eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Obstructive Sleep Apnea Syndrome: Follow-up

Author: Timothy D Murphy, MD, Assistant Professor, Department of Pediatrics, Division of Pulmonology, University of Pittsburgh; Consulting Staff, Division of Pulmonology, Children's Hospital of Pittsburgh
Coauthor(s): Andrew J Lipton, MD, MPH and TM, Staff Pediatric Pulmonologist, Assistant Professor of Pediatrics, Department of Pediatrics, Walter Reed Army Medical Center; David Gozal, MD, Vice-Chairman of Research and Director, Kosair Children's Hospital Comprehensive Sleep Medicine Center, Professor, Department of Pediatrics, University of Louisville
Contributor Information and Disclosures

Updated: Feb 27, 2009

Follow-up

Further Outpatient Care

  • In most otherwise healthy children with obstructive sleep apnea (OSA), tonsillectomy and adenoidectomy (T&A) results in complete resolution of the problem, and a postsurgical evaluation in the sleep laboratory is usually not recommended. However, residual mild sleep-disordered breathing is found in more than one third of these patients after T&A, particularly those included in the high-risk category. Thus, T&A alone may not suffice, and polysomnographic evaluation 6-8 weeks after T&A may confirm the need for additional treatment, including the use of intranasal steroids and oral leukotriene modifier therapy or continuous positive airway pressure (CPAP) and/or bilevel positive airway pressure (BiPAP).
  • Patients treated with noninvasive ventilation require close follow-up by a pediatric pulmonologist and may periodically require a repeat polysomnographic evaluation. Treat patients who are found to have significant hypoxemia during polysomnography as soon as possible with overnight supplemental oxygen until T&A can be performed. Carefully assess the patient when using oxygen because of the rare possibility that significant hypercapnia may develop during the night.

Deterrence/Prevention

  • Although no specific prevention has been reported, a high index of suspicion in patients with predisposing conditions or suggestive history is necessary for early detection. The need for increased awareness of and screening for obstructive sleep apnea among primary care providers is significant. History obtained during preventive health visits should include questions regarding snoring (frequency, quality), obvious nocturnal airway obstruction or apnea, restless sleep, mouth breathing, daytime inattention, hyperactivity or hypersomnolence, and family history of obstructive sleep apnea. Loud snoring 3 or more nights per week warrants further investigation.
  • Obesity is increasing in children; 16-33% of children and adolescents are obese. Primary care providers should provide basic weight loss information and support and readily refer patients to a pediatric weight loss program. A pediatric sleep disorders clinic should work closely with a weight loss program and can be a portal of entry for a patient into such care systems.

Complications

  • Complications of obstructive sleep apnea are discussed in detail in Mortality/Morbidity. Complications include deficits in neurocognitive function, failure to thrive (FTT), alterations in autonomic tone, modest elevations in arterial blood pressure, pulmonary hypertension, and cor pulmonale.
  • Children with obstructive sleep apnea have an increased prevalence of night terrors and other parasomnias.

Prognosis

  • In children with enlarged tonsils and adenoids that lead to obstructive sleep apnea, a T&A usually results in complete cure, although no definitive studies have clearly demonstrated this issue.
  • The outcome of patients who require extensive surgical management obviously depends on the severity of the condition that leads to upper airway compromise. With the emergence of noninvasive ventilation as an alternative option for these children, upper airway obstruction during sleep can be conservatively and successfully managed in most children.
  • In children with FTT, treatment of obstructive sleep apnea leads to resolution of the somatic growth disturbance. Similarly, pulmonary hypertension resolves. Although major improvements in neurobehavioral outcomes are expected, data are currently insufficient to support a complete recovery in some of the cognitive abilities affected by obstructive sleep apnea.

Patient Education

  • Compliance issues are of particular importance in patients treated with noninvasive ventilation. Weight loss through an appropriate program of diet and exercise is clearly beneficial for patients with obstructive sleep apnea who are obese.
  • For excellent patient education resources, visit eMedicine's Sleep Disorders Center. Also, see eMedicine's patient education article Disorders That Disrupt Sleep (Parasomnias).

Miscellaneous

Medicolegal Pitfalls

  • Refer patients in whom obstructive sleep apnea (OSA) is diagnosed following polysomnography for appropriate therapy. Failure to make an appropriate referral could result in legal action if a patient were to develop complications that could be attributed to obstructive sleep apnea, such as cor pulmonale.

Special Concerns

 


More on Obstructive Sleep Apnea Syndrome

Overview: Obstructive Sleep Apnea Syndrome
Differential Diagnoses & Workup: Obstructive Sleep Apnea Syndrome
Treatment & Medication: Obstructive Sleep Apnea Syndrome
Follow-up: Obstructive Sleep Apnea Syndrome
Multimedia: Obstructive Sleep Apnea Syndrome
References
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References

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Further Reading

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Keywords

obstructive sleep apnea syndrome, OSA, sleep apnea, sleep-induced apnea, snoring, increased upper airway resistance, upper airway obstruction, anatomic narrowing, abnormal mechanical linkage between airway dilating muscles and airway walls, muscle weakness, abnormal neural regulation, sleep fragmentation, increased work of breathing, alveolar hypoventilation, intermittent hypoxemia, adenotonsillar hypertrophy, tonsillectomy and adenoidectomy, T&A, daytime tiredness, fatigue, sleep drunkenness, respiratory disorders, achondroplasia, Crouzon syndrome, Apert syndrome, Duchenne muscular dystrophy, spinal muscular atrophy, myelomeningocele, obesity, Pierre Robin sequence, cerebral palsy, Down syndrome, sickle cell disease, choanal stenosis, hypothyroidism, Klippel-Feil syndrome, Hallerman-Streiff syndrome, mucopolysaccharidosis, osteopetrosis, oropharyngeal papillomatosis, Beckwith-Wiedemann syndrome, Pfeiffer syndrome, Prader-Willi syndrome, Treacher-Collins syndrome 

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Contributor Information and Disclosures

Author

Timothy D Murphy, MD, Assistant Professor, Department of Pediatrics, Division of Pulmonology, University of Pittsburgh; Consulting Staff, Division of Pulmonology, Children's Hospital of Pittsburgh
Disclosure: Nothing to disclose.

Coauthor(s)

Andrew J Lipton, MD, MPH and TM, Staff Pediatric Pulmonologist, Assistant Professor of Pediatrics, Department of Pediatrics, Walter Reed Army Medical Center
Andrew J Lipton, MD, MPH and TM is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

David Gozal, MD, Vice-Chairman of Research and Director, Kosair Children's Hospital Comprehensive Sleep Medicine Center, Professor, Department of Pediatrics, University of Louisville
David Gozal, MD is a member of the following medical societies: Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

Thomas Scanlin, MD, Chief, Division of Pediatric Pulmonary & Cystic Fibrosis, Assistant Professor, Department of Pediatrics, Robert Wood Johnson University Medical Group
Thomas Scanlin, MD is a member of the following medical societies: American Thoracic Society and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Heidi Connolly, MD, Associate Professor of Pediatrics and Psychiatry, University of Rochester; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center
Heidi Connolly, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

 
 
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