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PubMed2003

Treatment of obstructive sleep apnea in children: do we really know how?

Obstructive sleep apnea syndrome (OSAS) is a frequent, albeit underdiagnosed problem in children. If left untreated, OSAS may lead to substantial morbidities affecting multiple target organs and systems. The immediate consequences of OSAS in children include behavioral disturbance and learning deficits, pulmonary hypertension, as well as compromised somatic growth. However, if not treated promptly and early in the course of the disease, OSAS may also impose long-term adverse effects on neurocognitive and cardiovascular function, thereby providing a strong rationale for effective treatment of this condition. This review provides a detailed description of the current treatment modalities for pediatric OSAS, and uncovers the potential limitations of the available data on these issues. Furthermore, we postulate that OSAS will persist relatively often after tonsillectomy and adenoidectomy, and that critical studies need to be conducted to identify such patients and refine the clinical management algorithm for pediatric OSAS.

Anti-Inflammatory Agents↗

PubMed2004

Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome.

STUDY OBJECTIVES: Drivers suffering from obstructive sleep apnea syndrome (OSAS) have an increased risk for being involved in motor-vehicle collisions. This study estimates, for the first time, the annual OSAS-related collisions, costs, and fatalities in the United States and performs a cost-benefit analysis of treating drivers suffering from OSAS with continuous positive airway pressure (CPAP). DESIGN: The MEDLINE-PubMed database (1980 to 2003) was searched for information on OSAS. A meta-analysis was performed of studies investigating the relationship between collisions and OSAS. Data from the National Safety Council were used to estimate OSAS-related collisions, costs, and fatalities and their reduction with treatment. Next, the annual cost of treating OSAS with CPAP was calculated. Finally, multiple 1-way sensitivity analyses were performed. SETTING: N/A. PATIENTS OR PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: More than 800,000 drivers were involved in OSAS-related motor-vehicle collisions in the year 2000. These collisions cost 15.9 billion dollars and 1,400 lives in the year 2000. In the United States, treating all drivers suffering from OSAS with CPAP would cost 3.18 billion dollars, save 11.1 billion dollars in collision costs, and save 980 lives annually. CONCLUSION: Annually, a small but significant portion of motor-vehicle collisions, costs, and deaths are related to OSAS. With CPAP treatment, most of these collisions, costs, and deaths can be prevented. Treatment of OSAS benefits both the patient and the public.

Accidents, Traffic↗

PubMed2006

Effect of continuous positive airway pressure versus supplemental oxygen on sleep quality in obstructive sleep apnea: a placebo-CPAP-controlled study.

STUDY OBJECTIVE: We investigated the short-term effectiveness of continuous positive airway pressure (CPAP) and oxygen in improving sleep quality in patients with obstructive sleep apnea (OSA). DESIGN: Randomized, double-blind, placebo-controlled, parallel study. SETTING: General Clinical Research Center at a university hospital. PATIENTS: Seventy-six patients with untreated OSA. INTERVENTIONS: Patients were randomly assigned to 1 of 3 treatments (CPAP, placebo-CPAP, or nocturnal oxygen at 3 L per minute) for 2 weeks. Sleep quality was assessed at baseline and after 1 and 14 days of therapy. Repeated-measures analysis of variance was used to evaluate treatment and time effects, and their interaction. MEASUREMENTS AND RESULTS: Sixty-three patients completed the protocol. When compared with placebo-CPAP and nocturnal oxygen, CPAP increased rapid eye movement (REM) sleep and significantly reduced stage 1 sleep and the number of stage shifts (p < or = .003). CPAP improved, to within normal limits, the apnea-hypopnea index, total arousal index, and mean oxyhemoglobin saturation (p < or = .001). The effects of CPAP were apparent during the first night of therapy. Oxygen improved only mean nocturnal saturation (p = .009). CPAP had no significant effect on stage 2 sleep or slow-wave sleep. CONCLUSIONS: CPAP was associated with an improvement in sleep quality in patients with OSA by consolidating sleep, reducing stage 1 sleep, and improving REM sleep. CPAP was effective in correcting the respiratory and arousal abnormalities of OSA. The effectiveness of supplemental oxygen was limited to oxyhemoglobin desaturation.

Arousal↗

PubMed2003

Recent advances in understanding the pathogenesis of obstructive sleep apnea.

PURPOSE OF REVIEW: The pathogenesis of obstructive sleep apnea (OSA) is incompletely understood. Historically it was believed that patients with OSA have a small upper airway (often due to obesity) that is kept patent during wakefulness by the activity of upper airway dilating muscles. With the reduction in muscle tone at sleep onset, the airway collapses and causes apnea. While this appears to be the case for many patients with OSA, other patients show no major airway anatomic defects or minimal obesity. RECENT FINDINGS: This has led to the concept that other factors such as unstable ventilatory control and changes in lung volume during sleep may be involved in the pathogenesis of OSA. Recently there have been several advances in our understanding of how these mechanisms are involved in OSA pathogenesis. SUMMARY: A more complete understanding of apnea pathogenesis may improve therapeutic techniques and reduce the consequences of OSA.

Evoked Potentials, Somatosensory↗

PubMed2005

Effectiveness of adenotonsillectomy in the resolution of nocturnal enuresis secondary to obstructive sleep apnea.

OBJECTIVES: To investigate the relationship between obstructive sleep apnea (OSA) syndrome and nocturnal enuresis (NE) in patients who required tonsillectomy or adenoidectomy. STUDY DESIGN: Retrospective chart review with prospective collection of data. METHODS: All charts of patients ages 2 to 18 years that had tonsillectomy or adenoidectomy over a 44 month period were reviewed for presence of NE and indication for surgery. Those patients with a positive history of both NE and OSA were surveyed to determine whether there was no change in enuresis, decreased enuresis, or no enuresis postoperatively. RESULTS: Three hundred twenty-six children who had undergone tonsillectomy or adenotonsillectomy had data regarding enuresis available in their charts. One hundred seven of these 326 (32.8%) children had a positive history of enuresis. Of the 107 children with a positive history, 44 (41.1%) were female, and 63 (58.9%) were male. All 107 children with enuresis underwent adenotonsillectomy for OSA. None of the children who had a history of recurrent adenotonsillitis or chronic tonsillitis reported enuresis as a presenting symptom. Of the 107 children with a positive preoperative history of NE, 57 (53.3%) agreed to participate in the second phase of the study. Postoperatively, 61.4% (35) of the children were free of enuresis, 22.8% (13) had a decrease in enuresis, and 15.8% (9) had no change in enuresis. A chi-square test showed a statistically significant difference among the groups (P < .0001). CONCLUSIONS: NE is a relatively common finding in children with OSA symptoms. NE resolves or markedly improves in the vast majority of these patients postoperatively.

Adenoidectomy↗

PubMed2003

Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea.

BACKGROUND: There is increasing evidence that obstructive sleep apnea (OSA) is an independent risk factor for arterial hypertension. Because there are no controlled studies showing a substantial effect of nasal continuous positive airway pressure (nCPAP) therapy on hypertension in OSA, the impact of treatment on cardiovascular sequelae has been questioned altogether. Therefore, we studied the effect of nCPAP on arterial hypertension in patients with OSA. METHODS AND RESULTS: Sixty consecutive patients with moderate to severe OSA were randomly assigned to either effective or subtherapeutic nCPAP for 9 weeks on average. Nocturnal polysomnography and continuous noninvasive blood pressure recording for 19 hours was performed before and with treatment. Thirty two patients, 16 in each group, completed the study. Apneas and hypopneas were reduced by approximately 95% and 50% in the therapeutic and subtherapeutic groups, respectively. Mean arterial blood pressure decreased by 9.9+/-11.4 mm Hg with effective nCPAP treatment, whereas no relevant change occurred with subtherapeutic nCPAP (P=0.01). Mean, diastolic, and systolic blood pressures all decreased significantly by approximately 10 mm Hg, both at night and during the day. CONCLUSIONS: Effective nCPAP treatment in patients with moderate to severe OSA leads to a substantial reduction in both day and night arterial blood pressure. The fact that a 50% reduction in the apnea-hypopnea index did not result in a decrease in blood pressure emphasizes the importance of highly effective treatment. The drop in mean blood pressure by 10 mm Hg would be predicted to reduce coronary heart disease event risk by 37% and stroke risk by 56%.

Blood Pressure↗

PubMed2004

Planning adenotonsillectomy in children with obstructive sleep apnea: the role of overnight oximetry.

OBJECTIVE: Obstructive sleep apnea (OSA) in children is usually effectively treated by adenotonsillectomy (T&A). However, there may be a waiting list for T&A, and the procedure is associated with an increased risk of postoperative complications in children with OSA. Needed is a simple test that will facilitate logical prioritization of the T&A surgical list and help to predict children who are at highest risk of postoperative complications. The objective of this study was to develop and validate a severity scoring system for overnight oximetry and to evaluate the score as a tool to prioritize the T&A surgical list. METHODS: This study comprised 3 phases. In phase 1, a severity score was developed by review of preoperative overnight oximetry in children who had urgent T&A in 1999-2000. In phase 2, the score was validated retrospectively in 155 children who had polysomnography (PSG) before T&A in 1992-1998. In a phase 3, a 12-month prospective evaluation of a protocol based on the score was conducted. RESULTS: In phase 1, a 4-level severity score was developed on the basis of the number and the depth of desaturation events (normal to severely abnormal, categories 1-4). In phase 2, the McGill oximetry score correlated with severity of OSA by PSG criteria. In phase 3, a clinical management protocol was developed based on the score. Of 230 children tested, 179 (78%) had a normal/inconclusive oximetry (category 1) and went on to have PSG. Those with a positive oximetry (categories 2-4; 22%) had no additional sleep studies before T&A. Timing of T&A was based on oximetry score, leading to a significant reduction in waiting time for surgery for those with higher oximetry scores. Postoperative respiratory complications were more common with increasing oximetry score. CONCLUSIONS: Overnight pulse oximetry can be used to estimate the severity of OSA, to shorten the diagnostic and treatment process for those with more severe disease, and to aid clinicians in prioritization of T&A and planning perioperative care.

Adenoidectomy↗

PubMed2000

[Assessment of excessive day-time sleepiness in professional drivers with suspected obstructive sleep apnea syndrome].

Excessive daytime sleepiness is a common symptom of obstructive sleep apnea syndrome (OSAS) and can be a cause of traffic accidents, creating a problem of particular importance for professional drivers given the associated death, disability and professional repercussions. We assessed whether the Epworth sleepiness scale (ESS), which is a subjective measure of daytime sleepiness, correlates well with multiple sleep latency (MSL) testing, which gives an objective measure of daytime sleepiness. We also compared each method with the results of polysomnography (apnea-hypopnea index, arousal index and minimum oxygen saturation). We studied 55 professional drivers suspected of OSAS. All answered the ESS questionnaire and underwent polysomnographic and MSL testing. We found a significant, though not relevant, correlation between the degree of excessive daytime sleepiness estimated by the ESS and by MSL testing (r = -0.41; p = 0.002). A significant, though weak, correlation was found between the ESS score and the arousal index (r = 0.26; p < 0.05). Our results do not clarify which method is best for measuring excessive daytime sleepiness in professional drivers suspected of OSAS.

Automobile Driving↗

PubMed2000

Perioperative considerations of patients with obstructive sleep apnea.

This article reviews the condition of obstructive sleep apnea. Various treatment modalities are discussed, including surgery. Specific implications for nursing interventions during this potentially lifethreatening period are suggested.

Child↗

PubMed2005

Disturbed angiogenic activity in sera from obstructive sleep apnea patients.

It is increasingly recognized that obstructive sleep apnea (OSA) syndrome is a systematic rather than local disorder. There is also growing evidence that apart from the syndrome's major features: intermittent hypoxia and sleep fragmentation, functional activity of the immune system is altered in OSA patients, with several cytokines, such as tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) taking active part in sleep regulation. Little is known about the effects exerted by chronic intermittent hypoxia combined with persistent pro-inflammatory activity of the immune system on the vascular micro milieu in OSA. In this study we attempted to confirm the hypothesized imbalance between pro- and anti-angiogenic factors by evaluating direct and indirect angiogenic activity of OSA patients' sera in the in vivo serum-induced angiogenesis (SIA) and leukocyte-induced (LIA) assays, respectively, in mice. Both tests revealed significantly inhibited angiogenic activity of OSA patients' sera compared with healthy controls (P<0.001). Moreover, differences related to the subject's weight regarding in the mean number of newly-formed vessels were observed with a significantly greater inhibition in the normal-weighing apneic subjects than in the overweight or obese ones (P<0.01). The angiogenesis inhibition index was positively related to the serum IL-6 level (r=0.35; P<0.05) in the OSA group, but not to TNF-alpha, fasting serum leptin, or OSA syndrome severity as assessed by the AHI index. Our results demonstrate that OSA is accompanied by disturbed serum angiogenic activity, apparently resulting from an imbalance between pro- and anti-angiogenic factors, some of them being produced by the adipose tissue. The disordered angiogenic activity might be related to the pathophysiology of OSA and should be considered an important causative factor for the increased prevalence of cardiovascular diseases in OSA patients.

Adipose Tissue↗

PubMed2006

Gender differences in global cardiovascular risk factors of obstructive sleep apnea patients.

The morbidity and mortality of obstructive sleep apnea (OSA) are related principally to its cardiovascular complications. Metabolic syndrome (MBS) is recognized as raising the risk of cardiovascular disease. In this study, we analysied the diagnostic value of MBS to predict the diagnosis of severe OSA. Eight-seven subjects (54 males and 33 females) without any cardiac or pulmonary disease referred for evaluation of OSA, had overnight polysomnography. MBS were diagnosed according to NCEP criteria. According to apnea-hypopnea index (AHI), subjects were divided into two groups: severe OSA (AHI>or=30, 26 males, 15 females) and non-severe OSA (AHI<30, 28 males, 18 females). Ages were similar in both OSA groups for both genders. In the severe OSA group, number of patients with MBS was especially higher (in females n=13, 86.6%; in males n=19, 73%) than non-severe OSA (in females 6, 33%, in males 9, 32%). The mean values of the five diagnostic criteria of MBS were significantly higher in severe OSA than non-severe groups in both genders. Analysis of diagnostic value (criteria>or=3) of MBS for predicting the diagnosis of severe OSA in males and females revealed the sensitivity 73% and 86.6%, the specificity 67.8% and 94.4%, positive predictive value 67.9% and 86.7%, negative predictive value 73% and 85.7% respectively. Especially in female patients referred to the sleep clinics, evaluation of MBS criteria may play an important role in predicting severe OSA with high sensitivity and negative predictivity. Furthermore, the presence of MBS in OSA patients might increase cardiovascular complications.

Female↗

PubMed2005

Periodic limb movements and sleepiness in obstructive sleep apnea patients.

BACKGROUND AND PURPOSE: The aim of this study was to assess the possibility that periodic limb movements during sleep (PLMS) could play an additive role in the sleepiness associated with obstructive sleep apnea syndrome (OSAS) before treatment, or could account for residual sleepiness in successfully CPAP-treated patients. PATIENTS AND METHODS: In order to test this hypothesis, we compared objective sleepiness, assessed by the Multiple Sleep Latency Test (MSLT) and subjective sleep propensity, assessed by the Epworth Sleepiness Scale (ESS), in a clinical series of 57 patients consecutively diagnosed with OSAS (apnea/hypopnea index, 53.3+/-26.15), before and after 1 year of treatment with CPAP. RESULTS: Twenty-two patients (38.5%) had significant PLMS (at least 5 PLMS/h of sleep; mean 52.9+/-53.9) in absence of apneas (with CPAP). The two groups (with and without PLMS) were similar in gender distribution, BMI, apnea/hypopnea index or CPAP level. Patients with PLMS were older than those without PLMS. Sleepiness measurements following OSAS diagnosis and after 1 year of CPAP treatment were similar in patients PLMS compared to those without significant PLMS. There was no correlation in the PLMS patient group between the PLM index, Epworth Sleepiness Scale score and mean latency in the MSLT. CONCLUSION: In this study we did not find a link between PLMS and increased objective or self-evaluated sleepiness in OSAS patients, before or after treatment with CPAP.

Body Mass Index↗

PubMed2003

Obstructive sleep apnea in a referral population in India.

There are few published studies of obstructive sleep apnea in the Asian subcontinent. The objectives were to describe the syndrome and evaluate the utility of computed tomography (CT) cephalometry in patients found to have obstructive sleep apnea (OSA) by polysomnography. This article reports on a retrospective case series in a referral population. A total of 880 patients (560 males and 320 females) were seen in a referral center in Hyderabad, South India, during the last 7 years. All patients with suspected obstructive sleep apnea were evaluated with 16-channel polysomnogram by overnight sleep study; 600 subjects (68%; 480 males and 120 females) underwent evaluation with CT cephalometry. Mean age was 51.4 +/- 9.5 years (standard deviation). The mean apnea-hypopnea index (AHI) was 27.93 +/- 3.8. The majority of patients had more than 10 AHI; mean percentage of sleep efficiency was 80.62 +/- 15.38; mean percentage of rapid eye movement (REM) sleep was 13.79 +/- 7.89; mean awake arterial oxygen saturation (SaO2) was 90%; mean sleep SaO2 was 84% +/- 4.4%; mean Epworth Sleepiness Scale (ESS) score was 12.3 +/- 2.8. The tongue base area (TBA) was found to be significantly associated with obstructive sleep apnea (OSA), with mean TBA 1032.8 +/- 427 mm2 compared with normal controls at 561.1 +/- 197.6 mm2 (p < 0.001). Mean gonion-gnathion-hyoid angle (Go-Gn-H) was 28.5 +/- 10.5 in OSA and 16 +/- 16.7 in controls; uvula area was 452.5 +/- 145.8 mm2 in OSA and 221.4 +/- 49.85 mm2 in controls; uvula diameter was 13.8 +/- 2.74 mm in OSA and 10.1 +/- 1.72 mm in controls. A total of 704 patients with OSA (80%) were found to be hypertensive, with daytime mean blood pressure of 160/100 +/- 8.5/4.8 mm Hg. Mean duration of reported hypertension was 2 years. The present study showed moderate to severe OSA in a majority of suspected cases referred for polysomnogram. Mild disease was seen in 20.45% of patients (n = 180). On CT cephalometry, the TBA correlated significantly with OSA; hypertension is common in patients with OSA.

Cephalometry↗

PubMed2003

A mandibular protruding device in obstructive sleep apnea and snoring.

UNLABELLED: The overall purpose behind treatment in sleep-breathing disorders is to ease breathing and thereby reduce the risk of morbidity. The mandibular protruding device (MPD) is one method of treating both obstructive sleep apnea (OSA) and snoring. The aims of the studies were to study MPD users after 2 years and evaluate the following aspects of the MPD: subjective and objective effects on sleep, influences on airway passages and hard tissues, and the incidence and types of adverse events of the masticatory system including temporomandibular disorders. Further aims were to evaluate the impact of body posture and the effects of the MPD on pharyngeal width and to validate two methods for measuring mandibular protrusion and MPD advancement. MATERIALS AND METHODS: Seventy-seven subjects with OSA or snorers without OSA. were admitted to the study after a medical examination, which included a somnographic registration. The patients completed questionnaires regarding sleep quality and symptoms from the masticatory system, and underwent a clinical jaw function examination, were given an MPD, and were subjected to lateral cephalometric examination. Two follow-ups, 6 months and 2 years after MPD treatment were conducted. The study population comprised 65 patients at the 2-year follow-up. RESULTS: At the 2-year follow-up, a significant reduction of the subjective complaints was noted by 90% of the MPD users. In the objective evaluation, the oxygen desaturation index (ODI) of the OSA group (n = 39) decreased significantly from a mean of 14.7 to 3.1 and the mean arterial oxygen saturation (SaO2) increased significantly from 78% to 89%. The snorers maintained their initial values. In the total group, MPD treatment significantly increased most pharyngeal measures and lifted the hyoid bone. The pharyngeal area decreased significantly--by more than 50%--when the patient was supine, and the velum area increased significantly. At the 2-year follow-up, on upright cephalogram without MPD, the pharyngeal area had significantly increased and the velum area had significantly decreased. The mandible was posteriorly rotated (P < 0.01) as well as the lower incisors were proclined (P < 0.05). Mandibular advancement and vertical opening with an MPD, as measured with a ruler, compared well with measurements taken from a cephalogram. At the 2-year follow-up significant changes in the mean mandibular range of protrusion (+0.6 mm), overjet (-0.5 mm), and overbite (-0.8 mm) were registered. Nine of the 65 patients had developed a lateral open bite, and 2 were aware of the change. The reported frequency of headache was significantly reduced. At the 2-year follow-up there was a significant reduction in pain during mandibular movements. CONCLUSIONS: MPD treatment significantly reduced subjective complaints of sleep disturbances and significantly reduced ODI values among OSA patients. A high MPD compliance rate after 2 years (84%) indicated a well-tolerated treatment and a low rate of side effects were noted. The key factor in OSA and snoring is the obstruction of pharynx. The MPD treatment significantly increased the pharyngeal passages and significantly reduced the size of velum and thereby facilitated the breathing.

Adult↗

PubMed2006

Comparison of two endoscopic examination methods, the Muller maneuver and fiberoptic pharyngoscopy during sleep, in patients with obstructive sleep apnea.

OBJECTIVES: This study was designed to compare two endoscopic examination methods, the Muller maneuver (MM) and fiberoptic pharyngoscopy during sleep, both of which are used to detect obstructed segments in patients with obstructive sleep apnea. PATIENTS AND METHODS: The study included 28 patients (23 males, 5 females; mean age 44.6 years; range 28 to 59 years) who underwent uvulopalatopharyngoplasty (UPPP) for snoring or obstructive sleep apnea. Obstruction was examined both at the level of the soft palate and tongue base while the patients were awake and asleep and was scored. The Muller maneuver was performed in the sitting and supine positions. In addition, fiberoptic pharyngoscopy was performed right after induction of anesthesia. The results of the two methods were compared. RESULTS: Changes in body position were not associated with significant differences in the results of MM. The two methods were found to be highly discordant, in that a greater degree of obstruction was noted especially at the level of the soft palate by fiberoptic pharyngoscopy. CONCLUSION: It was concluded that the degree of obstruction might be underestimated by MM.

Adult↗

PubMed2002

Therapeutic efficacy of an oral appliance in the treatment of obstructive sleep apnea: a 2-year follow-up.

The purpose of this study was to investigate the long-term efficacy of an oral appliance, the Karwetzky activator, on respiratory and sleep parameters in patients with obstructive sleep apnea (OSA). Those selected for this study were 26 patients polysomnographically diagnosed with mild-to-moderate OSA. They were initially treated successfully with this appliance, as documented by a second polysomnographic study after 6 to 12 weeks. Further polysomnographic registrations 6 to 12 months and 18 to 24 months later were performed for each patient wearing the appliance. For 21 patients (81%), therapeutic efficacy was maintained; 5 patients (19%) showed a deterioration in respiratory parameters. We corrected this by adjusting the device in 2 patients. The mean apnea-hypopnea index decreased significantly from 17.8 events per hour at the baseline registration to 4.2 events per hour (P <.001) after 6 to 12 weeks of treatment. After 6 to 12 months, the apnea-hypopnea index was 8.2 events per hour. The index remained at this level 18 to 24 months later, with 8.3 events per hour. Mean oxygen saturation was not improved with the activator, but the number of desaturations had decreased at the 6-to-12 week review. Again, the improvement declined with time, but the number of oxygen desaturations was still significantly decreased at 18 to 24 months (P <.01). Although the respiratory parameters remained statistically improved throughout the study (P <.01), sleep architecture did not change statistically. In most patients, therapeutic efficacy was maintained at the 2-year follow-up, although there was a tendency for effectiveness to fall over time. We concluded that the Karwetzky activator may be an effective treatment alternative for patients with mild-to-moderate OSA, but therapy requires diligent and regular polysomnographic follow-ups. Further long-term studies are needed to assess the continued efficacy of this oral appliance in treating OSA.

Activator Appliances↗

PubMed1999

Effect of treating obstructive sleep apnea by tonsillectomy and/or adenoidectomy on obesity in children.

BACKGROUND: Obstructive sleep apnea is common in obese children who have enlarged tonsils and adenoids. OBJECTIVE: To determine if treatment of obstructive sleep apnea by tonsillectomy and/or adenoidectomy will result in normalization of an obese child's weight, as it does in underweight children, and as it does with other signs and symptoms. DESIGN: Retrospective cohort study. We recorded weight and height changes after tonsillectomy and/or adenoidectomy and compared changes of the obese and morbidly obese patients with those of the other patients. SETTING: A tertiary care inner-city hospital. PARTICIPANTS: Children (n = 45) who underwent tonsillectomy and/or adenoidectomy for obstructive sleep apnea in 1994-1995; their mean (+/-SD) age was 4.9+/-2.4 years at operation. RESULTS: At the time of surgery, 25 children were of normal weight; 3, underweight; 7, obese; and 10, morbidly obese. Postoperatively, 31 children (69%), including 10 of the 17 who were obese or morbidly obese, had substantial weight gain: the z score +/- SD for weight of the entire group increased from 1.37+/-2.49 to 2+/-2.27 (P<.001). The mean z score +/- SD for height increased from 0.03+/-1.08 to 0.58+/-0.94 (P<.001). The body mass index (BMI or Quetelet index): calculated as weight in kilograms divided by the square of the height in meters increased in 28 patients (62%) (P = .004). CONCLUSION: Treating obstructive sleep apnea by tonsillectomy and/or adenoidectomy is associated with increased gain in height, weight, and body mass index in most children, including the obese and morbidly obese.

Adenoidectomy↗

PubMed1987

The effects of aminophylline on sleep and sleep-disordered breathing in patients with obstructive sleep apnea syndrome.

The methylxanthine derivatives are known to have respiratory stimulant properties. To determine whether these drugs would improve obstructive sleep apnea, 10 male patients with obstructive sleep apnea (OSA) (Apnea Index greater than 15/h) were given infusions of aminophylline and a saline placebo on 2 separate nights a week apart, using a randomized crossover design. There was a significant decrease during aminophylline infusion in the frequency of those apneas, which contained periods of complete respiratory inactivity (central and mixed apneas; placebo, 4.3 +/- 1.8/h; aminophylline, 0.7 +/- 0.5/h; p less than 0.05). There was no change in either the frequency (placebo, 31.8 +/- 5.9/h; aminophylline, 28.7 +/- 8.7/h; NS) or duration of obstructive apneas. Mean and minimal arterial oxygen saturation values were also unchanged. Sleep architecture was markedly disturbed by aminophylline. There was a reduction in sleep efficiency (placebo, 84.8 +/- 2.0%; aminophylline, 60.2 +/- 5.0%; p less than 0.005), an increase in sleep fragmentation (sleep stage shifts/h: placebo, 11.6 +/- 1.3: aminophylline, 21.0 +/- 2.9; p less than 0.05) and less Stage 2 and more Stage 1 non-REM sleep. We conclude that aminophylline reduces central apnea and the central component of mixed apneas but has no effect on obstructive apnea. Theophylline is therefore unlikely to be therapeutically useful in patients with OSA, and because it leads to marked sleep disruption, its long-term use could conceivably increase the propensity to upper airway occlusion during sleep.

Aminophylline↗