Obstructive Sleep Apnea in Children

Alyssa Brzenski

Case

• A 31 month old term 17kg girl presents for Tonsillectomy and Adenoidectomy as an outpatient. She has a history of frequent ear infections, which have resolved since ear tubes were placed. According to her mom she snores loudly and is much more active than the other children her age. Mom doesn’t think that she stops breathing at night but notices that she always breathes through her mouth and always seems to have bad breath. She has no other past medical history. On exam you observe an overweight female with grade III tonsils but an otherwise unremarkable airway, heart and lung exam.

Tonsillectomy and Adenoidectomy

Indications for T&A

Tonsil Size

What is OSA in kids?

• OSA 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.”

• In kids this commonly occurs in REM.

• Obstructions worsen throughout the sleep period.

OSA in kids

OSA in Kids

Syndromes associated with OSA

OSA Differences- Peds vs Adults

How should we screen for OSA in our patients?

• “Does your child snore?”

• Should be referred for evaluation by a specialist or with a sleep study if • snores more than 3 times a week • 1 or more associated signs or symptoms

Screening with Polysomnography

Pediatric Sleep Studies

What should we be asking?

Treatment of OSA in Children

Should kids with OSA stay overnight after anesthesia?

What anesthetic should beused?

• No standard anesthetic recommended

• Reduce the use of narcotics

• Use a balanced technique, maximizing non-opioid strategies and regional anesthesia

Increased Sensitivity to Narcotics

• OSA Kids with younger age and lower preoperative O2 Nadir correlates with increased narcotic sensitivity

• Avoid Codeine products

Sources

• Schwengel D, Sterni LM, Tunkel DE, Heitmiller E. Perioperative Management of Children with Obstructive Sleep Apnea. Anesthesia and Analgesia. 2009; 109: 60-75.

• Marcus CL, et al. Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome. Pediatrics. 2012; 130: e714-755.