Auswirkungen einer chirurgischen Intervention auf die Polysomnographie bei Säuglingen und Kleinkindern mit obstruktivem Schlafapnoesyndrom

Table of Contents: Children suffering from snoring, stridor or orofacial malformations have an elevated risk of suffering from obstructive sleep apnea syndrome (OSAS). Consequently, these children can experience developmental retardation, failure to thrive, lack of concentration, daytime sleepiness and cardiovascular changes. The aim of this study was to evaluate whether an OSAS which had previously been diagnosed through cardiorespiratoric plysomnography (PSG) can be improved through surgical intervention in children between 0 and 6 years of age with the symptoms snoring, stridor or orofacial malformation. Methods A retrospective data analysis has been carried out of all children aged 0 to 6 years who presented themselves with the symptoms mentioned above between 1 January 2005 and 30 June 2009 at the paediatric hospital of the Philipps-Universität Marburg and received a cardiorespiratoric polysomnography to rule out an obstructive sleep apnea. According to the results of this PSG the patients were divided into two groups. Those with a normal mixed-obstructive-apnea-hypopnea-index (MOAHI) <1 were put into the reference group and those with a MOAHI ≥5 indicating an OSAS were put into the intervention group. The patients in the intervention group received a surgical intervention to eliminate the cause of the OSAS. After the intervention a second PSG was conducted to evaluate the effects of the surgical intervention on the PSG parameters. The primary criteria was the change in the MOAHI. Results Our results showed that 16 of the 36 children included in this study with the symptoms of snoring, stridor or orofacial malformation did not suffer from obstructive sleep apnea. In 20 of the 36 patients a significant improvement of the obstructive sleep apnea was reached through surgical intervention. Besides a reduction of the MOAHI a significant decrease of breath sounds, oxygen desaturations and duration of the longest obstructive apnea during sleep could be measured. Equally, an increase in the duration of quiet sleep and elevation of the minimal oxygen saturation took place. Inspite of the improvement of the OSAS, symptoms of a persistent OSAS with a MOAHI ≥5/h were found after intervention in eight patients who then required further treatment. 5.2.3 Discussion Our results showed that not all children with snoring, stridor or orofacial malformation suffer from obstructive sleep apnea. Equally, we could show that not all patients benefit from surgical intervention. This is congruent with results of other studies in which it is recommended that especially patients with an elevated risk for perioperative complications should receive a preoperative PSG to justify the indication for surgery as well as a PSG after intervention to evaluate the outcome. In many studies it could be shown that there is significant clinical improvement of OSAS symptoms after surgery. In some studies, however, these findings have not been objectified through polysomnography, which is indicated because of the risk of persistent OSAS after surgical intervention. We could show that the MOAHI is useful in documenting the change of an OSAS after intervention. Conclusion Many children with the symptoms of snoring, stridor or orofacial malformation suffer from obstructive sleep apnea. It is therefore important to carry out a cardiorespiratoric polysomnography if one of these symptoms is present. In case of pathological results an adequate therapy needs to be carried out. Control polysomnographies need to take place postoperatively to evaluate the success of the intervention and in case of persistent OSAS to initiate further diagnostic and therapy. Since the MOAHI is a parameter of sleep medicine which has rarely been the subject of investigation so far, studies would be desirable in which the MOAHI as important parameter of the pediatric sleepmedicine would be further investigated as important parameter of the pediatric sleep medicine especially in regards to its significance in the objectification of the need for intervention in patients with OSAS. Equally, there is a need for further investigation in regards to precise normal values for the MOAHI and whether the staging of the American Academy of Sleep Medicine for OSAS according to the AHI is applicable for the MOAHI as well or if the limits need to be adapted.