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A Child With Suspected Sleep Apnea Was Given

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How Is Obstructive Sleep Apnea Diagnosed

Snoring and Sleep Apnea in Children in India – Dr Paulose FRCS (ENT)

Once your child’s physician suspects sleep apnea, he or she may recommend that your child be seen by a sleep specialist. In addition to a complete medical history and physical examination, a sleep specialist may conduct the following tests to determine if your child has sleep apnea:

  • Sleep history: A report of your child’s nightly sleeping pattern.
  • Upper airway evaluation: By instrument evaluation and/or by x-rays.
  • Sleep study : This test is usually conducted in a specialized bedroom in a sleep laboratory with an adult caretaker nearby. It measures your child’s brain activity, heart rate, amount of air flow through the mouth and nose, oxygen and carbon dioxide content in the blood, muscle activity, chest and abdominal wall movement and sleep interruptions. A technician is present throughout to trouble shoot and replace sensors should the child take them off. The sleep study does not hurt and does not involve needle sticks. Sometimes a similar “mobile” bedside study may be recommended if your child is very sick and is in the hospital.

How Is Sleep Apnea Different Between Adults And Children

Sleep apnea leads to poor-quality sleep in all affected people, but the daytime symptoms can be different between adults and children. Adults are more likely to exhibit daytime sleepiness and fatigue, while children are more likely to show behavior issues such as difficulty concentrating and hyperactivity.

Additionally, sleep apnea is treated differently in children. In adults, the most common treatment is CPAP, while the most common treatment for children is surgery. Certain orthodontic treatments are only helpful in actively growing children and are not an option for adults with sleep apnea.

What Natural Treatments Are Available For Sleep Apnea In Children

The following natural treatments may help reduce obstructive sleep apnea in children. A childs healthcare provider will be in the best position to discuss the risks and benefits of the natural treatment listed below:

  • Weight loss: In children with obesity and obstructive sleep apnea, weight loss can alleviate symptoms. A pediatrician can assist with healthy diet and exercise planning. A dietician or nutritionist can also help create a weight loss plan. However, weight loss can take time, and a child with severe symptoms may benefit from initiating treatment that provides relief more quickly.
  • Avoiding allergens: It may be helpful to avoid substancessuch as pollen and moldthat can cause allergic rhinitis . Allergic rhinitis leads to congestion and airway restriction, which contribute to sleep apnea symptoms.
  • Nasal breathing retraining: Nasal breathing retraining is a type of physical therapy that aims to strengthen the tongue and surrounding muscles to help a child breathe effectively at night. It may help reduce symptoms, but data is limited.
  • Positional therapy: Positional therapy involves training a person to sleep in a different position. It may be used in children whose sleep apnea occurs only when they sleep on their back. Elevating the head of the bed can also help alleviate sleep apnea. However, limited information is available about the effectiveness of positional therapy in children.

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Getting Used To Your Cpap Device

Ease into it. Start by using your CPAP device for short periods. Try wearing it for a half hour or an hour while sitting up in bed watching TV or reading a book. Once youve gotten used to that, try using it lying down or when napping.

Use the ramp setting. Most devices can be programmed to start slowly and gradually increase air pressure. The goal is to be asleep before the machine reaches your prescribed pressure setting. Most people find this makes falling asleep much easier and more comfortable.

Reset the machine if air flow wakes you. If a high-pressure stream of air wakes you up, turn the CPAP device on and off to restart the ramp setting.

Postal Code Diagnosis And Treatment Of Sleep Apnea

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While CPAP treatment for OSA is funded in many other countries including the United Kingdom and the United States , it is not funded in the majority of Canadian provinces. In 2008, The Lung Association and the CTS jointly recommended funding of CPAP treatment under all provincial and federal health insurance plans for adults and children appropriately diagnosed with OSA however, little progress has been made over the past two years. It is now time to end the postal code differences that currently exist in Canada with regard to access to the diagnosis and treatment of OSA.

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Central Sleep Apnea Causes And Risk Factors

Like obstructive sleep apnea, central sleep apnea is more common in men and people over the age of 65. But unlike obstructive sleep apnea, central sleep apnea is often associated with serious illness, such as heart disease, stroke, neurological disease, or spinal or brainstem injury. Some people with obstructive sleep apnea can also develop central sleep apnea when theyre being treated with positive airway pressure devices.

Is It Sleep Apnea Or Just Snoring

Not everyone who snores has sleep apnea, and not everyone who has sleep apnea snores. So how do you tell the difference between normal snoring and a more serious case of sleep apnea?

The biggest telltale sign is how you feel during the day. Normal snoring doesnt interfere with the quality of your sleep as much as sleep apnea does, so youre less likely to suffer from extreme fatigue and sleepiness during the day. The way you sound when youre snoring also provides clues. As mentioned above, if youre gasping, choking, or making other unusual sounds, you should suspect sleep apnea.

Keep in mind that even if you dont have sleep apnea, a snoring problem can get in the way of your bed partners rest and affect your own sleep quality. But there are tips and treatments that can help you stop snoring.

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Glossectomy / Partial Glossectomy

In a systematic review and meta-analysis, Murphy and colleagues examined the effect of glossectomy as part of multi-level sleep surgery on sleep-related outcomes in patients with OSA. Two independent researchers conducted the review using PubMed-NCBI and Scopus literature databases. Studies on glossectomy for OSA that reported pre- and post-operative AHI score with 10 or more patients were included. A total of 18 articles with 522 patients treated with 3 glossectomy techniques met inclusion criteria. Pooled analyses showed a significant improvement in AHI , ESS , snoring visual analog scale , and lowest O2 saturation . Surgical success rate was 59.6 % and surgical cure was achieved in 22.5 % of cases. Acute complications occurred in 16.4 % of reported patients. Glossectomy was used as a standalone therapy in 24 patients. In this limited cohort, significant reductions in AHI and ESS were likewise observed. The authors concluded that glossectomy significantly improved sleep outcomes as part of multi-level surgery in adult patients with OSA. Moreover, they stated that there is currently insufficient evidence to analyze the role of glossectomy as a stand-alone procedure for the treatment of OSA, although the evidence suggested positive outcomes in select patients.

How Is Obstructive Sleep Apnea Treated

Four Options for Kids with Apnea

Sleep apnea is treated in one of four general ways, depending on the cause of the obstruction. Treatment options include:

  • Surgery: Removal of enlarged tonsils and adenoids . Other types of surgeries may be needed in children with structural abnormalities of their head and neck area. For example, a dental or facial surgeon may be able to adjust the position of poorly aligned teeth or the small jaw and thus create more room in the airway.
  • Lifestyle modification: Weight loss may be helpful in the management of OSA in overweight children.
  • Medications: Medications may sometimes be helpful in keeping airways clear or opening airways. Examples of such medications include fluticasone and montelukast .
  • Continuous positive airway pressure : CPAP involves wearing a mask over the nose during sleep. The mask is attached to a small portable machine that blows air through the nasal passages and into the airway. The air pressure generated by the machine keeps your child’s airway splinted open and allows him or her to breathe normally during sleep.

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Children With Craniofacial Syndromes

OSA is more common in children with craniofacial syndromes. Children who have syndromes with craniosynostosis, such as Apert’s syndrome, Crouzon’s disease, Pfeiffer’s syndrome, and Saethre-Chotzen syndrome abnormalities of the skull base and accompanying maxillary hypoplasia may have nasopharyngeal obstruction. Children with syndromes that involve micrognathia, such as Treacher Collins syndrome, Pierre Robin syndrome, and Goldenhar’s syndrome, become obstructed at the hypopharyngeal level. In children with trisomy 21, a narrow upper airway combined with macroglossia and hypotonic musculature predisposes them to OSA.

The surgical management of craniofacial syndromes and OSA in children frequently requires more than standard adenotonsillectomy. Tracheotomy often is necessary. In children with midfacial hypoplasia, craniofacial advancement may be indicated. Glossopexy, mandibular distraction or advancement, or tongue suspension should be considered in patients with micrognathia.30

Outlook For Children With Sleep Apnea

Sleep apnea treatment works for many children.

According to a 2018 review of studies, surgery to remove the tonsils and adenoids reduces obstructive sleep apnea symptoms in anywhere from 27 to 79 percent of children. Children were more likely to experience symptoms after surgery if they were older, had childhood obesity, or had more severe apnea prior to surgery.

A 2013 random trial found that Black children were also more likely than other children to experience symptoms after surgery. However, they also had more severe apnea overall.

Symptoms tend to improve with weight management, a CPAP machine, or an oral appliance.

If left untreated, sleep apnea can worsen and interfere with your childs quality of life. It can become difficult for them to concentrate in school. If it persists into adulthood, this disorder may put them at risk for complications such as stroke or heart disease.

If you observe any of the following symptoms in your child, speak with their doctor about the possibility of sleep apnea:

  • loud snoring
  • pauses in breathing while they sleep
  • severe daytime fatigue

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What Is A Boolean In Java

Metamorphosis Stage

Explanation:

Metamorphosis Stage is the final phase of the phase of socialization in which a new worker shifts him or herself to adapt to the workplace, prospective individuals or company.

At this point, staff comprehend and recognize themselves as part of the organisation. Staff create a feeling of relating and contribute to the achievement of organisational targets and ambitions.

What is the value of the variable?

In the above instruction, the variable is iNum and its value is 38

This is so, because int iNum = 38.78 means that the integer part of 38.78 be stored in iNum.

In 38.78, the integer part is 38 and the fractional part is 0.78.

Hence, 38 will be saved in iNum and the 0.78 be discarded

When Should We See A Doctor

Fig 10:

It is a good idea to consult a doctor anytime abnormal sleep symptoms are present. Also, children who are not sleeping well may have trouble focusing, display irritability, or have poor impulse control. If a child is struggling with behavior concerns, it could be helpful to ask the doctor whether a sleep disorder such as sleep apnea may be a contributing factor.

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What Causes Obstructive Sleep Apnea In Children

There are several causes of obstructive sleep apnea in children:

  • Enlarged tonsils and adenoids: A widely recognized risk factor for childhood OSA is enlarged tonsils and adenoids. Tonsils and adenoids are glands located at the back of the throat and are part of the immune system. The tonsils and adenoids may be enlarged due to genetics, frequent infections, or inflammation. When enlarged, these glands constrict the airway, making breathing during sleep more difficult.
  • Childhood obesity: OSA in children is also frequently caused by obesity, which also constricts the airway. Obstructive sleep apnea occurs in 60% of obese children.
  • Other risk factors: Other causes of OSA include having a small jaw or an overbite, the use of sedatives or opioids, and tongue and throat muscle weakness due to conditions like Down syndrome or cerebral palsy. Having nasal allergies, being around adults who smoke, and having a family history of obstructive sleep apnea are also found to be risk factors for childhood OSA.

What Is A Cpap Device And How Does It Work

A CPAP device is a machine that uses a hose and airtight nosepiece or mask to deliver a steady stream of air as you sleep. The air pressure helps keep your airway open, preventing pauses in breathing.

CPAP technology is constantly being updated and improved, and the new CPAP devices are lighter, quieter, and more comfortable than they used to be. So even if youve given up on them in the past, you owe it to yourself to give them a second look.

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What Causes Central Sleep Apnea In Children

Central sleep apnea can occur for a variety of reasons in children. It is important to note that a few central apnea events during sleep is considered normal. Central sleep apnea has been associated with rare genetic disorders in children, such as congenital central hypoventilation syndrome. It may also be present when children have health conditions that interfere with parts of the central nervous system that controls breathing.

Tests For Obstructive Sleep Apnoea

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Your GP will look in your childs throat to check his tonsils. The GP might send your child to an ear, nose and throat specialist if it looks like your childs adenoids and tonsils are the cause of your childs obstructive sleep apnoea.

To help the doctors work out whether its obstructive sleep apnoea, your child might need to undergo a sleep study called a polysomnography. This involves staying overnight in hospital , so that specialists can watch your childs breathing, heart rate, oxygen level, and brain, eye and muscle activity while shes sleeping.

Some children might have an oximetry test. This test also measures your childs heart rate and oxygen levels while hes sleeping, but it can be done at home.

These tests arent usually painful or uncomfortable.

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Central Sleep Apnea Happens When The Brain Is Involved

Central sleep apnea is less common than obstructive sleep apnea. It can also be trickier to diagnose and treat. Unlike obstructive sleep apnea, which is caused by a mechanical problem that blocks the airway, central sleep apnea occurs because the brain is not sending the proper messages to the muscles that control breathing. Central sleep apnea is caused by a neurological reason, explains Dr. Capasso.

While central and obstructive sleep apneas share many symptoms such as episodes of pauses in breathing, constant awakenings during the night, and extreme sleepiness during the day central sleep apnea often affects people who have underlying illnesses, too, such as a brain infection or other conditions that affect the brainstem. Common diseases associated with central sleep apnea include: severe obesity, Parkinsons disease, stroke, and chronic heart failure. Certain drugs, such as opioids or benzodiazepines, can also play a role in central sleep apnea. In patients who use opioids on a chronic basis, the breathing mechanisms can get numbed, Capasso explains.

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Your doctor may refer you to a sleep specialist for a diagnosis if he or she suspects central sleep apnea, which may involve an overnight sleep test to rule out obstructive sleep apnea or other sleep disorders. The sleep specialist may also work with your cardiologist or order scans of your head and heart to rule out other contributing illnesses.

Other Positive Airway Pressure Breathing Devices

In addition to CPAP, there are other devices that a sleep specialist may recommend for sleep apnea treatment.

Expiratory positive airway pressure single-use devices fit over the nostrils to help keep the airway open and are smaller, less intrusive than CPAP machines. These may benefit people with mild-to-moderate obstructive sleep apnea.

Bilevel positive airway pressure devices can be used for those who are unable to adapt to using CPAP, or for central sleep apnea sufferers who need assistance for a weak breathing pattern. This device automatically adjusts the pressure while youre sleeping, providing more pressure when you inhale, less when you exhale. Some BiPAP devices also automatically deliver a breath if the mask detects that you havent taken one for a certain number of seconds.

Adaptive servo-ventilation devices can be used for treating central sleep apnea as well as obstructive sleep apnea. The ASV device stores information about your normal breathing pattern and automatically uses airflow pressure to prevent pauses in your breathing while youre asleep.

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Tips To Improve Health And Comfort

Choose a CPAP device with a built-in humidifier. Most devices now include a built-in humidifier, which helps prevent the dryness and skin irritation that can sometimes occur.

If youre experiencing nasal congestion, you may prefer a full-face mask over a nasal or nasal pillow mask. Also be sure to keep your humidifier tank full, keep your tubing and mask clean, and make sure your filter is clean. Nasal sprays and antihistamines also help.

Keep your device clean. Its very important to clean your CPAP hose, nosepiece or mask, and humidifier tub regularly, as a dirty CPAP device can cause infections and even pneumonia. Your sleep doctor and device manufacturer will give you detailed cleaning instructions.

To ensure maximum comfort, ask your doctor about soft pads to reduce skin irritation, nasal pillows for nose discomfort, and chinstraps to keep your mouth closed and reduce throat irritation and dry mouth.

Mask the sound of the CPAP machine. Most new CPAP devices are quiet, but if the sound of your CPAP machine bothers you, try placing it beneath the bed and using a sound machine to muffle the noise.

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