Peds Snoring
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| Incidence of Primary Snoring | 7-10% of pediatric population. Before puberty: M=F, after puberty: M>F. nl labs
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| Obstructive sleep apnea syndrom | 1-3% of pediatric population, peak ages: 2-7 yo (also when tonsils and adenoids grow in),
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| 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
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| PE of patient with Obstructive breathing | frequently normal, adenotonsillar hypertrophy, macroglossia, retrognathia, obesity vs poor growth, blood pressure, cardiac examination
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| Components of the Upper Airway | nose, nasopharynx, oropharynx, laryngopharynx, larynx
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| Lab evaulation: | CBC/electrolytes (late finding, not so helpful), ECG, CXR (not so helpful), sinus films, lateral neck films, polysomnography (very helpful)
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| Gold standard for obstructive breathing/sleep apnea | polysomnography
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| Screening studies | clinical screening tests, home videotaping, wrist band actuator/bed monitor, overnight oximetry, home sleep studies, polysomnography
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| 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
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| Obstructive apnea | in children: obstructive apneas for 2 or more breaths.in adults: obstructive apnea > 10 seconds
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| Central Apnea | central apnea >/= 20 secondsany central apnea associated with an O2 desaturation > 4% and/or bradycardia
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| Hypopnea | decrease in measured airflow of 50%
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| Apnea index | child: >1 apneas/hour, adult>5-10 apneas/hour
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| Adult tx options for obstructive sleep apnea | weight loss, CPAP, Surgery, Dental appliances, Medication
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| Ped tx options for obstructive sleep apnea | observation, surgery, weight loss, CPAP, (dental appliances), (meds)
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| Indications for Surgery | failed CPAP therapy, Patient is not a candidate for CPAP therapy, surgically amenable problem
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| Nasopharynx causes of obstruction | turbinate enlargement, deviated septum, nasal polyps
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| Oropharynx causes of obstruction | tonsillar hypertrophy, adenohypertrophy, macroglossia, adipose tissue
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| Hypopharynx causes of obstruction | adipose tissue, macroglossia, mandibular size or structure abnormalities (such as micrognathia or retrognathia)
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| micrognathia definition | small jaw
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| retrognathia definition | a type of malocclusion which refers to a maxilla or mandible which is further posterior than would be expected.
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| weight loss and sleep apnea reduction | Number of apneas decreases by up to 50% for each 10% decrease in weight
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| CPAP | continuous positive airway pressure
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| Meds for sleep apnea | oxygen (address low SaO2 not apnea), thyroxine, theophylline, acetozolamide, medroxyprogesterone, antidepressants (SSRIs, TCAs)
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| Most common cause of sleep apnea in kids | enlarged tonsils and adenoids
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| most common cause of sleep apnea in adults | obesity
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| 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
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| Treatments of choice for OSA | surgery (T &A), weight loss, and CPAP
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| Most common surgery for kids with OSA | T & A
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| OSA complications | Pulmonary HTN, Devleopmental Delay, growth retardation, death, co pulmonale, behavioral problems, failure to thrive (FTT)
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