Paediatrics: Sleep apnoea

2021-04-15 02:13 PM

Apnoea is defined as a lack of breathing. Obstructive apnoea refers to a lack of airflow in the face of respiratory effort.

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 hypertrophy, 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 a 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 CO2measurement 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 foresight 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.