Obstructive Sleep Apnea in Children: Controversies in Diagnosis and Management
David G Ingram, Norman R Friedman
Citation Information :
Ingram DG, Friedman NR. Obstructive Sleep Apnea in Children: Controversies in Diagnosis and Management. Int J Head Neck Surg 2016; 7 (2):83-88.
To discuss commonly encountered diagnostic and therapeutic dilemmas in pediatric obstructive sleep apnea (OSA).
Background
Pediatric OSA is a fairly common childhood disorder, affecting 1 to 5% of all children and much larger proportions of children with selected comorbidities. Untreated OSA is associated with deleterious effects on neurobehavioral outcomes, cardiovascular health, and growth.
Results
We discuss several important diagnostic dilemmas, including when to obtain a preoperative polysomnogram (PSG), the relationship between OSA and sleep-disordered breathing, and limitations of conventional PSG-derived metrics. Management challenges commonly encountered in clinical practice include defining surgical cure and providing reliable estimates for families preoperatively, issues related to the use of positive airway pressure, and emerging alternative and complementary therapeutic modalities.
Conclusion
While recently published clinical practice guidelines have provided important standards for the diagnosis and management of pediatric OSA, many areas of uncertainty remain.
Clinical significance
We provide a review of current diagnostic and therapeutic controversies relevant to the practicing clinician.
How to cite this article
Ingram DG, Friedman NR. Obstructive Sleep Apnea in Children: Controversies in Diagnosis and Management. Int J Head Neck Surg 2016;7(2):83-88.
Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012 Sep;130(3):e714-e755.
Systematic review of pediatric tonsil size and polysomnogram-measured obstructive sleep apnea severity. Otolaryngol Head Neck Surg 2011 Jun;144(6):844-850.
Cognitive and academic functions are impaired in children with all severities of sleep-disordered breathing. Sleep Med 2011 May;12(5):489-496.
Clinical assessment of pediatric obstructive sleep apnea. Pediatrics 2004 Jul;114(1):33-43.
Utility of symptoms to predict treatment outcomes in obstructive sleep apnea syndrome. Pediatrics 2015 Mar;135(3):e662-e671.
Quality of life and obstructive sleep apnea symptoms after pediatric adenotonsillectomy. Pediatrics 2015 Feb;135(2):e477-e486.
Esophageal pressures, polysomnography, and neurobehavioral outcomes of adenotonsillectomy in children. Chest 2012 Jul;142(1):101-110.
The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Darien (IL): American Academy of Sleep Medicine; 2015.
Planning adenotonsillectomy in children with obstructive sleep apnea: the role of overnight oximetry. Pediatrics 2004 Jan;113(1 Pt 1):e19-e25.
Validation of the Sonomat: a contactless monitoring system used for the diagnosis of sleep disordered breathing. Sleep 2014 Sep 1;37(9):1477-1487.
Clinical practice guideline: polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg 2011 Jul;145(1 Suppl):S1-S15.
Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics 2008 Jul;122(1):e149-e155.
Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics 2006 Jan;117(1):e61-e66.
Montelukast for children with obstructive sleep apnea: a double-blind, placebocontrolled study. Pediatrics 2012 Sep;130(3):e575-e580.
Anti-inflammatory medications for obstructive sleep apnea in children. Cochrane Database Syst Rev 2011 Jan 19;(1):CD007074.
A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 2013 Jun 20;368(25):2366-2376.
Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 2009 Jun;140(6):800-808.
Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med 2010 Sep;182(5):676-683.
Prognosis for spontaneous resolution of obstructive sleep apnea in children. Chest 2015 Nov;148(5):1204-1213.
Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatrics 2006 Mar;117(3):e442-e451.
Comparison of treatment modalities in syndromic children with obstructive sleep apnea—a randomized cohort study. Int J Pediatr Otorhinolaryngol 2014 Sep;78(9):1526-1533.
Postoperative bilevel positive airway pressure ventilation after tonsillectomy and adenoidectomy in children—a preliminary report. Int J Pediatr Otorhinolaryngol 1999 Dec 15;51(3):177-180.
; Kadon, S.; Carter, B.; Mangeot, C.; Simakajornboon, N. Efficacy of auto-adjusting CPAP in pediatric patients with obstructive sleep apnea: preliminary results. A30. Pediatric sleep and sleep medicine. American Thoracic Society International Conference Abstracts, Vol. 189, 2014. p. A1269-A1269.
Critical role of myofascial reeducation in pediatric sleepdisordered breathing. Sleep Med 2013 Jun;14(6):518-525.
Algorithm for the diagnosis and treatment of pediatric OSA: a proposal of two pediatric sleep centers. Sleep Med 2012 Mar;13(3):217-227.
