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Peds Snoring

QuestionAnswer
Incidence of Primary Snoring 7-10% of pediatric population. Before puberty: M=F, after puberty: M>F. nl labs
Obstructive sleep apnea syndrom 1-3% of pediatric population, peak ages: 2-7 yo (also when tonsils and adenoids grow in),
Sx of obstructive sleep apnea: Sleeping - snoring, observed apnea, resuscitative gasps, disturbed or restless sleep, paradoxical chest wall movements, observed difficulty breathing, enuresis. Awake sx: mouth breathing, nasal obstruction, excessive daytime tiredness, behavioral problems, hyperactivity, trouble concentrating
PE of patient with Obstructive breathing frequently normal, adenotonsillar hypertrophy, macroglossia, retrognathia, obesity vs poor growth, blood pressure, cardiac examination
Components of the Upper Airway nose, nasopharynx, oropharynx, laryngopharynx, larynx
Lab evaulation: CBC/electrolytes (late finding, not so helpful), ECG, CXR (not so helpful), sinus films, lateral neck films, polysomnography (very helpful)
Gold standard for obstructive breathing/sleep apnea polysomnography
Screening studies clinical screening tests, home videotaping, wrist band actuator/bed monitor, overnight oximetry, home sleep studies, polysomnography
What is measured in a sleep study? EEG, EMG (+/-limb leads), SaO2, Impedance monitoring (chest wall, abdomen), EOG, ECG, EtCO2, Nasal/oral airflow, pH probe, video EEG, Esophageal manometry
Obstructive apnea in children: obstructive apneas for 2 or more breaths.in adults: obstructive apnea > 10 seconds
Central Apnea central apnea >/= 20 secondsany central apnea associated with an O2 desaturation > 4% and/or bradycardia
Hypopnea decrease in measured airflow of  50%
Apnea index child: >1 apneas/hour, adult>5-10 apneas/hour
Adult tx options for obstructive sleep apnea weight loss, CPAP, Surgery, Dental appliances, Medication
Ped tx options for obstructive sleep apnea observation, surgery, weight loss, CPAP, (dental appliances), (meds)
Indications for Surgery failed CPAP therapy, Patient is not a candidate for CPAP therapy, surgically amenable problem
Nasopharynx causes of obstruction turbinate enlargement, deviated septum, nasal polyps
Oropharynx causes of obstruction tonsillar hypertrophy, adenohypertrophy, macroglossia, adipose tissue
Hypopharynx causes of obstruction adipose tissue, macroglossia, mandibular size or structure abnormalities (such as micrognathia or retrognathia)
micrognathia definition small jaw
retrognathia definition a type of malocclusion which refers to a maxilla or mandible which is further posterior than would be expected.
weight loss and sleep apnea reduction Number of apneas decreases by up to 50% for each 10% decrease in weight
CPAP continuous positive airway pressure
Meds for sleep apnea oxygen (address low SaO2 not apnea), thyroxine, theophylline, acetozolamide, medroxyprogesterone, antidepressants (SSRIs, TCAs)
Most common cause of sleep apnea in kids enlarged tonsils and adenoids
most common cause of sleep apnea in adults obesity
Indications for Polysomnography: snoring, witness apneas, restless sleep, excessive daytime tiredness, sleep disturbances (parasomnias, dyssomnias), seizures and neuromuscular dz with FEV1<40-50%, assessment of alveolar hypoventilation, poorly controlled SS dz, unexplained: pulmonary HTN, cor pulmonale, polycythemia
Treatments of choice for OSA surgery (T &A), weight loss, and CPAP
Most common surgery for kids with OSA T & A
OSA complications Pulmonary HTN, Devleopmental Delay, growth retardation, death, co pulmonale, behavioral problems, failure to thrive (FTT)
Created by: ltm12
 

 



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