Materiały źródłowe

• #1 Diagnosis and Treatment of Obstructive Sleep Apnea in Pediatric Individuals | BCBSND

  https://www.bcbsnd.com/providers/policies-precertification/medical-policy/d/diagnosis-and-treatment-of-obstructive-sleep-apnea-in-pediatric-individuals

  Diagnosis and Treatment of Obstructive Sleep Apnea in Pediatric Individuals […] Obstructive Sleep Apnea (OSA) in pediatric individuals is a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns. […] Left untreated, OSA can result in complications, which may include neurocognitive impairment, behavioral problems, failure to thrive, or cor pulmonale, particularly in severe cases. […] For the purposes of this policy the treatment of OSA may be considered medically necessary when ANY of the following conditions are met: A pediatric individual is defined between the age of zero (0) and 17 years of age. […] Clinically significant OSA for pediatric individuals is defined as follows: Apnea Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) of at least five (5) per hour; or AHI or RDI of at least 1.5 per hour with excessive daytime sleepiness, behavioral problems, or hyperactivity. […] Attended polysomnography (PSG) performed on pediatric equipment is the diagnostic test of choice for the pediatric individual because it is the only technique shown to quantify the ventilatory and sleep abnormalities associated with sleep-disordered breathing.

• #1 Diagnosis and Treatment of Obstructive Sleep Apnea in Pediatric Individuals | BCBSND

  https://www.bcbsnd.com/providers/policies-precertification/medical-policy/d/diagnosis-and-treatment-of-obstructive-sleep-apnea-in-pediatric-individuals

  Diagnosis of OSA in pediatric individuals is made when ALL of the following criteria are met: The caregiver reports EITHER: Snoring; or Labored, obstructive or paradoxical breathing; or and […] The caregiver observed ONE OR MORE of the following: Aggressive behavior; or Diaphoresis; or Excessive daytime sleepiness; or Hyperactivity; or Morning headaches; or Movement arousals; or Neck hyperextension during sleep; or Paradoxical rib cage motion during inspiration; or Secondary enuresis; or Slow growth; and […] PSG reveals one (1) or more obstructive apneas or hypopneas per hour of sleep; and […] PSG demonstrates EITHER of the following: Frequent arousals from sleep associated with increased respiratory effort, oxyhemoglobin desaturation associated with apnea, hypercapnia during sleep, or markedly negative esophageal pressure swings; or Periods of hypercapnia, oxyhemoglobin desaturation, or both during sleep that are associated with snoring, paradoxical inward rib cage motion during inspiration, and either frequent arousals from sleep or markedly negative esophageal pressure swings; and […] The pediatric individual’s findings are not better explained by another sleep disorder, medical disorder, neurological disorder, medication, or substance abuse.

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

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

  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.

• #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.

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

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

  Presentation of the paediatric form of the disease differs from adult OSA, as children are more likely to present with behavioural problems, poor attention, and reduced academic performance than daytime sleepiness. It is therefore important to be vigilant for OSA, take an otolaryngology history, and specifically ask about snoring and other common symptoms, especially in children who are disruptive or struggling at school. With treatment, prognosis is excellent. GP referrals for paediatric OSA are increasing as awareness of the disease improves, although diagnosis is still delayed, with up to 31% of patients waiting 4 years for treatment. […] Refer any child with a history of regular night-time snoring when well in conjunction with adenotonsillar hypertrophy plus any of the symptoms of OSA to an ENT surgeon for further investigation. Children with suspected complicated OSA should be referred to paediatrics first. Currently there is no role for watchful waiting by the GP in symptomatic children as adenotonsillectomy has been shown to improve symptoms. Preliminary investigation involves home pulse oximetry, where a soft cuff is fitted to the child’s toe or finger prior to bedtime. A positive result is a strong predictor that the child has OSA, although a negative test does not exclude it. Specialist centres may perform a more detailed sleep study (polysomnography), used to assess severity and decide postoperative care.

• #4 Jornal Brasileiro de Pneumologia – Pediatric obstructive sleep apnea: diagnosis and management

  https://www.jornaldepneumologia.com.br/details/3981/en-US/pediatric-obstructive-sleep-apnea–diagnosis-and-management;

  Obstructive sleep apnea (OSA) is a respiratory disorder characterized by a reduction in or cessation of airflow in the airways during sleep. […] In children, the first step for the clinician is to ask if the child/adolescent snores. An affirmative answer should prompt a more focused evaluation. […] Clinical and polysomnography (PSG) criteria that are not attributable to other disorders are necessary for the diagnosis of OSA. […] According to the American Academy of Sleep Medicine (AASM), the clinical diagnostic criteria for pediatric OSA include the presence of one or more of the following symptoms: snoring; labored, paradoxical, or obstructed breathing during sleep or drowsiness; hyperactivity; behavioral problems; and learning disabilities or other cognitive problems. […] The AASM has also established PSG criteria for pediatric OSA, which include an obstructive apnea-hypopnea index (AHI) 1 event/hour of sleep, with or without a pattern of obstructive hypoventilation defined as hypercapnia during 25% of the total sleep time, together with snoring, flattening of the inspiratory nasal pressure waveform, or paradoxical thoracoabdominal motion.

• #4 Jornal Brasileiro de Pneumologia – Pediatric obstructive sleep apnea: diagnosis and management

  https://www.jornaldepneumologia.com.br/details/3981/en-US/pediatric-obstructive-sleep-apnea–diagnosis-and-management;

  Assessment of the severity of respiratory events according to the PSG findings, even if based on practice and limited consensus, can also help define the management approach. […] If a patient with pediatric OSA has adenotonsillar hypertrophy and has no contraindication to surgery, surgical removal of the tonsils and adenoids (adenoidectomy and/or tonsillectomy) is the first line of treatment. […] The treatment of OSA in children is approached comprehensively, considering their unique needs and their developing physical characteristics. […] Regular monitoring is necessary in order to assess the efficacy of treatment and adjust it as needed, thus ensuring adequate sleep, promoting healthy growth, and improving the overall well-being of the child.

• #5 SciELO Brasil – Pediatric obstructive sleep apnea: diagnosis and management Pediatric obstructive sleep apnea: diagnosis and management

  https://www.scielo.br/j/jbpneu/a/Brvtdq9SSmB4vs4BwChXYtr/?lang=en

  Obstructive sleep apnea (OSA) is a respiratory disorder characterized by a reduction in or cessation of airflow in the airways during sleep. It is known to be present in 1-5% of the pediatric population. Therefore, OSA is now common in childhood, especially given the significant increase in childhood obesity, which constitutes a significant risk factor for this pathology. Another main risk factor is adenotonsillar hypertrophy. Consequently, in the pediatric population, OSA is more common in children between two and six years of age. In addition, prematurity, craniofacial anomalies, neuromuscular diseases, genetic syndromes (such as Down, Prader-Willi, and Crouzon syndromes), asthma, and allergic rhinitis are considered risk factors for the development of pediatric OSA. […] In children, the first step for the clinician is to ask if the child/adolescent snores. An affirmative answer should prompt a more focused evaluation. Clinical and polysomnography (PSG) criteria that are not attributable to other disorders are necessary for the diagnosis of OSA. According to the American Academy of Sleep Medicine (AASM), the clinical diagnostic criteria for pediatric OSA include the presence of one or more of the following symptoms: snoring; labored, paradoxical, or obstructed breathing during sleep or drowsiness; hyperactivity; behavioral problems; and learning disabilities or other cognitive problems. Other possible clinical findings of pediatric OSA include night sweats, nocturnal enuresis (especially secondary), headaches on awakening, mouth breathing (during sleep or while awake), tonsillar hypertrophy, adenoidal facies, micrognathia/retrognathia, and a high-arched palate.

• #5 SciELO Brasil – Pediatric obstructive sleep apnea: diagnosis and management Pediatric obstructive sleep apnea: diagnosis and management

  https://www.scielo.br/j/jbpneu/a/Brvtdq9SSmB4vs4BwChXYtr/?lang=en

  The AASM has also established PSG criteria for pediatric OSA, which include an obstructive apnea-hypopnea index (AHI) 1 event/hour of sleep, with or without a pattern of obstructive hypoventilation-defined as hypercapnia during 25% of the total sleep time, together with snoring, flattening of the inspiratory nasal pressure waveform, or paradoxical thoracoabdominal motion. Assessment of the severity of respiratory events according to the PSG findings, even if based on practice and limited consensus, can also help define the management approach. If the respiratory events index, most commonly the AHI, is less than 5 events/hour, OSA is considered mild, whereas an AHI of 5.0-9.9 indicates moderate OSA and an AHI 10 indicates severe OSA. […] Regular monitoring is necessary in order to assess the efficacy of treatment and adjust it as needed, thus ensuring adequate sleep, promoting healthy growth, and improving the overall well-being of the child.

• #6 Diagnostic Issues in Pediatric Obstructive Sleep Apnea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2645257/

  Obstructive sleep apnea syndrome (OSAS) in children includes a spectrum of respiratory disorders with significant morbidities. Diagnosis of OSAS is based on clinical suspicion, history, and physical findings, and confirmation is made by polysomnography. […] The current review describes methodologies that are available today for assessment and diagnosis of OSAS in children and summarizes the most recent recommendations of the American Academy of Sleep Medicine Task Force regarding scoring sleep-related respiratory events in children. […] The process of diagnosing childhood OSAS continues to evolve as more morbidities are recognized and more precise diagnostic methodologies become available. […] The physical examination should include an assessment of the child’s growth pattern. […] The diagnosis of OSAS should be made when a significant deviation (2 SD mean) from normal polysomnographic values are present.

• #7 Pediatric Obstructive Sleep Apnea | Ento Key

  https://entokey.com/pediatric-obstructive-sleep-apnea/

  Overnight, in-laboratory PSG is the gold standard for diagnosing OSA in children. […] In a cross-sectional study of 349 children (median age of 4.5 years), abnormal nocturnal pulse oximetry had a 97% positive predictive value (PPV) but a 47% negative predictive value (NPV) for detecting OSA compared with PSG. […] Nap PSG is not recommended for the definitive diagnosis of OSA by either the American Academy of Sleep Medicine or the American Academy of Pediatrics, because it can underestimate the presence or severity of OSA compared with in-laboratory nocturnal PSG. […] Evaluation of children with OSA should include the common history and physical examination elements. […] Although this evaluation is important, history and physical examination alone are rarely sufficient to diagnose OSA.

• #8 AAP Clinical Practice Guideline on Diagnosis and Management of Childhood Obstructive Sleep Apnealogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/pa201209190000004/2012/09/19/aap-clinical-practice-guideline-diagnosis-and

  The American Academy of Pediatrics (AAP) revised the guideline for primary care clinicians on diagnosis and management of obstructive sleep apnea (OSA) in children and adolescents. […] OSA is defined as a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction that disrupts normal ventilation during sleep. […] The sensitivity and specificity of history and physical examination alone are low. Polysomnography (overnight sleep study with physiological monitoring and video recording) is the gold standard for diagnosing OSA. […] Objective testing is preferable to clinical evaluation alone. […] This guideline is a major contribution to pediatric sleep medicine for primary care clinicians. It highlights the unreliability of history and physical clues in predicting OSA and indicates that a sleep study of some kind is important for making the diagnosis.

• #9 Diagnosis and Treatment of Sleep Apnea in Children: A Future Perspective Is Needed

  https://www.mdpi.com/2227-9059/11/6/1708

  Obstructive sleep apnea (OSA) in children is a prevalent, but still, today, underdiagnosed illness, which consists of repetitive episodes of upper airway obstruction during sleep with important repercussions for sleep quality. […] The diagnosis of OSA in the pediatric population differs according to the different clinical guidelines and is described according to the Spanish, European, and American guidelines. […] Although medical history and physical examination are useful to screen and determine which patients are suspected of having OSA, the sensitivity and specificity are scarce. Thus, objective sleep tests are needed. The gold standard is overnight, attended, in-laboratory polysomnography (PSG), a complex test that records neurophysiological and cardiorespiratory variables. […] However, PSG may not be readily available, so alternative diagnostic tests can be performed: daytime nap PSG, ambulatory PSG, respiratory polygraphy (RP), nocturnal oximetry, the Pediatric Sleep Questionnaire, or nocturnal video recording.

• #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. […] When the history and physical are concerning for pediatric OSA, the gold standard for diagnosis is nocturnal polysomnography (PSG). However, evaluation with a PSG can be expensive, time-consuming, and resource-limited. […] During PSG, certain specific parameters of sleep quality and quantity are measured. This is done by using sensors to measure brain activity, heart rate, nasal and oral air movement, blood oxygen levels, limb movements, eye movements, and the presence of snoring. […] The majority of children experience improvement after surgery. There has been data to support that AT results in better outcomes as compared to watchful waiting and that PSG findings were normalized in 79% of children who underwent AT as compared to 46% with watchful waiting.

• #11 Childhood Sleep Apnea Workup: Approach Considerations, Polysomnography, Apnea Hypopnea Index

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

  Polysomnography is necessary to document obstructive sleep apnea and gauge its severity. A history of snoring alone is not adequate for making a diagnosis of obstructive sleep apnea or for determining its seriousness. […] Some children with obstructive sleep apnea have primarily obstructive hypoventilation in which repetitive partial obstructions occur with some degree of relative oxygen desaturation and hypercapnia. Because of this, pediatric polysomnographic testing should include some means of determining CO2 levels, such as end-tidal (ET) CO2 monitoring or transcutaneous CO2 monitoring. […] PSG, continuously monitored by appropriately trained technical personnel, may be difficult to arrange due to relative unavailability, with long waiting periods between referral and testing times. For these reasons, attempts have recently been made to evaluate the role of outpatient overnight studies to provide more accessible and practical approaches to the diagnosis of pediatric obstructive sleep apnea. However, these outpatient studies are not well validated yet or covered by third party payers and, thus, remain largely available only as research tools.

• #11 Childhood Sleep Apnea Workup: Approach Considerations, Polysomnography, Apnea Hypopnea Index

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

  Currently, the only available tool for definitive diagnosis of obstructive sleep apnea is an overnight polysomnographic evaluation in the sleep laboratory. An overnight polysomnographic study usually includes multiple channels that aim to monitor sleep state, as well as cardiac and respiratory parameters. […] Polysomnography remains the criterion standard for establishing the diagnosis of obstructive sleep apnea (OSA) in infants, children, and adults. Ideally, polysomnography should be performed overnight and during the patient’s usual bedtime. […] Polysomnographic normal standards differ between children and adults. In the pediatric age range, abnormalities include oxygen desaturation under 92%, more than one obstructive apnea per hour, and elevations of ET CO2 measurements of more than 50 mm Hg for more than 9% of sleep time or a peak level of greater than 53 mm Hg.

• #12 Jornal Brasileiro de Pneumologia – Pediatric obstructive sleep apnea: diagnosis and management

  https://www.jornaldepneumologia.com.br/details/3981/en-US

  Assessment of the severity of respiratory events according to the PSG findings, even if based on practice and limited consensus, can also help define the management approach. […] If the respiratory events index, most commonly the AHI, is less than 5 events/hour, OSA is considered mild, whereas an AHI of 5.0-9.9 indicates moderate OSA and an AHI 10 indicates severe OSA.

• #13 Diagnosis of Pediatric Obstructive Sleep Apnea | Encyclopedia MDPI

  https://encyclopedia.pub/entry/45735

  Diagnosis of obstructive sleep apnea (OSA) in children with sleep-disordered breathing (SDB) requires hospital-based, overnight level I polysomnography (PSG). Obtaining a level I PSG can be challenging for children and their caregivers due to the costs, barriers to access, and associated discomfort. Less burdensome methods that approximate pediatric PSG data are needed. […] Level I polysomnography (PSG) is an overnight evaluation performed in an accredited sleep laboratory. The session is attended by a sleep technician and includes a minimum of seven parameters: electrooculography (EOG), electroencephalography (EEG), chin electromyography (EMG), airflow, respiratory effort, oxygen saturation, and electrocardiography (ECG). The severity of OSA is determined by the apnea-hypopnea index (AHI), or the frequency of partial or complete reduction in airflow. Mild, moderate, or severe OSA correspond to AHI thresholds of less than 5, 5–9, and 10 and over, respectively. Pediatric OSA is diagnosed when the PSG reports an AHI ≥ 1.

• #13 Diagnosis of Pediatric Obstructive Sleep Apnea | Encyclopedia MDPI

  https://encyclopedia.pub/entry/45735

  Home sleep apnea testing (HSAT) is an unattended, home-based sleep study that utilizes portable and wearable monitors with the goal of replicating level I PSG. Pediatric HSAT uses fewer resources and is more cost efficient than level I PSG, with the additional benefits of increased patient comfort and improved accessibility. The AASM does not currently support the use of HSAT to diagnose pediatric OSA. Difficulties in feasibility, validity, identifying arousals and hypoventilation, issues with use in young children or children with comorbidities, and differences in body sizes are the cited challenges. However, the feasibility of HSAT in children (under 16 years of age) has been demonstrated in multiple studies. A recent systematic review and meta-analysis demonstrated that HSAT had a pooled sensitivity of 74% and a pooled specificity of 90% for detecting OSA in children (ages 1–18 years). In children aged 2–17 years, HSAT and PSG yielded similar AHI and the lowest oxygen saturation measurements in children ≥ 6 years old. Similarly, in a study of children aged 5–18 years, HSAT demonstrated excellent concordance with level I PSG. The authors concluded that HSAT is a feasible and comparable alternative to level I PSG. A Spanish study found that home respiratory polygraphy is a potential reliable alternative to in-laboratory PSG in children aged 2–14 years. Despite these data, HSAT remains unapproved in children.

• #13 Diagnosis of Pediatric Obstructive Sleep Apnea | Encyclopedia MDPI

  https://encyclopedia.pub/entry/45735

  Level I PSG is currently the only approved method to diagnose pediatric OSA. The American Academy of Sleep Medicine (AASM) and the American Academy of Pediatrics (AAP) recommend PSG to screen children with any SDB symptoms. The American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) recommends PSG prior to AT in children under 2 years of age or in those with obesity, craniofacial or neuromuscular disorders, Down syndrome, sickle cell disease, or mucopolysaccharidoses. The AAO–HNS also recommends PSG if the need for surgery is uncertain or if the severity of the SDB cannot be explained by a physical exam. […] While a PSG is routinely recommended preoperatively by the AASM and the AAP, only 10% of children who are scheduled for AT undergo a PSG. This is likely due to the significant barriers to obtaining a PSG. For example, there is limited access to certified sleep laboratories and providers with the technical expertise necessary to diagnose OSA in infants and young children. The PSG itself is burdensome, requiring the use of multiple monitors during sleep in an unfamiliar laboratory environment. As caregivers need to be present throughout the duration of the test, their employment, productivity, and responsibilities to other members of the family may be impacted. Finally, the cost of PSG in the United States ranges from USD 1000 to USD 4000, posing a marked strain on the healthcare system.

• #14

  https://journals.lww.com/co-pulmonarymedicine/fulltext/2015/11000/home_sleep_testing_for_the_diagnosis_of_pediatric.5.aspx

  The current paradigm shift in the diagnosis of sleep apnea in adults has further emphasized the urgent need for the development and validation of less inconvenient and laborious approaches than the in-laboratory nocturnal polysomnography for evaluation of children. […] These efforts have been primarily centered around the following: first, refinements and validation of questionnaires; second, single-channel recordings such as oximetry, airflow, or ECG; third, home-based polysomnography and polygraphy; and fourth, biomarkers. […] The major overall findings emanating from such studies indicate that none of the approaches provides an ideal substitute to in-laboratory nocturnal polysomnography. […] Conversely, many of the proposed approaches enable effective screening in a cost-effective manner, and may be particularly suitable when access to pediatric sleep medicine facilities is limited or unavailable.

• #15 Pediatric Obstructive Sleep Apnea > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/pediatric-obstructive-sleep-apnea

  Symptoms of pediatric obstructive sleep apnea include: Snoring, often with pauses, snorts or gasps between breaths, Heavy breathing while sleeping, Extremely restless sleep, Bedwetting (especially if a child previously stayed dry at night), Daytime sleepiness or behavioral problems. […] If your child has trouble sleeping or gets frequent throat infections, such as strep throat, your pediatrician may suggest seeing a pediatric sleep specialist or an ear, nose and throat doctor. […] In addition to taking a thorough medical history and conducting a physical examination, your childs doctor may order several tests to diagnose pediatric obstructive sleep apnea. […] Tests may include: Polysomnogram (overnight sleep study), Oximetry, Electrocardiogram. […] If your child has obstructive sleep apnea, your physician may recommend removal of the tonsils (tonsillectomy) or adenoids (adenoidectomy), or both.

• #15 Pediatric Obstructive Sleep Apnea > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/pediatric-obstructive-sleep-apnea

  If the tonsils and/or adenoids are removed, your child may need another sleep study if the apnea was severe or if symptoms persist, Dr. Canapari says. […] If the tonsils or adenoids are not the problem, continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BPAP) may help while your child sleeps. […] At Yale Medicine, you will find pediatric specialists in both sleep medicine and otolaryngology. […] An overnight sleep study is often key to diagnosing your childs obstructive sleep apnea.

• #16 Obstructive Sleep Apnea in Children | AAFP

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

  The reliability of clinical assessment in the diagnosis of sleep-disordered breathing has not been determined. Several studies indicate that parents’ observation of their child’s breathing is an inaccurate basis for the diagnosis of OSA. […] Adenotonsillectomy should be considered first-line treatment for sleep-disordered breathing in children when there is physical evidence of adenotonsillar hypertrophy. […] Polysomnography is necessary for diagnosis and treatment of patients with multiple medical comorbidities, children with craniofacial syndromes, and patients with an unclear etiology (i.e., modest physical findings or examination findings inconsistent with severity of apnea), and to determine the degree of apnea.

• #17 Pediatric Obstructive Sleep Apnea (OSA) | Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/o/obstructive-sleep-apnea

  Pediatric obstructive sleep apnea (OSA) is a common, treatable condition. Obstructive sleep apnea causes breathing difficulties while sleeping. […] Children and teens who snore should see a doctor to figure out if they have pediatric obstructive sleep apnea. In some cases, they may need to see a pediatric sleep specialist. […] To diagnose this condition, a pediatric sleep specialist uses a test called polysomnography (PSG). This test records a child’s sleep activity for at least one night in a sleep lab. The study can determine the severity of the sleep apnea. It can also help doctors come up with the best treatment plan. […] Your child may need to undergo a second PSG a few months after treating the pediatric obstructive sleep apnea. This second test can determine if the treatment or surgery worked. In some cases, the treatment can stop snoring but not cure pediatric OSA.

• #18 Obstructive Sleep Apnea in Children – Medical Clinical Policy Bulletins | Aetna

  https://www.aetna.com/cpb/medical/data/700_799/0752.html

  Nocturnal polysomnography (NPSG) remains the gold standard diagnostic test to differentiate primary snoring from OSAS in children. […] A PSG may be performed in conjunction with a positive airway pressure (PAP) machine to determine the titration of oxygen flow. […] Positive airway pressure (PAP) titration study is used to set the right level of PAP which can be administered as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BPAP) once individual tolerance and optimal levels are determined by a sleep technologist. […] According to the American Academy of Pediatrics guideline on the diagnosis and management of childhood OSAS (2002), complex high-risk patients should be referred to a specialist with expertise in sleep disorders. […] Indications for a repeat NPSG after an adenotonsillectomy or other pharyngeal surgery for OSAS include high-risk children, or if symptoms of OSAS persist after treatment.

• #18 Obstructive Sleep Apnea in Children – Medical Clinical Policy Bulletins | Aetna

  https://www.aetna.com/cpb/medical/data/700_799/0752.html

  This Clinical Policy Bulletin addresses obstructive sleep apnea in children. […] Aetna considers the following modalities medically necessary for the diagnosis and treatment of obstructive sleep apnea in children and when criteria are met: […] Nocturnal polysomnography (NPSG) for children and adolescents younger than 18 years of age when performed in a healthcare facility for any of the following indications: To diagnose obstructive sleep apnea syndrome (OSAS) and differentiate it from snoring; or […] NPSG for children when performed in a healthcare facility after an adenotonsillectomy or other pharyngeal surgery for OSAS when any of the following is met (study should be delayed 6 to 8 weeks post-operatively): Age younger than 3 years; or […] Drug-induced sleep endoscopy (DISE) for surgical planning in children (to age 18) with persistent obstructive sleep apnea documented by a sleep study, and who are refractory to non-invasive therapy and are eligible for surgery;

• #19 Diagnosing Sleep Apnea in Children | NYU Langone Health

  https://nyulangone.org/conditions/sleep-apnea-in-children/diagnosis

  If your doctor suspects that your child has enlarged adenoids, an otolaryngologist at Hassenfeld Childrens Hospital may perform a nasal endoscopy. […] Sleep endoscopy is an exam that provides your childs doctor with detailed information about what anatomical features may be causing sleep apnea and how the airway collapses during sleep.

• #20 Obstructive sleep apnea – Wikipedia

  https://en.wikipedia.org/wiki/Obstructive_sleep_apnea

  Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep. […] The diagnosis of OSA syndrome is made when the patient shows recurrent episodes of partial or complete collapse of the upper airway during sleep resulting in apneas or hypopneas, respectively. […] To define the severity of the condition, the Apnea-Hypopnea Index (AHI) or the Respiratory Disturbance Index (RDI) are used. […] Nighttime in-laboratory Level 1 polysomnography (PSG) is the gold standard test for diagnosis. […] The diagnosis of OSA in children is often complicated by the fact that symptoms may differ from those in adults, and it is crucial to identify the condition early to prevent long-term consequences.

• #21 Obstructive Sleep Apnea: Pediatric Diagnostic Challenges – MCG Health

  https://www.mcg.com/blog/2018/03/27/obstructive-sleep-apnea-pediatric-diagnostic-challenges/

  In medicine, there are times when the main challenge is realizing that your patient has a problem. Some conditions, such as obstructive sleep apnea, can present subtly. This is true in the adult population, but it can be an even bigger problem in the pediatric population. […] The Challenges Around Diagnosing Pediatric Obstructive Sleep Apnea (OSA) In adults, obstructive sleep apnea typically presents with daytime sleepiness, morning headache, memory impairment, and daytime fatigue. However, in children, sleep apnea may manifest differently than in adults, presenting with symptoms such as hyperactivity, emotional difficulties, decreased academic performance, and difficulty concentrating. […] Because of this, it is essential for the pediatric primary care provider to gather a detailed clinical history. Lack of understanding and expertise in identifying this condition may lead to low rates of screening and referral.

• #22

  https://www.backtable.com/shows/ent/articles/pediatric-obstructive-sleep-apnea-diagnosis

  If a sleep study shows very mild OSA, the decision to proceed with surgery should involve a thorough discussion with the parents. […] Shared-decision making is important here since parents must understand the risks and benefits of the surgery. […] If the child is having a lot of problems, we know that a sleep study that shows very mild OSA or no OSA does not mean that the child doesn’t have behavioral problems or quality of life issues.

• #23 Childhood Sleep Apnea Differential Diagnoses

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

  Obstructive sleep apnea (OSA) must be differentiated from simple snoring, which is a vibratory inspiratory noise that is usually not accompanied by oxygen desaturation, hypercapnia, or sleep disruption. Overnight polysomnography can be performed to differentiate pronounced snoring from true obstructive sleep apnea in the pediatric age group. […] Multiple sleep latency testing (MSLT) following overnight polysomnography is necessary to confirm a diagnosis of narcolepsy and differentiate this from obstructive sleep apnea. […] Any evaluation for suspected sleep apnea must include a careful history with inquiries about sleep times, bedtime routines, and a description of the sleeping environment. Parents should be asked to complete a sleep diary for 1-2 weeks to evaluate whether a child is sleeping enough.

• #24 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. […] A polysomnogram can discriminate among primary snoring, UARS, and OSA, whereas questionnaires alone cannot. […] Polysomnography has been the gold standard for the diagnosis of OSA in adults and is equally useful in determining its presence and severity (as well as the efficacy of treatment for it) in children. […] The recently published American Thoracic Society consensus statement concerning the appropriate standards and indications for pediatric cardiopulmonary sleep studies recommends polysomnography in children: to detect the presence and severity of OSA; to differentiate between benign snoring and snoring associated with partial or complete airway obstruction, hypoxemia, and sleep disruption; to evaluate disturbed sleep, daytime hypersomnolence, cor pulmonale, failure to thrive, or polycythemia that is unexplained by other medical conditions; to assess relevant symptoms in children with major risk factors for OSA; to assess the child with OSA who is at increased risk for perioperative and postoperative complications; and to titrate CPAP therapy in pediatric OSA.

• #25 Diagnosis and evaluation of a child suspected for obstructive sleep apnea: an overview • New Medicine 3/2020 • Czytelnia Medyczna BORGIS

  https://www.czytelniamedyczna.pl/7000,diagnosis-and-evaluation-of-a-child-suspected-for-obstructive-sleep-apnea-an-ove.html

  Wczesna diagnoza OBS jest wana, aby zapobiec powanym negatywnym konsekwencjom zdrowotnym. […] Diagnoza i ocena dziecka z podejrzeniem obturacyjnego bezdechu sennego: przegld […] Wczesna diagnoza OBS jest wana, aby zapobiec powanym negatywnym konsekwencjom zdrowotnym. […] W tej pracy przegldowej zawarlimy biec wiedz dotyczc oceny dziecka z podejrzewanym OBS. […] Obstructive sleep apnea (OSA) is a frequent disorder in pediatric population characterized by airway blockage while asleep, leading to many adverse health effects. […] Early identification of OSA patient is crucial in order prevent serious negative health consequences. […] In this review article we provide up-to-date overview concerning assessment of a child with suspected OSA. […] We focus on available diagnostic modalities, which include attended in-lab sleep studies, with polysomnography (PSG) remaining a gold standard in diagnosing OSA in children, and widely developed home sleep apnea testing (HSAT) belonging to ambulatory sleep studies.

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