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Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

David Gozal1, Hui-Leng Tan2, Leila Kheirandish-Gozal1

  • 1Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA.

Journal of Clinical Medicine
|March 28, 2020
PubMed

Insights

Pediatric obstructive sleep apnea (OSA) treatment has shifted from assuming surgery is curative to recognizing residual issues. New approaches are needed to personalize care for children with persistent OSA.

Area of Science:

  • Pediatric Sleep Medicine
  • Otolaryngology
  • Respiratory Medicine

Background:

  • Adenotonsillectomy (T&A) was historically the primary treatment for pediatric obstructive sleep apnea (OSA).
  • Persistent OSA after T&A is common in specific pediatric subgroups, including those with severe OSA, obesity, asthma, or anatomical factors.
  • Current treatment paradigms for residual pediatric OSA are varied and lack strong evidence.

Purpose of the Study:

  • To review the evolving treatment landscape for pediatric obstructive sleep apnea (OSA).
  • To identify patient factors associated with persistent OSA after adenotonsillectomy (T&A).
  • To discuss current and emerging treatment options for residual pediatric OSA and the need for evidence-based precision medicine.

Main Methods:

  • Literature review of pediatric obstructive sleep apnea (OSA) treatment strategies.
  • Analysis of factors contributing to persistent OSA post-adenotonsillectomy (T&A).
  • Synthesis of evidence for complementary therapies such as CPAP, anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy.

Main Results:

  • Adenotonsillectomy (T&A) is not universally curative for pediatric obstructive sleep apnea (OSA).
  • Specific patient characteristics predict persistent OSA after T&A.
  • Evidence supporting non-surgical interventions for residual pediatric OSA is currently limited.

Conclusions:

  • A multidisciplinary approach is essential for managing residual pediatric obstructive sleep apnea (OSA).
  • There is a critical need for prospective studies to guide personalized treatment selection for pediatric OSA.
  • Moving beyond a 'one-size-fits-all' model towards precision medicine is crucial for improving pediatric OSA care.

Keywords:
CPAPadenotonsillectomydiagnosisinflammationobesityorthodonticssleep disordered breathingsleep studies

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