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Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Athanasios G Kaditis1, Maria Luz Alonso Alvarez2, An Boudewyns3

  • 1Pediatric Pulmonology Unit, First Dept of Paediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece kaditia@hotmail.com.

The European Respiratory Journal
|November 7, 2015
PubMed

Insights

This European Respiratory Society Task Force report outlines a 7-step approach for diagnosing and managing obstructive sleep disordered breathing (SDB) in children aged 2-18 years, emphasizing objective assessment and stepwise treatment.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Respiratory Health

Background:

  • Obstructive sleep disordered breathing (SDB) in childhood presents diagnostic and management challenges.
  • Evidence from prospective cohort studies and randomized controlled trials on SDB natural history and treatment is limited.
  • A European Respiratory Society Task Force convened to address these gaps.

Purpose of the Study:

  • To summarize conclusions on the diagnosis and management of SDB in children aged 2-18 years.
  • To consolidate evidence into a practical, stepwise management framework.
  • To provide guidance for clinicians based on the best available evidence.

Main Methods:

  • Systematic review and consolidation of evidence from 362 selected articles.
  • Development of a seven-step management strategy.
  • Focus on objective assessment, identification of comorbidities, and stepwise treatment.

Main Results:

  • SDB diagnosis is initiated by recognizing symptoms of upper airway obstruction.
  • Identification of central nervous/cardiovascular morbidity, growth failure, enuresis, and long-term persistence predictors is crucial.
  • Objective severity assessment via polysomnography (e.g., apnea-hypopnea index [AHI]) guides treatment decisions.

Conclusions:

  • Children with AHI >5, AHI 1-5 with comorbidities, or complex conditions benefit from treatment.
  • Treatment involves a stepwise approach addressing predisposing factors.
  • Re-evaluation after interventions is essential to detect residual disease and guide further management.

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