Pediatric Year in Review

PEDIATRIC YEAR IN REVIEW 10 DISE FOR TREATMENT OF OSA IN CHILDREN WITH UNDERLYING COMPLEXITY He S, Peddireddy NS, Smith DF, Duggins AL, Heubi C, Shott SR, et al. Outcomes of Drug-Induced Sleep Endoscopy- Directed Surgery for Pediatric Obstructive Sleep Apnea. Otolaryngol Head Neck Surg. 2018;158(3):559-65 Summary The aim of this study was to determine the effectiveness of DISE directed surgery for infant OSA or persistent OSA post adeno-tonsillectomy (AT). Two groups of children were evaluated pre and post DISE+surgery with PSG; 1) Children with persistent OSA after AT or 2) infants with OSA. Response to surgery was defined as an obstructive AHI of <5 events per hour (if baseline AHI was >5 events per hour) or AHI <1 event per hour (with baseline AHI of <5 events per hour). There were 56 patients (34% were female) with a mean age of 5.5 ±5.5 years of which the majority were Caucasian. There were multiple co-morbidities including laryngomalacia, Down syndrome, Pierre Robin and developmental delay. The mean AHI was 14.9 per hour and most of these, 47/56, had AHI >5 events per hour. The most common surgeries were adenoidectomy (48%), tonsillectomy (27%), supraglottoplasty (37.5%) and lingual tonsillectomy (12.5%). Other surgeries included UPP, posterior mid-line glossectomy, mandible distraction and one patient had a tracheostomy. Overall, the mean OAHI changed from 14.9 ± 13.5 to 10.3±16.2 and SaO2 nadir increased from 82.4%+10.2 to 80.1 ± 9.6%. Specifically after surgeries, 18% had complete resolution of OSA, 37.5% had mild residual OSA, but 27% still had persistent severe OSA. Comments 1. DISE directed surgery was significantly more effective for children without previous AT e.g. infants with OSA. 2. DISE was more effective in subjects with lower OAHI suggesting that multilevel collapse is more difficult to effectively treat with surgery. 3. Black race was associated with a lower likelihood of response. 4. Need to further understand who is most likely to benefit from DISE targeted surgery. OTHER ARTICLES OF INTEREST Hornero R, Kheirandish-Gozal L, Gutierrez-Tobal GC, Philby MF, Alonso-Alvarez ML, Alvarez D, et al. Nocturnal Oximetry-based Evaluation of Habitually Snoring Children. Am J Respir Crit Care Med. 2017;196(12):1591-8. Strollo PJ, Jr., Soose RJ, Maurer JT, de Vries N, Cornelius J, Froymovich O, et al. U pper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014;370(2):139- 49. Propst EJ, Amin R, Talwar N, Zaman M, Zweerink A, Blaser S, et al. Midline posterior glossectomy and lingual tonsillectomy in obese and nonobese children with down syndrome: Biomarkers for success. Laryngoscope. 2017;127(3):757-63. Overbergh C, Installe S, Boudewyns A, Van Hoorenbeeck K, Verhulst SL. The Optiflow interface for chronic CPAP use in children. Sleep medicine. 2018; 44:1-3. Alebraheem Z, Toulany A, Baker A, Christian J, Narang I. Facilitators and Barriers to Positive Airway Pressure Adherence for Adolescents. A Qualitative Study. Ann Am Thorac Soc. 2018;15(1):83-8. Walter LM, Tamanyan K, Weichard AJ, Davey MJ, Nixon GM, Horne RSC. Sleep disordered breathing in children disrupts the maturation of autonomic control of heart rate and its association with cerebral oxygenation. The Journal of physiology. 2019;597(3):819-30. Van Eyck A, De Guchtenaere A, Van Gaal L, De Backer W, Verhulst SL, Van Hoorenbeeck K. Clinical Predictors of Residual Sleep Apnea after Weight Loss Therapy in Obese Adolescents. The Journal of pediatrics. 2018; 196:189-93. e1. Smith DF, Amin RS. Obstructive Sleep Apnea and Cardiovascular Risk in Pediatrics. Chest. 2019. Kheirandish-Gozal L, Gozal D. Obstructive Sleep Apnea and Inflammation: Proof of Concept Based on Two Illustrative Cytokines. Int J Mol Sci . 2019;20(3). Farre N, Farre R, Gozal D. Sleep Apnea Morbidity: A Consequence of Microbial-Immune Cross-Talk? Chest. 2018;154(4):754-9. Combs D, Skrepnek G, Seckeler MD, Barber BJ, Morgan WJ, Parthasarathy S. Sleep-Disordered Breathing is Associated with Increased Mortality in Hospitalized Infants with Congenital Heart Disease. J Clin Sleep Med. 2018;14(9):1551-8. UPDATE IN THE MANAGEMENT OF SLEEP DISORDERED BREATHING IN CHILDREN