications such as: High blood pressure. High cholesterol. A higher than typical blood sugar level that raises the risk of diabetes. Other heart and blood vessel conditions. […] But in most children, treatment can help manage complications.

• #71 Pediatric obstructive sleep apnea – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/symptoms-causes/syc-20376196

  Without treatment, pediatric obstructive sleep apnea can lead to other health conditions called complications. Rarely, pediatric obstructive sleep apnea can cause infants and young children not to grow as much as those who don’t have the condition. Children who don’t receive treatment also may have a higher risk of later complications such as: High blood pressure. High cholesterol. A higher than typical blood sugar level that raises the risk of diabetes. Other heart and blood vessel conditions. […] But in most children, treatment can help manage complications.

• #72 Pediatric Sleep Disordered Breathing / Obstructive Sleep Apnea |

  https://www.bmc.org/patient-care/conditions-we-treat/db/pediatric-sleep-disordered-breathing-obstructive-sleep-apnea

  A common physical cause of airway narrowing contributing to SDB is enlarged tonsils and adenoids. Overweight children are at increased risk for SDB because fat deposits around the neck and throat can also narrow the airway. […] Children with abnormalities involving the lower jaw or tongue or neuromuscular deficits such or cerebral palsy have a higher risk of developing sleep disordered breathing. […] Potential consequences of untreated pediatric sleep disordered breathing […] Children with SDB may become moody, inattentive, and disruptive both at home and at school. Sleep disordered breathing can also be a contributing factor to attention deficit disorders in some children. […] SDB can cause increased nighttime urine production, which may lead to bedwetting. […] Children with SDB may not produce enough growth hormone, resulting in abnormally slow growth and development. […] OSA can be associated with an increased risk of high blood pressure or other heart and lung problems.

• #73 Diagnostic and Therapeutic Approach to Children and Adolescents with Obstructive Sleep Apnea Syndrome (OSA): Recommendations in Emilia-Romagna Region, Italy

  https://www.mdpi.com/2075-1729/12/5/739

  The definition and evaluation of the organizational process and outcome indicators of the developed flow-chart, and the impact of its implementation will remain fundamental. […] Paediatric OSA is a multifactorial disease and therefore requires a multidisciplinary approach involving the family paediatrician, the paediatrician-pneumologist specialising in sleep-disordered breathing, the otorhinolaryngologist, the child neuropsychiatrist/neurologist (hospital and/or territorial), the orthodontist and other specialists (maxillofacial surgeon, cardiologist, anaesthetist) depending on the patient’s clinical picture. […] Although watchful waiting as therapeutic approach can be useful in the majority of the cases, early treatment is essential in selected patients to improve the child’s long-term outcome, especially when cognitive and/or behavioural problems coexist. Treatment of OSA has been shown to be associated with improvements in behaviour, attention and social relationships.

• #74 Pediatric Obstructive Sleep Apnea | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26809

  A growing risk factor for pediatric OSA is childhood obesity. […] When the history and physical are concerning for pediatric OSA, the gold standard for diagnosis is nocturnal polysomnography (PSG). […] Many different treatment options are depending on the severity of the OSA. […] If there is adenotonsillar hypertrophy, the most effective treatment is adenotonsillectomy (AT). […] Continuous positive airway pressure (CPAP) is another potential treatment option. […] Any patient with a reversible risk factor for OSA, especially obesity, should be counseled on reversing the issue. […] If left untreated, pediatric OSA can have serious morbidities and long-term complications. […] Before diagnosis, parents should be educated at well-child checks to be vigilant about signs and symptoms of pediatric OSA, including loud nightly snoring, frequent nighttime awakenings, secondary nocturnal enuresis, and behavioral changes in their children. […] Children with loud nightly snoring, fragmented sleep, and behavioral issues should be screened for OSA. […] Rapid assessment, evaluation, diagnosis, and management are necessary for the patient and family when there is a concern for pediatric OSA.

• #75 Recognising paediatric obstructive sleep apnoea in primary care: diagnosis and management | British Journal of General Practice

  https://bjgp.org/content/67/659/282

  In the overwhelming majority of uncomplicated OSA, adenotonsillectomy resolves symptoms, leading to improvement in sleep and quality of life, as well as resolution of behavioural symptoms. For the few children that adenotonsillectomy fails, or if it is contraindicated, they should be referred for continuous positive airway pressure (CPAP). […] GPs should be vigilant for paediatric OSA as it is common and may affect up to 1 in 30 children. OSA in children may present with behavioural problems and poor attention, which parents may not necessarily link to a sleep disorder. It is therefore important that the GP elicits a sleep history. Obesity is a risk factor and is thought to be responsible for rising levels of paediatric OSA. Any child with a history of snoring and any of the daytime or night-time symptoms of OSA should be referred; with treatment the prognosis is excellent.

• #76 2 Apnea Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/apnea-nursing-care-plans/

  Therapeutic interventions and nursing actions for patients with apnea may include: Assess the frequency and pattern of breathing; Observe the presence of apnea and changes in the heart rate, Assess skin, nail beds, skin, and mucous membranes for pallor or cyanosis, Place the infant on an apnea monitor and pulse oximeter, Assess respiratory rate, depth, and ease, periods of apnea, Assess the infant for skin color and perfusion, Assess for changes in consciousness, the presence of irritability and somnolence, Monitor ABG levels and oxygen saturation, Monitor chest-Xray studies for further evaluation, Position the infants head and neck in a neutral position, Avoid prolonged suctioning; Discourage taking rectal temperatures and tube feedings, Provide tactile stimulation by applying a gentle rub on the soles of the feet or chest wall, Administer methylxanthines (e.g., theophylline, caffeine) as prescribed, Administer continuous nasal airflow or CPAP via a nasal mask, or a face mask, Prepare the infant for assisted mechanical ventilation as indicated, Educate the parents on the use of apnea monitor and allow for a return demonstration of the application.

• #77 Pediatric Obstructive Sleep Apnea Diagnosis and Treatment: What You Need to Know – Pediatrics Nationwide

  https://pediatricsnationwide.org/2024/12/18/pediatric-obstructive-sleep-apnea-diagnosis-and-treatment-what-you-need-to-know/

  Pediatric obstructive sleep apnea, a common condition in children, is definitively diagnosed with sleep studies and can be treated through various modalities, depending on disease severity. […] A pediatric sleep study, or pediatric polysomnography, is critical to definitively diagnosing OSA and evaluating treatment success, Dr. Kalra explains. […] Medical, dental and surgical approaches are available to treat OSA, but each case requires a personalized approach. […] Overall, tailoring the treatment to the individual characteristics of the patient through shared decision-making with families can help achieve the best treatment outcomes, he concluded.

• #78 2 Apnea Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/apnea-nursing-care-plans/

  Compromised family coping for patients with apnea may occur due to the significant impact that the infants condition can have on the familys daily routine and emotional well-being. […] Assess family anxiety level and erratic behaviors (anger, tension, disorganization) perception of a crisis situation, Assess the familys previous coping methods and perceived effectiveness, Assist the family to identify and use 3 techniques to cope with and solve problems and gain control over the situation, Assess the history of apnea, sudden infant death syndrome (SIDS), and life-threatening events of infants in the family, Assess for the presence of apneic episodes, bradycardia, cyanosis, gastroesophageal reflux, upper respiratory infection, and poor feeding with choking during feedings, Assess parents ability to take part in apnea monitoring and to learn CPR as an intervention in case of an episode, Encourage verbalization of feelings and provide accurate information about infant apnea, Educate parents that over-protective behaviors may affect infant growth and development, Reinforce appropriate coping behaviors, Reinforce the need to sustain the health of family members and social contacts, Encourage parents to verbalize feelings about unmet needs and the ability to meet and develop self-expectations, Provide a calm, supportive, and positive environment; encourage and commend positive parental behaviors, Encourage touching and play activities between parents and infants, Provide parents with step-by-step procedures in written or picture form about apnea monitoring and resuscitation, Teach parents about safety issues of home apnea monitoring, Demonstrate for parents, and allow for return demonstration on how to attach electrodes to the belt and monitor, apply belt to infants chest, turn to monitor on, set the monitor, test the monitor alarms, remove and care of monitor after use, Instruct other significant others and support persons to care for the child with a home monitor, including CPR, Demonstrate for parents and allow for return demonstration of CPR on infant model.

• #79 Diagnostic and Therapeutic Approach to Children and Adolescents with Obstructive Sleep Apnea Syndrome (OSA): Recommendations in Emilia-Romagna Region, Italy

  https://www.mdpi.com/2075-1729/12/5/739

  Obstructive sleep apnoea syndrome (OSA) in paediatrics is a rather frequent pathology caused by pathophysiological alterations leading to partial and prolonged obstruction (hypoventilation) and/or intermittent partial (hypopnoea) or complete (apnoea) obstruction of the upper airways. […] Unfortunately, there are few data on shared diagnostic-therapeutic pathways that address OSA with a multidisciplinary approach in paediatric age. This document summarizes recommendations from the Emilia-Romagna Region, Italy, developed in order to provide the most appropriate tools for a multidisciplinary approach in the diagnosis, treatment and care of paediatric patients with OSA. […] The relationship between the paediatrician of the patient and her/his parents must see a synergy of behaviour between the various players in order to avoid uncertainty about the diagnostic and therapeutic decisions as well as the follow-up phase.

• #80 Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

  https://www.mdpi.com/2077-0383/9/3/888

  Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. […] Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. […] The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. […] In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care.

• #81 Pediatric Obstructive Sleep Apnea | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26809

  A growing risk factor for pediatric OSA is childhood obesity. […] When the history and physical are concerning for pediatric OSA, the gold standard for diagnosis is nocturnal polysomnography (PSG). […] Many different treatment options are depending on the severity of the OSA. […] If there is adenotonsillar hypertrophy, the most effective treatment is adenotonsillectomy (AT). […] Continuous positive airway pressure (CPAP) is another potential treatment option. […] Any patient with a reversible risk factor for OSA, especially obesity, should be counseled on reversing the issue. […] If left untreated, pediatric OSA can have serious morbidities and long-term complications. […] Before diagnosis, parents should be educated at well-child checks to be vigilant about signs and symptoms of pediatric OSA, including loud nightly snoring, frequent nighttime awakenings, secondary nocturnal enuresis, and behavioral changes in their children. […] Children with loud nightly snoring, fragmented sleep, and behavioral issues should be screened for OSA. […] Rapid assessment, evaluation, diagnosis, and management are necessary for the patient and family when there is a concern for pediatric OSA.

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