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Obstructive sleep disordered breathing in children: beyond adenotonsillectomy.
Jean-Paul Praud1, Dominique Dorion
1Respiratory Medicine Division, Department of Pediatrics, Université de Sherbrooke, Québec, Canada. jean-paul.praud@usherbrooke.ca
Pediatric Pulmonology
|August 6, 2008
Summary
Adenotonsillectomy (AT) for childhood obstructive sleep disordered breathing (SDB) has limitations. New treatments like CPAP, anti-inflammatories, and orthodontic interventions show promise, but more research is needed.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Orthodontics
Background:
- Adenotonsillectomy (AT) is the primary treatment for childhood obstructive sleep disordered breathing (SDB), with an 80% cure rate.
- However, AT carries risks including morbidity, pain, and potential SDB recurrence or incomplete cure in up to 75% of cases.
- This challenges the traditional view of AT as a definitive solution for pediatric SDB.
Purpose of the Study:
- To review current and emerging treatment options for childhood obstructive sleep disordered breathing (SDB).
- To highlight the limitations of traditional adenotonsillectomy (AT) and explore alternative and complementary therapies.
- To emphasize the need for further research and multidisciplinary collaboration in managing pediatric SDB.
Main Methods:
- Literature review of studies on adenotonsillectomy (AT) and alternative treatments for childhood obstructive sleep disordered breathing (SDB).
- Analysis of data regarding the efficacy, limitations, and potential of continuous positive airway pressure (CPAP), anti-inflammatory agents, and orthodontic interventions.
- Discussion of the role of orthodontic assessment and collaboration in SDB management.
Main Results:
- Adenotonsillectomy (AT) is associated with significant morbidity and may not achieve complete cure in a substantial percentage of children with obstructive sleep disordered breathing (SDB).
- Continuous positive airway pressure (CPAP) is an option for residual SDB post-AT, but compliance issues exist, especially in infants.
- Anti-inflammatory treatments and orthodontic interventions show promise for improving or curing SDB by addressing airway space.
Conclusions:
- While AT remains a common treatment, its limitations necessitate exploring alternative and complementary therapies for childhood obstructive sleep disordered breathing (SDB).
- Emerging treatments like CPAP, anti-inflammatories, and particularly orthodontic interventions offer potential for durable SDB management.
- Randomized controlled trials are crucial to define indications for new treatments, alongside systematic orthodontic evaluation for optimal SDB care.
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