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obstructive sleep apnea

Importance of Screening Children with Adenotonsillar Hypertrophy for Obstructive Sleep Apnea

Teaser: 

Madison O.L. Rays, Sharon Chung, PhD, Maya Capua, MD, Colin M. Shapiro, MBBCh, PhD, FRCPC,

Youthdale Child and Adolescent Sleep Centre and Youthdale Treatment Centres, Toronto, ON.

CLINICAL TOOLS

Abstract: Obstructive sleep apnea (OSA) is a disorder in which patients stop breathing repeatedly during sleep, and it is linked to a number of serious medical consequences. However, most patients with OSA remain undiagnosed. The consequences of OSA are particularly severe in children. Adenotonsillar hypertrophy (AT) is a major factor in the etiology of Obstructive Sleep Apnea (OSA) in children. Physicians should consider snoring, pauses in breathing while asleep, restless sleep, bizarre sleeping positions, paradoxical chest movements, cyanosis, bedwetting, hyperactivity, and disruptive behaviour in school as possible indications of untreated OSA in children. The presentation of OSA in children differs substantially from that in adults. For example, hyperactivity is often a primary symptom in children but is not a symptom typically found in adults.
Key Words: obstructive sleep apnea (OSA), children, adenotonsillar hypertrophy (AT), medical consequences.
The presentation of OSA in children is significantly different than that in adults; hyperactivity can be a primary symptom in children but is not typically found in adults.
Adenotonsillar hypertrophy is an indicator of undiagnosed OSA in children and merits a sleep study.
Untreated OSA in children can lead to medical and psychiatric issues.
Adenotonsillectomy, a common treatment for OSA in children with large tonsils, not only reduces or eliminates the OSA, but in most cases improves the associated behavioral problems.
Evidence-based medicine supports the need for children with adenotonsillar hypertrophy to be referred to a sleep specialist to be screened for OSA regardless of the degree of tonsillar enlargement.
The I'm Sleepy questionnaire allows doctors to quickly and easily identify children with a high risk of having OSA.
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Disclaimer: 
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The Need for Obstructive Sleep Apnea Screening: A Wake-Up Call to Physicians

Teaser: 

Sharon A. Chung, PhD1and Colin M. Shapiro, MBBCh, PhD, MRCPsych, FRCP(C)1-3

1Youthdale Treatment Centres, Toronto, Ontario, Canada. 2International Sleep Clinic, Parry Sound, Canada and the 3University of Toronto, Department of Psychiatry, Canada.

CLINICAL TOOLS

Abstract: Obstructive Sleep Apnea (OSA), where patients stop breathing numerous times during sleep, is a disorder linked to serious medical, socioeconomic, and psychological morbidity, yet most patients with OSA remain undetected. Physicians should consider symptoms of frequent/loud snoring, complaints of daytime sleepiness or fatigue, high blood pressure and obesity or excessive body fat distribution in the neck or upper chest area as possible indications of untreated OSA.
Key Words: obstructive sleep apnea, screening, management.
Untreated OSA is associated with significant morbidity and mortality and results in increased healthcare utilization.
OSA is more prevalent in individuals with a chronic medical illness.
Almost 90% of individuals with OSA remain undiagnosed.
Treatment of OSA improves medical outcome; this is particularly relevant in medically ill patients.
Evidence-based medicine supports screening for OSA as part of routine clinical care.
Newer technology allows doctors to 'skip the waiting line' and obtain quick and accurate sleep testing for their patients.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is only $20 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
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Disclaimer at the end of each page

Treatment-Resistant Hypertension among Older Adults

Treatment-Resistant Hypertension among Older Adults

Teaser: 


Fatemeh Akbarian, MD, Dermatologist, Clinical Research Fellow, University of Toronto, Toronto, ON.
Vahid Ghafarian, MD, MPH, BSc.PT, Physiotherapist, Northpark Physiotherapy and Annex Retirement Residence, Toronto, ON.
Mohammad Ali Shafiee, MD, FRCPC, General Internist, Nephrologist, Department of Medicine, Toronto General Hospital, University Health Network; Clinician Teacher, University of Toronto, Toronto, ON.

Treatment-resistant hypertension (TRHTN) is a common challenge in geriatric practice and a significant cause of mortality and morbidity among older adults. In this overview, we will use a case-based approach to define the magnitude of the problem, identify characteristics of individuals with TRHTN, and explore the causes of uncontrolled hypertension including technical issues, patient-related and physician-related factors, and secondary causes of hypertension. We will then provide a simple approach to the problem, illustrating straightforward diagnostic workup and therapeutic options. In our approach most of the emphasis has been given to detailed history-taking and a targeted physical examination.
Key words: resistant hypertension, hyperaldosteronism, obstructive sleep apnea, older adults.