The second day of conference began with inspirational words from Barbara Phillips, MD MPH. She is well known in the sleep community for her forthright positions on many issues. While her presentation did not speak directly to issues concerning sleep, she was providing encouragement to the group of pediatric sleep specialists gathered in the room and thinking about the future direction this group should take in their efforts to promote pediatric sleep medicine. The second session was devoted to a working group on the treatment of sleep disordered breathing - OSA and primary snoring. The leader of the session was Dr. Christian Guilleminault from Stanford University(pictured above). Dr. G has a spot in the pantheon of physicians and researchers in the field of sleep medicine. His background is psychiatry and not pulmonology like many of other specialists in sleep.
This discussion got off to a fast start. Dr. G asked where should the clinical examination of a child suspected of sleep disordered breathing (SDB) begin. Clearly it is in the upper airway, but for him the upper airway begins at the tip of the nose. Before looking at the tonsils, when considering children one must look to see if there are any malformations of the nasal opening. Another area to consider when examming a child suspect of SDB, which for him includes snoring, is the roof of the mouth. How the hard palate is shaped can have an impact on the breathing of the child. And SDB can have an impact on the how the face of the child grows.
The session lasted an hour and 45 minutes and Dr. G challenged some of the ideas of those assembled in the working group. Time flew past and at the end four recommendations were reported out to the rest of the conference. How the group will act on these recommendations remains to be seen, but it was fascinating to listen to him and be offered a different perspective on treatment from the traditional first line treatment for SDB in children - Tonsillectomy and Adenoidectomy (T & A).
Here were the four recommendations - though not all were unanimous:
1. Every child presenting with symptoms of SDB should have a thorough clinical examination by a physician knowledgeable in sleep medicine.
2. Formal polysomnography should be used to quantify/assess severity in every child with symptoms suggestive of SDB.
3. Treatment considerations need both to extend beyond simply T & A and to include considerations as the most effective surgical approach if T & A is employed.
4. Follow up clinical evaluation and polysomnography should occur in every child after surgical intervention.
With that I close out on the Peds Sleep Med meeting... excited about collaborating on a new education bulletin for parents to have children who have sleep disordered breathing and sufficiently convinced that there is more to the treatment of sleep apnea in children than just the surgical option.