Role of upper airway evaluation in the multidisciplinary management of
obstructive sleep apnea in children below 2 years of age.
Abstract
Background: Diagnosis and treatment of obstructive sleep apnea
(OSA) in infants and young children is challenging because of its
clinical heterogeneity and lack of age-specific guidelines.
Aim: We report the management and treatment outcome of OSA in
children below two years of age. Treatment decisions were based upon the
pattern of upper airway (UA) obstruction, clinical presentation and OSA
severity. Methods: Retrospective, non-randomized observational
cohort study at a tertiary center. Children with OSA who underwent an UA
evaluation (drug-induced sleep endoscopy or direct laryngoscopy) were
included. Results: The study population comprised 100 patients,
57 boys and 43 girls, with a median age of 0.72 years (range 0.0-2.0)
and OSA confirmed by polysomnography. Multilevel UA collapse was present
in 26%, (adeno)tonsillar hypertrophy in 31% and 21% had
laryngomalacia. Laryngomalacia was more common in children below six
months of age and adenotonsillar hypertrophy was observed mainly in
children older than 1.5 year of age. Treatment improved OSA severity in
the entire study population with a significant reduction in obstructive
apnea/hypopnea index from 10.8/h (range 2.1-99.1) to 1.7/h (range
0.0-73.0) (p<0.001), an improvement in mean oxygen saturation
from 96.9% (range 88.9-98.4) to 97.4% (range 92.3-99.0)
(p<0.001) and in minimal oxygen saturation from 85.4% (range
37.0-96.0) to 88.8% (range 51.0-95.5) (p<0.001).
Conclusion: Multidisciplinary management of young children with
OSA guided by the pattern of UA obstruction and OSA severity, results in
favorable treatment outcomes. The pattern of UA obstruction changes in
the first two years of life from a dynamic collapse to structural
abnormalities.