67 Questions
What is a crucial factor in deciding treatment options for children with OSA?
Severity of nighttime sleep problems and daytime dysfunction
When might adenotonsillectomy be considered as a treatment option for children with OSA?
If the child has enlarged tonsils
What is a potential consideration when deciding on adenotonsillectomy for children with OSA and underlying medical conditions?
Presence of neuromuscular disorders
What does a preoperative polysomnogram provide for children undergoing adenotonsillectomy?
Baseline data in case OSA persists or recurs after surgery
Why might adenotonsillectomy be the first choice for children with OSA and enlarged tonsils?
To address potential airway obstruction
What is a risk factor for persistent OSA and/or respiratory complications following adenotonsillectomy in children younger than 3 years?
Down syndrome
Children with obesity (BMI ≥95th percentile) undergoing adenotonsillectomy are at increased risk for:
Requiring adjuvant procedures due to multiple sites of obstruction
What condition requires evaluation for hypothyroidism prior to adenotonsillectomy in children?
Down syndrome
What is a common feature of adenoid and tonsil size in children with sickle cell disease?
Larger than normal volunteers
What is a characteristic of craniofacial anomalies that affects the outcomes of adenotonsillectomy?
Presence of multiple sites of airway obstruction
Which group of children may also have significant hypoventilation in addition to obstructive symptoms post-adenotonsillectomy?
Children with neuromuscular disorders
What is a common indication for adenotonsillectomy in children with obstructive sleep apnea?
AHI greater than 10
In children with non-severe OSA (AHI 2-10), what are the two management options mentioned?
Adenotonsillectomy or watchful waiting
What factor influences the decision between adenotonsillectomy and watchful waiting in children with non-severe OSA?
Symptom severity and patient preference
In which group of children may the results of adenotonsillectomy be less dramatic compared to lean children?
Obese children
What improvement is typically observed in children with OSA and enlarged tonsils after adenotonsillectomy?
Improved daytime sleepiness
Which aspect has not shown a clear benefit following adenotonsillectomy in children aged 2-9 with mild to moderate OSA?
Improved executive skills
What is a potential concern when considering supplemental oxygen therapy for children with OSA?
Risk of alveolar hypoventilation
What is a primary reason for using nasal CPAP or BiPAP in children with predisposing factors for OSA?
Aiding breathing in cases where adenotonsillectomy is ineffective
What is a significant outcome reported by studies on rapid maxillary expansion in children with narrow jaws and adenotonsillar hypertrophy?
Reduction in AHI, especially in children with small tonsils
Why is weight loss emphasized in obese children with OSA?
To reduce the risk of additional obesity-related comorbidities
In what scenario might rapid maxillary expansion be considered as an alternative to adenotonsillectomy in children with narrow jaws?
When the child has not responded to orthodontic treatment alone
What is the primary cause of hyponatremia after tonsillectomy?
Inappropriate administration of hypertonic solutions
What is the most common severe complication of tonsillectomy?
Postoperative hemorrhage
When does primary bleeding typically occur after tonsillectomy?
Within the first 24 hours
Which technique for tonsillectomy is associated with higher rates of secondary postoperative bleeding?
Coblation
What is the recommended management for children with sickle cell disease undergoing adenotonsillectomy?
Preoperative transfusions to decrease hemoglobin level
Why are preoperative coagulation studies not routinely performed before adenotonsillectomy?
Limited predictive value
What is the significance of a clot in the tonsillar fossa post-tonsillectomy?
Confirms complete hemostasis
How should children with significant postoperative bleeding after adenotonsillectomy be managed?
Admitted and observed
What can repeated postoperative bleeding after adenotonsillectomy indicate?
Injury to a large vessel with pseudoaneurysm formation
Why do children with type 1 von Willebrand disease undergo preoperative administration of desmopressin acetate before adenotonsillectomy?
To prevent hemorrhage
What is the purpose of drug-induced sleep endoscopy?
To determine the site of obstruction during natural sleep
Which technique allows assessment of airway collapsibility during sleep?
Drug-induced sleep endoscopy
What is a key difference between flexible fiberoptic laryngoscopy and drug-induced sleep endoscopy?
The site of obstruction determination
Why is PSG considered mandatory for children with comorbidities?
To document the severity of SDB
What is the primary focus of office physical examination using flexible fiberoptic laryngoscopy?
Identifying the site of obstruction during sleep
What is a common method used to assess surgical outcomes after DISE-directed surgery in children with OSA?
Cine MRI
Why is surgery in children often staged rather than addressing multiple sites at once?
Due to a higher risk of oropharyngeal scarring and stenosis
Which condition can typically be diagnosed by DISE and was treated with carbondioxide laser supraglottoplasty in children with residual OSA post adenotonsillectomy?
Laryngomalacia
What technique was performed for the treatment of laryngomalacia in children with OSA, resulting in a decrease in AHI for 92% of patients?
Carbondioxide laser supraglottoplasty
What is a common cause of persistent obstruction post-adenotonsillectomy, leading to residual OSA in children?
Occult laryngomalacia
Describe the earliest description of pediatric OSA mentioned in the text.
Obese, red-faced, hypersomnolent boy named Joe in an 1837 novel by Charles Dickens, The Posthumous Papers of the Pickwick Club.
Who accurately described pediatric OSA in 1892?
William Osler
What term did Osler coin to describe morbidly obese, hypersomnolent patients?
pickwickian
Who were the first to describe the clinical features of pediatric OSA in 1976?
Guilleminault and colleagues
In what year did Spector and Bautista associate pediatric respiratory distress with tonsillitis and adenoiditis?
1956
What are the potential morbidities associated with childhood obstructive sleep apnea?
Neurocognitive abnormalities
What is the condition characterized by elevated upper airway resistance without classic apnea or hypopnea?
Upper airway resistance syndrome (UARS)
What is the primary etiology of pediatric obstructive sleep apnea?
Fixed and/or dynamic narrowing of the airway
What are the proposed mechanisms underlying the neurocognitive and behavioral deficits in pediatric sleep-disordered breathing?
Sleep disruption, hypoxia, hypercapnia, brain inflammation, and hormonal changes
What consequences can pediatric sleep-disordered breathing lead to, beyond neurocognitive deficits?
Cardiac dysfunction, blood pressure dysregulation, growth impairment
What are some potential effects of hypoxemia and sleep fragmentation on children with sleep-disordered breathing?
Altered brain neurochemistry, growth hormone secretion
What is the peak incidence age range for pediatric obstructive sleep apnea (OSA)?
2-6 years
What genetic factor is more common in nonobese children with OSA, especially those with neurocognitive dysfunction?
Apolipoprotein E ε-4 allele
Which gender is affected at higher rates by pediatric OSA, with a 50-100% higher prevalence?
Boys
What is the estimated prevalence range of sleep-disordered breathing (SDB) in children based on parental reports and diagnostic testing?
0.1% to 13.0%
What do the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) guidelines recommend regarding PSG prior to tonsillectomy?
PSG is recommended only for selected children with specific premorbid conditions or when there is uncertainty in the need for surgery.
What are the indications for PSG after adenotonsillectomy in children?
PSG is indicated for symptomatic children post-surgery and as a prerequisite for nasal CPAP or BiPAP in high-risk children or surgical failures.
What is known about the natural history of untreated sleep-disordered breathing in children?
Little is known due to most children with OSA and significant SDB undergoing treatment, limiting studies on long-term effects or resolution.
What percentage of children in the watchful waiting group normalized their sleep studies in the Childhood Adenotonsillectomy Trial (CHAT)?
46% of the watchful waiting group normalized their sleep studies.
What are the primary differences in PSG recommendations between the American Thoracic Society Consensus Committee and the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS)?
While the American Thoracic Society recommends PSG prior to adenotonsillectomy for snoring children, the AAO-HNS guidelines suggest PSG only for specific cases with premorbid conditions or uncertain need for surgery.
In the context of adenotonsillectomy, why might PSG be necessary for some children post-surgery?
PSG may be needed post-surgery for symptomatic children or as a prerequisite for treatment with nasal CPAP or BiPAP in high-risk cases or surgical failures.
What is the significance of the Childhood Adenotonsillectomy Trial (CHAT) in understanding pediatric OSA treatment?
It is the only randomized, controlled clinical trial comparing adenotonsillectomy to watchful waiting for pediatric OSA.
What do the 1996 American Thoracic Society Consensus Committee and the 2012 American Academy of Pediatrics Clinical Practice Guidelines recommend regarding PSG before adenotonsillectomy?
They recommend obtaining PSG to differentiate primary snoring from OSA.
Why is there limited knowledge about the natural history of untreated sleep-disordered breathing in children?
Most children diagnosed with OSA or significant SDB undergo treatment, leaving few untreated cases for long-term study.
What did the Childhood Adenotonsillectomy Trial (CHAT) find regarding the normalization of sleep studies in the watchful waiting group?
46% of the watchful waiting group showed normalization in their sleep studies.
Explore the patient characteristics associated with persistent OSA and respiratory complications post adenotonsillectomy in children. Learn about the importance of preoperative polysomnogram and perioperative management decisions.
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