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Objective There is a lack of consensus and a paucity of data regarding how to best treat pediatric patients with mild obstructive sleep apnea. The objective of our study was to compare outcomes following adenotonsillectomy vs. observation in children with mild obstructive sleep apnea based on polysomnography results. Methods A retrospective chart review was performed on children ages 9 months to 9 years with 2 or more polysomnograms completed at a tertiary care academic center. Children diagnosed with mild obstructive sleep apnea (obstructive apnea–hypopnea index 1–5) on polysomnography performed from 1999 to 2013 were included. Patients underwent adenotonsillectomy or watchful waiting for obstructive sleep apnea. The primary outcome was the change in apnea–hypopnea index. Results There were 62 patients who met inclusion criteria for the study; 19 of the 62 patients were obese, while 15 had a craniofacial syndrome or hypotonia. Eighteen patients underwent adenotonsillectomy for mild obstructive sleep apnea while 44 were observed. The mean apnea–hypopnea index of patients after adenotonsillectomy improved from 3.50 (95% Confidence Interval [CI] 2.97–4.03) to 2.69 (95% CI 1.48–3.90), while the mean apnea–hypopnea index of the observation group worsened from 3.09 (95% CI 2.76–3.42) to 5.18 (95% CI 2.46–7.90). Between-group analysis showed significant improvement in the surgery group ( p = 0.03), with a persistent improvement on multivariate analysis adjusting for baseline apnea–hypopnea index ( p = 0.05). This difference was seen mostly in non-obese, non-syndromic children ( p = 0.04). There was no significant difference between groups amongst obese ( p = 0.25) and syndromic ( p = 0.36) patients. Conclusions Adenotonsillectomy leads to a significant improvement in apnea–hypopnea index on follow-up polysomnography over an observational approach, especially in non-obese, non-syndromic children. A prospective, randomized trial is necessary to help determine appropriate treatment strategies for pediatric mild obstructive sleep apnea.

Venous malformations and lymphatic malformations of the head and neck region are uncommon causes for obstructive sleep apnea in the pediatric population. The need for treatment for these malformations depends on the location and size of lesion and associated complications such as ulceration, bleeding, or chronic airway obstruction leading to obstructive sleep apnea. Treatment options for obstructive sleep apnea include conservative approach with continuous positive airway pressure therapy, surgical excision, and sclerotherapy. Management of children with large venous or lymphatic malformations that develop severe obstructive sleep apnea often requires multidisciplinary care involving otolaryngology, sleep medicine, and interventional radiology. We report 2 pediatric cases, one with congenital lymphatic malformation and another with venous malformation causing polysomnographically confirmed severe sleep apnea and discuss their management.

This study was designed to determine the need for water supplementation to maintain water homoeostasis in exclusively breastfed infants during summer in a tropical country. A prestudy questionnaire revealed that 97% of 34 nurses and 63% of 70 doctors advocated such supplementation. 45 healthy, male, exclusively breastfed babies, aged 1-4 months, were recruited from a well-baby clinic. 9 who had never received supplemental water plus a random selection of 14 others were allocated to group I (breastmilk only); the remaining 22 infants were allocated to group II (breastmilk plus supplemental fluid according to the mother's usual practice). The babies were studied at the hospital for 8 h; breastmilk intake was measured by weighing the infant before and after each feed, water intake by calibrated bottles, and urine output by accurate collection and measurement. The maximum room temperatures were 34-41 degrees C and relative humidities 9-60% (below 50% in all but 3 infants). In group II the mean water intake was 11% (95% confidence interval 7-16%) of the total fluid intake. Both breastmilk intake (274 vs 210 ml) and total fluid intake (274 vs 233 ml) were higher in group I than in group II (p = 0.003, p = 0.073, respectively), after adjustment for age, weight, length, room temperature, and humidity. However, there were no significant differences between the groups in urine output, urine or serum osmolality, weight change, or rectal temperature whether or not the factors adjusted for included total fluid intake. Thus, exclusively breastfed infants do not need supplemental water to maintain water homoeostasis; a reduced breastmilk intake is a potential disadvantage of this practice.