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Session Schedule

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0:00:00
Introduction

0:00:55
Improving sleep in children with Down syndrome
Rosemary Horne (Australia)

0:21:15
EEG characteristics and cognitive dysfunction in children with OSA
Zhifei Xu (China)

0:37:05
Can adenotonsillectomy in childhood enhance long-term cardiovascular health for individuals with OSA?
Jun Chun Ting Au (Canada) presented by Albert Li (Hong Kong)

0:54:21
Optimizing treatment for pediatric OSA: Insights from HFNC and CPAP therapies
Kate Chan (Hong Kong)

1:16:20
Question and answer

Summary

This symposium will bring together a diverse group of junior and senior researchers in the field of pediatric sleep medicine from Australia, Canada, China and Hong Kong. They will present their novel findings to enhance the understanding and management of OSA in children with or without medical complexity.

Obstructive sleep apnea (OSA) is a prevalent condition affecting in 1–5% of otherwise healthy children, with significantly higher rates observed in children with underlying medical complexity (e.g. Down syndrome) and/or obesity. Although untreated OSA can lead to serious long-term health problems, including cardiovascular abnormalities, behavioral and neurocognitive deficits, and metabolic disorders, as well as lower quality of life and increased health care utilization, it is often underdiagnosed and undertreated in various populations.

The current gold standard for the diagnosis of OSA is polysomnography (PSG), which provides extensive physiological data during sleep, including electroencephalogram (EEG), respiratory airflow, and oxygen saturation. However, the severity of OSA is primarily determined by the obstructive apnea hypopnea index (OAHI), which measures the number of obstructive apneas and hypopneas per hour of sleep. Unfortunately, this metric is not a reliable predictor of OSA-related complications, such as cardiovascular abnormalities and neurocognitive deficits. The lack of an objective biomarker to predict OSA complications in children hinders effective management and early intervention, which are essential for reducing morbidity and improving outcomes. This symposium will present and discuss novel findings regarding several emerging biomarkers that could help better define and manage childhood OSA, such as hypoxic burden (HB), a measure of the total amount of hypoxia due to respiratory events during sleep, and sleep disruption as quantified by EEG spectral analysis.

Adenotonsillar hypertrophy is a significant anatomical risk factor for childhood OSA, and adenotonsillectomy (AT) is typical the first-line therapeutic option with a cure rate of over 70% in otherwise healthy, non-obese children. However, more than 50% of children with genetic syndromes and/or obesity continue to experience moderate to severe persistent OSA following AT. More importantly, it remains uncertain whether the immediate benefits of AT in childhood can be maintained into adulthood. New data on long-term cardiovascular outcomes after AT in children will be presented at this symposium.

For children with persistent OSA after AT, or for those for whom surgery is contraindicated, continuous positive airway pressure (CPAP) is the gold standard treatment. While CPAP is effective in treating OSA, its overall success is negated by low adherence among children, primarily due to discomfort and claustrophobia associated with wearing a tight-fitting mask during sleep and the poor tolerability to the delivery of pressurized air. High flow nasal cannula (HFNC) therapy has been shown to be as efficacious as CPAP in reducing OSA severity in laboratory settings. However, the long-term adherence to HFNC in home settings and its long-term clinical efficacy are still uncertain. Findings from a recently completed randomized controlled trial comparing the effectiveness of HFNC and CPAP in home settings will be presented and discussed.