Sleep Apnea- ENT Clinic Dubai DRHC

Make a general examination, looking for any craniofacial abnormalities.

  • Listen carefully for stertor while awake, or asleep.
  • Watch for mouth breathing.
  • Carry out an oral examination, to determine the size of the tonsils.

These can be graded by 2 Methods:

The Brodsky score

0 - tonsils in fossa

1 - Tonsils occupying up to 25% of the airway

2 - 26% to 50%

3 - 51% to 75%

4 - more than 75%

The Friedman score

0 - No tonsils

1 - Tonsil within pillars

2 - Tonsil beyond pillars

3 - Tonsil extending to the midline

4 - Tonsils touching in the midline.

  • Examine the nose to establish whether there is coexisting rhinitis and whether there is likely to be adenoid hypertrophy.
  • Examine the ears for coexisting otitis media with effusion.
  • Look for neck lymphadenopathy

How to confirm the diagnosis of sleep apnea

  • Oximetry overnight for observation of the O2 saturation and heart rate
  • Polysomnography
  • Nasolaryngoscopy
  • Imaging for the airway and mandible
  • Laboratory tests

How to manage sleep apnea

  • Diet and exercise to reduce the bulky tissue around the airway passage
  • Medicines for treating adenoids, allergy GERD etc.
  • Adenoidectomy with or without tonsillectomy or tonsillotomy
  • Jaw distraction in micrognathia (small mandible) or big tong tongue etc.
  • Oral appliance
  • Tongue reduction if the tongue was big
  • Continuous positive airway pressure (CPAP) may be required in children where treatment is not possible.

Indications for pediatric respiratory investigations

  • Diagnosis of OSA unclear or inconsistent
  • Age <2 years
  • Weight <15 kg
  • Down syndrome
  • Cerebral palsy
  • Hypotonia or neuromuscular disorders
  • Craniofacial anomalies
  • Mucopolysaccharidosis
  • Obesity (BMI >2.5 SDS (standard deviation scores),
  • Significant comorbidity such as congenital heart disease,
  • chronic lung disease
  • Residual symptoms after adenotonsillectomy