Sleep-Related Breathing Disorders
Objectives:
- Recognize the signs and symptoms of a sleep-related breathing disorder.
- Understand what polysomnography (PSG) entails and how it identifies obstructive vs central apnea. Learn about other diagnostic modalities: i.e. drug-induced sleep endoscopy.
- Learn about the epidemiology and pathogenesis of Obstructive Sleep Apnea (OSA).
- Understand the pathophysiology of OSA in the context of genetic disorders, neuromuscular disorders, skeletal disorders, and endocrine conditions.
- Learn about OSA medical treatments (intranasal steroids, montelukast), surgical management, and positive airway pressure therapies (e.g. CPAP/BiPAP).
- Appreciate the long-term consequences of OSA.
- Recognize the clinical features of central apnea hypoventilation syndromes (apnea of prematurity, congenital central hypoventilation syndrome, ROHHAD).
Articles:
- Excellent review article focusing on diagnosis: signs, symptoms, risk factors, utility of nocturnal PSG for diagnosis, and diagnostic alternatives (Objectives 1, 2)
- Overview of predisposing factors, diagnosis, treatment. (Objectives 1, 2, 3, 5, 6)
- Article describing long-term consequences and complications of OSA
- Great overview of polysomnography: discusses the indications, how to create a child-friendly environment for overnight PSG, as well as techniques & scoring (Objective 2)
- Extensive review discussing the validity and clinical utility of polysomnography in various pediatric populations (Objective 2)
- High-Risk Populations: brief overview of common medical conditions that predispose patients to OSA (Objective 4)
- Neuromuscular Diseases (NMD): discuss the components of breathing, and pathophysiology behind SDB in NMD. (Objective 4)
- Craniofacial syndromes with sleep-related breathing disorders: Discusses craniosynostosis, cleft lip/palate, and micrognathia, and the associated syndromes (i.e. Pierre Robin sequence, Treacher Collins, Stickler, Apert, Cruzon, Pfeiffer) (Objective 4)
- Down syndrome: review of sleep issues, including behavioral components. Discusses risk factors including hypotonia, craniofacial features, and obesity. Difficulties administering overnight PSG in a patient with an intellectual disability, and alternative measures to diagnose. (Objective 4)
- Overview of indications for positive airway pressure therapy in children, types of devices, & strategies to increase adherence (Objective 5)
- Review article from 2020 of all current treatment options (surgical and nonsurgical), as well as options for residual OSA post tonsillectomy and adenoidectomy. (Objective 5)
- Supplement 2020 Cochrane Review: montelukast and intranasal steroids for mild to moderate OSA. Found insufficient evidence for intranasal steroids, and short-term benefits of montelukast in non-obese otherwise healthy children. (Objective 5)
- CHAT trial 2013: the only RCT demonstrating the benefits of adenotonsillectomy over watchful waiting (Objective 5)
- Central sleep apnea: nice table listing different etiologies and categorizing them; also discusses diagnosis, pathophysiology, & management including flow charts for decision-making (Objective 7)
- AAP 2012 Practice Guidelines: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
- Specific diseases/conditions:
Additional Resources: coming soon
Self-Assessment: coming soon