Obstructive Sleep
Apnea in Children
Alyssa Brzenski
Case
• A 31 month old term 17kg girl presents for Tonsillectomy
and Adenoidectomy as an outpatient. She has a history
of frequent ear infections, which have resolved since ear
tubes were placed. According to her mom she snores
loudly and is much more active than the other children
her age. Mom doesn’t think that she stops breathing at
night but notices that she always breathes through her
mouth and always seems to have bad breath. She has no
other past medical history. On exam you observe an
overweight female with grade III tonsils but an otherwise
unremarkable airway, heart and lung exam.
Tonsillectomy and
Adenoidectomy
Indications for T&A
Tonsil Size
What is OSA in kids?
• OSA is a “disorder of breathing during sleep
characterized by prolonged partial upper airway
obstruction and/or intermittent complete
obstruction (obstructive apnea) that disrupts normal
ventilation during sleep and normal sleep patterns.”
• In kids this commonly occurs in REM.
• Obstructions worsen throughout the sleep period.
OSA in kids
OSA in Kids
Syndromes associated with
OSA
OSA Differences- Peds vs
Adults
How should we screen for
OSA in our patients?
• “Does your child snore?”
• Should be referred for evaluation by a specialist or
with a sleep study if
• snores more than 3 times a week
• 1 or more associated signs or symptoms
Screening with
Polysomnography
Pediatric Sleep Studies
What should we be asking?
Treatment of OSA in Children
Should kids with OSA stay
overnight after anesthesia?
What anesthetic should be
used?
• No standard anesthetic recommended
• Reduce the use of narcotics
• Use a balanced technique, maximizing non-opioid
strategies and regional anesthesia
Increased Sensitivity to
Narcotics
• OSA Kids with younger age and lower preoperative
O2 Nadir correlates with increased narcotic
sensitivity
• Avoid Codeine products
Sources
•
Schwengel D, Sterni LM, Tunkel DE, Heitmiller E. Perioperative Management of Children with Obstructive
Sleep Apnea. Anesthesia and Analgesia. 2009; 109: 60-75.
•
Marcus CL, et al. Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome. Pediatrics.
2012; 130: e714-755.