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Published on: December 6, 2016
Pediatric Obstructive Sleep Apnea
Zarmina Ehsan1, Stacey L Ishman2
1Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2021, Cincinnati, OH 45229, USA.
Insights
Screening for obstructive sleep apnea (OSA) in children with sleep disordered breathing is recommended. Treatment for pediatric OSA includes surgery, medications, or airway pressure devices, with a multi-modality approach preferred.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Otolaryngology
Background:
- Obstructive sleep apnea (OSA) is a common condition in children.
- Sleep disordered breathing necessitates screening for OSA.
- Adenotonsillectomy is the primary surgical intervention for pediatric OSA.
Purpose of the Study:
- To outline the recommended diagnostic and therapeutic approaches for pediatric obstructive sleep apnea.
- To provide an overview of treatment options for children diagnosed with OSA.
Main Methods:
- In-laboratory polysomnography for screening.
- Evaluation of medical management options including intranasal steroids and montelukast.
- Assessment of continuous positive airway pressure (CPAP) therapy.
- Consideration of surgical interventions beyond adenotonsillectomy.
- Review of lifestyle modifications like weight loss and oral appliance therapy.
Main Results:
- Adenotonsillectomy is the first-line treatment for pediatric OSA.
- Medical therapies (intranasal steroids, montelukast) are options for mild OSA.
- CPAP is indicated for moderate to severe OSA, surgical candidates awaiting surgery, or persistent OSA post-surgery.
- Further upper airway surgery is viable for cases refractory to medical management or post-adenotonsillectomy.
- Weight loss and oral appliances offer additional therapeutic benefits.
Conclusions:
- A multi-modality approach is preferred for the diagnosis and management of pediatric OSA.
- Treatment strategies should be tailored to OSA severity and individual patient factors.
- Comprehensive management may involve a combination of surgical, medical, and supportive therapies.
Abstract:
Screening for obstructive sleep apnea (OSA) with in-laboratory polysomnography is recommended for children with sleep disordered breathing. Adenotonsillectomy is the first-line therapy for pediatric OSA, although intranasal steroids and montelukast can be considered for those with mild OSA and continuous positive airway pressure for those with moderate to severe OSA awaiting surgery, poor surgical candidates or persistent OSA. Bony or soft tissue upper airway surgery is reasonable for children failing medical management or those with persistent OSA following adenotonsillectomy. Weight loss and oral appliance therapy are also useful. A multi-modality approach to diagnosis and treatment is preferred.
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