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Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
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Clinical practice: diagnosis and treatment of childhood snoring

Ioannis M Vlastos1, John K Hajiioannou

  • 1Department of Otolaryngology, Aghia Sophia Children's Hospital of Athens, 26 Kirprion Agoniston, Dasos Haidariou, Athens, Greece. giannisvlastos@yahoo.gr

European Journal of Pediatrics
|July 22, 2009
PubMed

Insights

Pediatric obstructive sleep-disordered breathing ranges from simple snoring to severe obstructive sleep apnea. Current evidence suggests a multidisciplinary approach for diagnosis and treatment, moving beyond traditional adenotonsillectomy.

Area of Science:

  • Pediatrics
  • Sleep Medicine
  • Otolaryngology

Background:

  • Obstructive sleep-disordered breathing (OSDB) in children is common, with presentations varying from primary snoring to obstructive sleep apnea (OSA).
  • OSA can lead to significant cognitive, cardiac, and growth issues in children.
  • Inconsistent diagnostic methods hinder consensus on optimal treatment strategies.

Purpose of the Study:

  • To review diagnostic modalities for pediatric OSDB.
  • To evaluate current and alternative treatment options for pediatric OSDB.
  • To propose an evidence-based diagnostic and treatment algorithm for pediatric OSDB.

Main Methods:

  • Review of history, clinical examination, radiologic evaluations, and sleep studies.
  • Analysis of various treatment modalities including adenotonsillectomy, continuous positive airway pressure (CPAP), and orthodontic interventions.
  • Synthesis of evidence to propose a diagnostic and treatment workup.

Main Results:

  • Adenotonsillectomy remains a primary treatment, but its limitations and recurrences are noted.
  • Factors beyond adenotonsillar hypertrophy, such as obesity and craniofacial abnormalities, influence treatment outcomes.
  • Multidisciplinary approaches involving various specialists are often necessary.

Conclusions:

  • A comprehensive, multidisciplinary approach is essential for managing pediatric OSDB.
  • Evidence-based diagnostic and treatment pathways are proposed.
  • Individualized care plans are crucial for addressing the complexities of pediatric OSDB.

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