Obstructive Sleep Apnoea

Description

Diagnostic  criteria

General and supportive measures

Medicine treatment

Referral

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ICD-10 code: G47.3

DESCRIPTION

Affects all ages as either partial or complete airway obstruction that disrupts gas exchange and sleep patterns. Associated with truncal obesity and increased BMI, recurrent otitis media, allergic rhinitis/asthma and syndromic conditions e.g. Down syndrome, Treacher-Collins syndrome, Apert syndrome etc.

Presents with daytime (sleepiness, decreased cognition) and night (habitual snoring, paradoxical breathing, and sweating, breathing pauses) symptoms. Clinical signs include developmental delay, adenoidal facies, tonsillar and adenoidal hypertrophy, pulmonary hypertension and cor-pulmonale.

DIAGNOSTIC CRITERIA

• Lateral neck X-ray.
• Overnight pulse oximetry.
• FBC (polycythaemia), hypothyroidism (Down syndrome).
• ECG/ECHO (pulmonary hypertension/cor-pulmonale).
• Polysomnography (if available).
• Apnoea/hypopnoea index > 1.

GENERAL AND SUPPORTIVE MEASURES

• Avoid tobacco smoke exposure.
• Lose weight.

MEDICINE TREATMENT

Intranasal steroid, e.g.:

• Fluticasone 50 µg/spray.
  • < 12 years: 1 spray into each nostril daily.
  • > 12 years: 1 spray into each nostril twice daily.

Discuss with paediatrician for management of obesity.

Surgical management

Refer to ENT for consideration of surgical options.

Complications

• Neurodevelopmental regression, low self-esteem, aggressive, moody, ADHD.
• Decreased quality of life.
• Failure to thrive.

REFERRAL

Refer all patients.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter 15: Respiratory System,  15.6 Obstructive Sleep Apnoea