Obstructive Sleep Apnea in Adolescence
Obstructive sleep apnea (OSA) in adolescent patients is becoming increasingly common with the rise in obesity rates. Management of these patients is less straightforward than management in younger children or older adults, as there are substantial rates o
- PDF / 393,309 Bytes
- 15 Pages / 360 x 576 pts Page_size
- 101 Downloads / 230 Views
Obstructive Sleep Apnea in Adolescence Stacey Gunn and Umakanth A. Khatwa
Abbreviations AAP AASM AAO-HNSF AHI BMI CPAP DISE ICSD-3 PSG NREM REM
American Academy of Pediatrics American Academy of Sleep Medicine American Academy of Otolaryngology and Head and Neck Surgery Apnea-hypopnea index Body mass index Continuous positive airway pressure Drug-induced sleep endoscopy International Classification of Sleep Disorders 3rd edition Polysomnography Non-rapid eye movement sleep Rapid eye movement sleep
S. Gunn, M.D. Division of Pulmonary, Critical Care and Sleep, Beth Israel Deaconess Medical Center, Boston, MA, USA U.A. Khatwa, M.D. (*) Division of Respiratory Diseases, Department of Medicine, Boston Children’s Hospital, 333 Longwood Ave, LO486, Boston, MA 02115, USA e-mail: [email protected]
© Springer International Publishing Switzerland 2017 S.V. Kothare, R. Quattrucci Scott (eds.), Sleep Disorders in Adolescents, DOI 10.1007/978-3-319-41742-4_4
45
46
S. Gunn and U.A. Khatwa
Clinical Case 1 Jacob is a 14 year-old generally healthy teenage boy, presenting with a 2 years history of excessive daytime sleepiness, with difficulty focusing on his schoolwork, and a tendency to fall asleep during afternoon classes. His mother is unable to say definitively whether he snores. Jacob's bedtime is 10:30 pm on weeknights, and he uses his iPad until he falls asleep around midnight. He has a hard time waking up in the morning for school, which starts at 7 am. On the weekends, he sleeps from 2 am until 11 am. On physical examination, he is well-appearing, of normal weight (BMI 22 kg/m2), with a Mallampati class II airway, and 3+ tonsils. There is no micrognathia, retrognathia, or hyponasality. The nasal septum is midline and nasal turbinates are not enlarged. With concern for obstructive sleep apnea, overnight polysomnography was ordered to confirm the diagnosis and establish disease severity. In preparation, sleep hygiene recommendations were made, including limiting exposure to electronics before bed, and keeping a consistent sleep schedule between weekdays and weekends. Polysomnography was notable for severe obstructive sleep apnea, with AHI 21 events per hour and O2 saturation nadir 91 %, and was also notable for a prolonged sleep onset latency of 62.5 min, and a delayed REM onset latency of 154.0 min. The patient was scheduled for adenotonsillectomy which he tolerated well, and was discharged to home the following day. A repeat polysomnogram 8 weeks postoperatively demonstrated a reduction in the residual AHI to 2 events per hour. At follow-up, he reported better daytime energy levels and was no longer falling asleep in class.
Discussion Based on this patient’s presentation, there is a reasonably high suspicion for obstructive sleep apnea as a contributor to his excessive daytime sleepiness. Typical signs and symptoms that raise concern for obstructive sleep apnea are outlined in Table 4.1. A careful history must be taken in this age group, as a history of snoring is not
4
Obstructive Sleep Apnea
Data Loading...
