Research into childhood obstructive sleep-disordered breathing examined

Studies increasing, but gaps remain in diagnosis and treatment methods, according to a new study in the journal CHEST®

Glenview, IL, August 3, 2017

Although sleep apnea is typically considered a condition affecting adults, breathing problems during sleep in children are common and may affect their health and behavior. Disturbed sleep in children due to breathing problems is often caused by large tonsils and adenoids blocking the upper airways. This is called obstructive sleep-disordered breathing (oSDB) and has been the subject of increased research during the past decade. While milder forms of oSDB are most common, the more severe form requires tonsil or adenoid surgery. Through a comprehensive review of published research, investigators have identified important gaps in how and where children with this condition are best managed. Their findings are published in the journal CHEST.

Breathing problems during sleep vary from simple snoring without impact on sleep or oxygen saturation in the blood, to obstructive sleep apnea (OSA), during which children have repeated episodes of restricted breathing and/or drops in oxygen saturation levels. Although clinical guidelines for treatment were issued by the American Academy of Pediatrics (AAP) in 2012, there is still debate on the best pathway of care for children.

According to lead investigator Anne G. M. Schilder, PhD, evidENT, Ear institute, University College London, Royal National Throat Nose and Ear Hospital, “oSDB is a very common condition in children and reports suggest its incidence is on the rise. This may be in part related to the increase in childhood obesity. Parents and professionals have become more aware that this condition may have negative long-term health consequences and, therefore, it is important that children suffering from this condition are well managed and available resources are allocated appropriately. This means timely treatment of children who need it and avoiding unnecessary surgery of those unlikely to benefit from it.”

Based on the patient’s symptoms and signs alone, it is difficult for doctors in primary care and hospitals to distinguish the more common milder forms of oSDB from the more severe. “A sleep study is the gold standard but expensive and not widely available,” explained Prof Schilder. “There is no agreement regarding which patients need such a study and how best to interpret its results, that is who needs surgery or medical treatment. Rather than focusing research on individual steps in the patient pathway, there is a need for a more holistic approach to research in this area, taking into account the views of all professionals caring for these children, as well as their parents.”

Therefore, investigators carried out a systematic review to map the research in childhood oSDB that has been conducted to date. Their goals were to support further guideline development, identify evidence gaps, and guide future research. Evaluating more than 5,700 studies through November 2015 eligible for inclusion, they identified an increase in annual publications since 2000, with 46% published since 2011, when evidence-based data for the AAP guidelines were evaluated.

Most publications (61%) focused on individual treatment modalities, incidence, or prognosis. Few publications (2.7%) focused on health service delivery, outcomes, and health economics. Observational studies comprised 78.5% of publications, 2.4% were randomized controlled trials, and 0.4% used a qualitative approach as their main methodology.

Investigators found that the recent surge in research activity into childhood oSDB has improved the knowledge base for this condition; however, the lack of health services, health economics, and outcomes research impacts the applicability of evidence informing current guidance and leaves important questions for future research.

“Mapping so many papers has been quite an undertaking for our team, but so rewarding, since it highlights clearly what future research should focus upon,” concluded Prof Schilder.

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Notes for editors
The article is “Research Into Childhood Obstructive Sleep-Disordered Breathing: A Systematic Review," by Roderick P. Venekamp, PhD; Deepak Chandrasekharan, BM, BCh; Francois Abel, MD; Helen Blackshaw, PhD; Irene A. Kreis, PhD; Hannah E. R. Evans, MSc; Anne G. M. Schilder, PhD (https://doi.org/10.1016/j.chest.2016.12.001). It appears in the journal CHEST, volume 152, issue 1 (July 2017) published by Elsevier.

Full text of this article and interviews with the authors are available to credentialed journalists upon request; contact Andrea Camino, American College of Chest Physicians, at +1 224-521-9513 or acamino@chestnet.org.

evidENT at University College London is supported by a National Institute for Health Research (NIHR) Research Professorship award to Anne G. M. Schilder. Expert systematic review advice from Irene Kreis was made available through a Royal College of Surgeons of England Clinical Trials Initiative award.

About the journal CHEST®
The journal CHEST®, the official publication of the American College of Chest Physicians, features the best in peer-reviewed, cutting-edge original research in the multidisciplinary specialties of chest medicine: pulmonary, critical care and sleep medicine; thoracic surgery; cardiorespiratory interactions; and related disciplines. Published since 1935, it is home to the highly regarded clinical practice guidelines and consensus statements. Readers find the latest research posted in the Online First section each week and access series that provide insight into relevant clinical areas, such as Recent Advances in Chest Medicine; Topics in Practice Management; Pulmonary, Critical Care and Sleep Pearls; Ultrasound Corner; Chest Imaging and Pathology for Clinicians; and Contemporary Reviews. Point/Counterpoint Editorials and the CHEST Podcasts address controversial issues, fostering discussion among physicians. www.chestjournal.org

About American College of Chest Physicians (CHEST)
CHEST is the global leader in advancing best patient outcomes through innovative chest medicine education, clinical research and team-based care. Its mission is to champion the prevention, diagnosis and treatment of chest diseases through education, communication and research. CHEST serves as an essential connection to clinical knowledge and resources for its 19,000 members from around the world who provide patient care in pulmonary, critical care and sleep medicine. For more information, visit www.chestnet.org.

About Elsevier
Elsevier is a global information analytics business that helps institutions and professionals progress science, advance healthcare and improve performance for the benefit of humanity. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, more than 35,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com

Media contact
Andrea Camino
American College of Chest Physicians (CHEST)
+1 224-521-9513
acamino@chestnet.org