Marco Zaffanello, Giuseppe Lippi, Laura Tenero, Michele Piazza, Luca Sacchetto, Luana Nosetti, Emma Gasperi, Giorgio Piacentini

Childhood nasal obstruction and sleep-disordered breathing during clinical setting: Myth or reality?

Objectives: .The severity of sleep apneas largely depends on abnormal size of upper airway. Therefore, nasalexamination is essential part of clinical evaluation of children with sleep-disordered breathing.Methods: We performed a retrospective survey involving children aged 4 years and older which underwentin-laboratory overnight cardiorespiratory polygraph study between January 2016 and May 2017. Nasalobstruction test was used to score severity.Results: Fifty-three children (62% males) with a median age of 6.1 (IQR 3.1) years were enrolled in this study.Linear regression analysis showed that nasal obstruction score was correlated with apnea-hypopnea index (β= 0.345; p < 0.014) and oxygen desaturation index (β = 0.328; p < 0.022), whilst no association was foundwith age, BMI z-score, snoring and phase angle. Correlation analysis also showed that nasal obstruction scorewas correlated with apnea-hypopnea index (r = 0.364; p = 0.009) and oxygen desaturation index (r = 0.350; p= 0.012) after adjustment for age and BMI z-score., but not with snoring time or phase angle degree.Conclusions: Nasal obstruction test may be a useful, time saving assessment which aid exploring sleepdisordered breathing in children. However, this test should not be used alone because it is plagued by objectiveconsideration and at risk of under or overestimation.

PDF

___

[1] Wilhelm CP, deShazo RD, Tamanna S, Ullah MI, Skipworth LB. The nose, upper airway, and obstructive sleep apnea. Ann Allergy Asthma Immunol 2015;115:96-102.
[2] Zaffanello M, Piacentini G, Gasperi E, Maffeis C, Fava C, Bonafini S, et al. Snoring in a cohort of obese children: Association with palate position and nocturnal desaturations. J Pediatr Neonat Individual Med 2016;5:e050134.
[3] White DP. The pathogenesis of obstructive sleep apnea: advances in the past 100 years. Am J Respir Cell Mol Biol 2006 ;34:1-6.
[4] Grime C, Tan HL. Sleep disordered breathing in children. Indian J Pediatr 2015;82:945-55.
[5] Tawfik KO, Sedaghat AR, Ishman SL. Trends in inpatient pediatric polysomnography for laryngomalacia and craniofacial anomalies. Ann Otol Rhinol Laryngol 2016;125:82-9.
[6] Strohl KP, Butler JP, Malhotra A. Mechanical properties of the upper airway. Compr Physiol 2012;2:1853-72.
[7] Rappai M, Collop N, Kemp S, deShazo R. The nose and sleepdisordered breathing: what we know and what we do not know. Chest 2003;124:2309-23.
[8] Sarkar S, Seshadri D. Conducting record review studies in clinical practice. J Clin Diagn Res 2014;8:JG01-4.
[9] Liistro G, Rombaux P, Belge C, Dury M, Aubert G, Rodenstein DO. High mallampati score and nasal obstruction are associated risk factors for obstructive sleep apnoea. Eur Respir J 2003;21:248-52.
[10] Tagetti A, Bonafini S, Zaffanello M, Benetti MV, Vedove FD, Gasperi E, et al. Sleep-disordered breathing is associated with blood pressure and carotid arterial stiffness in obese children. J Hypertens 2017;35:125-31.
[11] Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012;8:597-619.
[12] Villa MP, Pietropaoli N, Supino MC, Vitelli O, Rabasco J, Evangelisti M, et al. Diagnosis of pediatric obstructive sleep apnea syndrome in settings with limited resources. JAMA Otolaryngol Head Neck Surg 2015;141:990-6.
[13] Ross KR, Rosen CL. Sleep and respiratory physiology in children. Clin Chest Med 2014;35:457-67.
[14] Hammer J, Newth CJ. Assessment of thoraco-abdominal asynchrony. Paediatr Respir Rev 2009;10:75-80.
[15] Hammer J, Newth CJ, Deakers TW. Validation of the phase angle technique as an objective measure of upper airway obstruction. Pediatr Pulmonol 1995;19:167-73.
[16] Phillips BG, Kato M, Narkiewicz K, Choe I, Somers VK. Increases in leptin levels, sympathetic drive, and weight gain in obstructive sleep apnea. Am J Physiol Heart Circ Physiol 2000;279:H234-7.
[17] Gold AR, Schwartz AR. The pharyngeal critical pressure. The whys and hows of using nasal continuous positive airway pressure diagnostically. Chest 1996;110:1077-88.
[18] Izu SC, Itamoto CH, Pradella-Hallinan M, Pizarro GU, Tufik S, Pignatari S, et al. Obstructive sleep apnea syndrome (OSAS) in mouth breathing children. Braz J Otorhinolaryngol 2010;76:552-6.
[19] Pacheco MC, Casagrande CF, Teixeira LP, Finck NS, de Araújo MT. Guidelines proposal for clinical recognition of mouth breathing children. Dental Press J Orthod 2015;20:39-44.
[20] Oliveira HF, Sampaio AL, Oliveira CA, Teixeira MC, Miranda LA, Miranda DA. Evaluation of airway obstruction by adenoid tissue: comparison of measures in the sitting and recumbent. Int J Pediatr Otorhinolaryngol 2012;76:1278-84.
[21] Cielo CM, Gungor A. Treatment options for pediatric obstructive sleep apnea. Curr Probl Pediatr Adolesc Health Care 2016;46:27-33.
[22] Venekamp RP, Hearne BJ, Chandrasekharan D, Blackshaw H, Lim J, Schilder AG. Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children. Cochrane Database Syst Rev 2015;10:CD011165.
[23] Zicari AM, Duse M, Occasi F, Luzzi V, Ortolani E, Bardanzellu F, et al. Cephalometric pattern and nasal patency in children with primary snoring: the evidence of a direct correlation. PLoS One 2014;9:e111675.
[24] Colavita L, Miraglia Del Giudice M, Stroscio G, Visalli C, Alterio T, Pidone C, et al. Allergic rhinitis and adenoid hypertrophy in children: is adenoidectomy always really useful? J Biol Regul Homeost Agents 2015;29(2 Suppl 1):58-63.
[25] Alonso-Álvarez ML, Terán-Santos J, Ordax Carbajo E, CorderoGuevara JA, Navazo-Egüia AI, Kheirandish-Gozal L, et al. Reliability of home respiratory polygraphy for the diagnosis of sleep apnea in children. Chest 2015;147:1020-8