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.

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