Paediatrics: Sleep apnoea

Sleep apnoea

Apnoea is defined as a lack of breathing. Obstructive apnoea refers to a lack of airflow in the face of respiratory effort. It is most often associated with sleep. The obstructive sleep apnoea syndrome (OSAS) may be due to tonsillar/adenoidal hypetrophy, macroglossia, or micrognathia.

Diagnosis

History

·Snoring and sleep disturbance.

·Daytime sleepiness or inattention.

·Eneuresis.

·Only about 15% of snoring children have significant airway obstruction.

Examination

A thorough examination is needed:

·Symptoms of upper airway obstruction and OSAS are more likely to be due to adenoidal hypertrophy, rather than just tonsillar hypertrophy.

·Middle ear infection and chronic effusion: these are features associated with adenoidal hypertrophy.

·Mouth breathing leading to dry mouth and cracked lips.

Investigation

A thorough history and examination should identify children who need further treatment. However, there is a place for the following as part of an assessment.

·Sleep study: this could include just overnight pulse oximetry, but to diagnose impaired gas exchange transcutaneous CO₂ measurement is necessary as well. Sometimes more extensive polysomnography may be needed, mainly to differentiate obstructive from central causes of sleep apnoea..

·Chest X-ray and ECG: to examine for s right heart cardiac consequences of airway obstruction.

Treatment 

Surgery is indicated when the following criteria are met.

Tonsillectomy

Any of:

·Airway obstruction (usually performed with adenoidectomy).

·History of recurrent tonsillitis (>7 episodes in 1yr, or >10 episodes in 2yrs).

·History of two episodes of peritonsillar abscess.

Adenoidectomy

Any of:

·Airway obstruction.

·Recurrent or chronic middle ear infection.

·Recurrent or chronic nasopharyngitis.

·Chronic mouth breathing.