Innovative imaging techniques to predict treatment outcome in pediatric obstructive sleep apnea
1 March 2019
Antwerp University Hospital (UZA) - Auditorium Kinsbergen (route 12) - Wilrijkstraat 10 - 2650 EDEGEM
Prof S. Verhulst, Prof W. De Backer
PhD defence Maria Slaats - Faculty of Medicine and Health Sciences
Abstract (Presentation in Dutch)
Pediatric obstructive sleep apnea (OSA) is a manifestation of sleep-disordered breathing. OSA is associated with a number of significant complications such as daytime neurobehavioral problems, learning deficits, growth retardation and cardiovascular complications. Therefore, OSA needs to be treated correctly. Adenotonsillar hypertrophy is the most important predisposing factor in children with OSA. The pathophysiology is likely to be multifactorial because of the high incidence of residual OSA after adenotonsillectomy (ATE). There are several risk factors for OSA such as obesity, Down syndrome (DS), and ethnicity.
The purpose of this thesis was to investigate whether upper airway (UA) imaging could provide more information about UA characteristics in children with OSA mainly to predict treatment outcome. In this thesis, we investigated the use of (functional) imaging in normal-weight children, obese children, and children with DS.
Firstly, we investigated whether functional respiratory imaging could provide more information about UA characteristics in normal-weight children with OSA mainly to predict treatment outcome. In this retrospective study, we concluded that both UA conductance of the functional imaging and the tonsil score by clinical examination predicted treatment response in 91 children.
Secondly, we characterized treatment outcome in 33 young children with DS and OSA by UA imaging. We concluded that children with a less favorable response to surgery had a smaller volume of the zones below the tonsils which could be due to enlargement of the lingual tonsils, glossoptosis or macroglossia which is not treated by ATE.
Thirdly, we evaluated the UA by imaging and drug induced sedation endoscopy (DISE), and compared the results after ATE in 27 obese children with OSA. We concluded that subjects with more central obesity and a more concave shape of the UA had significantly more oxygen desaturations during sleep. We concluded that a straighter shape of the UA and more complex OSA (a higher total score during DISE) correlated with a less improvement after treatment.
Finally, we investigated whether ethnicity could influence UA morphology, OSA severity or treatment response in European children by UA imaging. In our study, black African (bA) children had more severe OSA compared to Caucasian children. Furthermore, there was a difference in UA morphology between bA and Caucasian children: the UA volume of the tongue base and hypopharynx was significantly smaller in children from Africa.