Pediatric obstructive sleep apnea revisited: Perioperative considerations for the pediatric Anesthesiologist

Development and validation of a predictive model (CHASE-OSA) for preoperative assessment of moderate-to-severe pediatric obstructive sleep apnea

PURPOSE

Undetected obstructive sleep apnea (OSA) in children increases the likelihood of perioperative respiratory complications. Current screening tools for OSA often lack sensitivity or are overly complex. This study aimed to develop and validate a simplified preoperative predictive model for moderate-to-severe pediatric OSA.

METHODS

The study included children aged 1 to 18 years who underwent either polysomnography or nocturnal pulse oximetry from January 2013 to December 2020. OSA severity was categorized using these tests, and potential predictors were identified using multivariable logistic regression. The outcomes of the tests were used to create a risk-based scoring system. Internal validation was performed using bootstrapping procedures.

RESULTS

Out of the 1,327 participants, 882 individuals (66.5%) were diagnosed with moderate-to-severe OSA. Predictors considered for developing the scoring system included Craniofacial abnormalities, adenotonsillar Hypertrophy, Age 1-5 years, Snoring > 5 nights/week, Excessive daytime sleepiness, Obesity, Stopping breathing, and Awakening during sleep (CHASE-OSA). The scoring system developed demonstrated an area under the receiver operating characteristic curve of 0.85 (95% CI: 0.83-0.88). The CHASE-OSA score, ranging from 0 to 14, classified scores < 6 as low-risk and ≥ 6 as high-risk for moderate-to-severe pediatric OSA. This cutoff demonstrated a sensitivity of 86%, specificity of 70%, and positive and negative predictive values of 85% and 71%, respectively.

CONCLUSION

The CHASE-OSA predictive model provides a concise and user-friendly preoperative screening tool for identifying moderate-to-severe pediatric OSA. It facilitates risk assessment, enhances perioperative care optimization, and informs postoperative management planning. Further research is needed to comprehensively validate its clinical utility.

Clinical predictors of moderate-to-severe pediatric obstructive sleep apnea

Background

Children with moderate-to-severe obstructive sleep apnea (OSA) require specific management. However, the risk factors associated with this level of severity in pediatric OSA remain poorly defined. This study aimed to identify clinical predictors of moderate-to-severe pediatric OSA.

Methods

This retrospective study enrolled children aged 1-18 years who underwent respiratory polygraphy or nocturnal oximetry between January 2013 and December 2017. Patient history, demographics, and sleep study data were analyzed. Logistic regression analysis was conducted to assess risk factors associated with moderate-to-severe pediatric OSA. The STROBE checklist was followed in reporting this research.

Results

Among 818 children with a median age of 5 years (IQR: 3, 9), 69.4% were male, and 96.7% were diagnosed with OSA. Of those diagnosed, 542 (66.3%) had moderate-to-severe cases. Independent predictors of moderate-to-severe OSA, with their adjusted odds ratios (95% CI), included: age 1-5 years; 6.16 (3.98-9.53), obesity; 2.08 (1.35-3.19), adenotonsillar hypertrophy; 1.58 (1.05-2.36), frequent snoring (>5 nights/week); 6.86 (4.40-10.67), stopped breathing during sleep; 2.34 (1.50-3.63), awakening during sleep; 2.04 (1.32-3.12), and excessive daytime somnolence; 2.10 (1.28-3.43).

Conclusions

Children referred to a sleep center demonstrated an increased risk of being diagnosed with moderate-to-severe OSA. Key clinical predictors of moderate-to-severe OSA included age 1-5 years, frequent snoring, episodes of stopped breathing or awakening during sleep, excessive daytime somnolence, obesity, and adenotonsillar hypertrophy. Prioritizing early sleep investigations and appropriate management for children exhibiting these predictors may enhance clinical outcomes and mitigate the risk of long-term complications.

Considerations in Surgical Management of Pediatric Obstructive Sleep Apnea: Tonsillectomy and Beyond

Obstructive sleep apnea (OSA) is an increasingly recognized disorder with a reported incidence of 5.7% in children. Tonsillectomy (with or without adenoidectomy) in pediatric OSA in otherwise healthy non-obese children has a success rate of approximately 75%. However, the cure rate reported for all children undergoing tonsillectomy varies from 51% to 83%. This article reviews the history of tonsillectomy, its indications, techniques, various methods, risks, and successes. The article also explores other surgical options in children with residual OSA post-tonsillectomy.

Geographic disparities in performance of pediatric polysomnography to diagnose obstructive sleep apnea in a universal access health care system

BACKGROUND

Diagnostic polysomnography (PSG) is recommended prior to adenotonsillectomy (AT) for children with obstructive sleep apnea (OSA) and certain high-risk characteristics, but resource limitations often prevent this practice.

OBJECTIVE

We performed a population-based assessment of children across Ontario, Canada to describe and quantify disparities in PSG.

METHODS AND MATERIALS

This retrospective cohort study was performed using provincial health administrative data held at ICES. We identified children 0-10 years old who underwent PSG and AT between 2009 and 2018, and those with a PSG within 18 months prior to and/or 12 months following AT. We calculated the odds of PSG prior to/following AT after adjustment for demographics, medical comorbidities, geographic and socioeconomic characteristics. Our main predictor was driving time/distance to the nearest pediatric sleep centre ascertained using spatial analysis and geographic information systems.

RESULTS

We identified 27,837 children <10 years old who underwent AT for OSA in Ontario. Only 12.8% had a PSG within 18 months prior and 5.7% had a PSG within 12 months following AT. Shorter driving time/distance, older age, male sex and certain comorbidities were associated with increased odds of PSG.

CONCLUSION

Only a small proportion of children in our cohort underwent PSG prior to or following AT surgery despite universal access to healthcare. This study suggests a need to increase overall PSG access, particularly for those living distant from existing pediatric sleep centres. Future studies could determine if increased PSG testing in 'underserviced areas' would reduce overall surgery rates and/or improve health outcomes.