From Bench to Bedside: Updates in Pediatric Obstructive Sleep Apnea

Abstract

Program Description: Pediatric obstructive sleep apnea (OSA) has been identified in 2% to 4% of children in the United States. While adenotonsillectomy is widely regarded as the primary therapy for pediatric OSA, evidence suggests that anatomy alone is not enough to explain the presence of OSA. With this in mind, evaluation of other factors contributing to OSA has revealed that inflammation, and specifically leukotrienes, may contribute to airway obstruction and that medical treatment of airway inflammation may be effective to treat sleep disordered breathing (SDB). In addition, the evidence regarding accurate diagnosis of sleep-disordered breathing in children is still subject to debate. While sleep studies are unquestionably the gold standard for diagnosis, the use of criteria adapted from adult studies has led to come controversy regarding the correct parameters to use for diagnosis. Additional investigations have found that respiratory patterns in children differ from those in adults and standard sleep study parameters may not be very specific or sensitive. Therefore, flow-based respiratory measures have been developed to help determine which children would benefit from treatment and measure response to treatment after surgery. While accurate measurement of SDB is essential, quantification of the consequences of OSA and SDB is also important and the relationship between neurobehavioral measures and SDB has been explored. Understanding the role of inflammation and the potential for flow-based respiratory measures is critical in advancing the treatment of pediatric OSA. In addition, a better understanding of the relationship between neurocognitive and behavioral measures and SDB is fundamental to developing rationale strategies for treatment.

Educational Objectives: 1) Appreciate the current state of understanding regarding inflammation and biomarkers in pediatric obstructive sleep apnea. 2) Understand how the measurement of airflow in children can best reflect sleep-disordered breathing. 3) Understand the relationship between neurocognition and sleep disordered breathing in children and changes seen with treatment.