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Management of obstructive sleep apnea in children: A practical approach

Kevin D Pereira1, Cindy K Jon, Peter Szmuk

  • 1Corresponding author: Kevin D. Pereira, MD, Division of Pediatric Otolaryngology, Department of Otorhinolaryngology-Head and Neck Surgery, 16 S. Eutaw St., Suite 500, Baltimore, MD 21201. Email: Kpereira@smail.umaryland.edu From the Division of Pediatric Otolaryngology, Department of Otorhinolaryngology-Head and Neck Surgery, Baltimore (Dr. Pereira); the Division of Pulmonary Medicine, University of Texas Houston McGovern Medical School (Dr. Jon); the Division of Pediatric Anesthesiology (Dr. Szmuk) and the Department of Pediatric Otolaryngology (Dr. Mitchell), University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; and the Department of Pediatric Otolaryngology, Otolaryngology Consultants of Memphis (Tennessee) (Dr. Lazar).

Ear, Nose, & Throat Journal
|July 20, 2016
PubMed

Insights

Most children with sleep disordered breathing (SDB) don't get polysomnography (PSG) before adenotonsillectomy (T&A). T&A is effective for normal-weight children, but perioperative care needs individualization.

Area of Science:

  • Pediatric Sleep Medicine
  • Otolaryngology
  • Pulmonology

Background:

  • Management of pediatric sleep disordered breathing (SDB) varies across institutions.
  • There is a need for an updated review of current SDB management practices in children.

Purpose of the Study:

  • To review current literature on the management of SDB in children.
  • To provide a consensus on practical approaches for clinicians, particularly otolaryngologists.

Main Methods:

  • A PubMed literature review was conducted from 1995 to 2015.
  • Articles were selected based on clinical applicability, evidence strength, and practicality.
  • Four tertiary care providers from pediatric anesthesiology, pulmonology, sleep medicine, and otolaryngology independently reviewed and analyzed literature.

Main Results:

  • The majority of children with SDB do not undergo polysomnography (PSG) prior to adenotonsillectomy (T&A).
  • Adenotonsillectomy (T&A) is the primary treatment, effective in normal-weight children but less so in obese children.
  • Clinical practice guidelines differ, and perioperative management requires individualization, especially for young children, those with severe SDB, or comorbidities.

Conclusions:

  • Indications for PSG in children with SDB are presented with a practical approach for otolaryngologists.
  • Perioperative management of pediatric SDB patients is challenging and requires tailored strategies.
  • Overnight observation is recommended for high-risk pediatric SDB patients.

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