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Paediatric obstructive sleep apnoea: can our identification of surgical candidates be evidence-based?

Published online by Cambridge University Press:  14 February 2018

L Pabla ,
J Duffin ,
L Flood  and
K Blackmore
L Pabla*
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
J Duffin
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
L Flood
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
K Blackmore
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
*
Address for correspondence: Miss Lakhbinder Pabla, ENT Department, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK E-mail: Lakh.pabla.bal@gmail.com
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Abstract

Background:

Paediatric obstructive sleep apnoea is a common clinical condition managed by most ENT clinicians. However, despite the plethora of publications on the subject, there is wide variability, in the literature and in practice, on key aspects such as diagnostic criteria, the impact of co-morbidities and the indications for surgical correction.

Methods:

A systematic review is presented, addressing four key questions from the available literature: (1) what is the evidence base for any definition of paediatric obstructive sleep apnoea?; (2) does it cause serious systemic illness?; (3) what co-morbidities influence the severity of paediatric obstructive sleep apnoea?; and (4) is there a medical answer?

Results and conclusion:

There is a considerable lack of evidence regarding most of these fundamental questions. Notably, screening measures show low specificity and can be insensitive to mild obstructive sleep apnoea. There is a surprising lack of clarity in the definition (let alone estimate of severity) of sleep-disordered breathing, relying on what may be arbitrary test thresholds. Areas of potential research might include investigation of the mechanisms through which obstructive sleep apnoea causes co-morbidities, whether neurocognitive, behavioural, metabolic or cardiovascular, and the role of non-surgical management.

Keywords

ChildTonsillectomySleep Apnea, ObstructiveComorbidityPolysomnography
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 4 , April 2018 , pp. 284 - 292
Copyright
Copyright © JLO (1984) Limited 2018 

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