Obstructive sleep apnoea in children: perioperative considerations

Obstructive sleep apnoea (OSA) has become a major public health concern as its incidence and severity have increased in tandem with the obesity epidemic. In children, OSA is now recognized as a common disorder and can be associated with significant morbidity. OSA belongs to a spectrum of diagnoses known as sleep-related breathing disorders in which the airway is completely (apnoea) or partially (hypopnoea) occluded during sleep despite continued respiratory efforts. This airway obstruction can cause abnormal gas exchange leading to hypoxaemia, hypercapnia, sleep fragmentation, and their attendant physiological and behavioural consequences. The degrees of hypercapnia, hypoxaemia, and upper airway airflow reduction are the primary factors determining the severity of OSA. In young children, adenotonsillar hypertrophy is the most common anatomical abnormality associated with OSA, and adenotonsillectomy is, therefore, the most common surgical intervention. Perioperative complications associated with adenotonsillectomy are more common in children with severe OSA. A thorough understanding of the pathophysiology of OSA, careful and complete preoperative assessment, meticulous intraoperative and postoperative management, and early recognition of potential perioperative complications are essential to optimization of outcomes. The safe anaesthetic management of a child with OSA requires an anaesthetic technique tailored to the underlying aetiology and severity of OSA and the surgical procedure. This review focuses on the epidemiology, pathogenesis, and diagnosis of OSA, and the state-of-the-art and future directions in the perioperative management of children with OSA.