JOURNAL ARTICLE
REVIEW

Diagnosis and management of childhood obstructive sleep apnea syndrome

Carole L Marcus, Lee Jay Brooks, Kari A Draper, David Gozal, Ann Carol Halbower, Jacqueline Jones, Michael S Schechter, Sally Davidson Ward, Stephen Howard Sheldon, Richard N Shiffman, Christopher Lehmann, Karen Spruyt
Pediatrics 2012, 130 (3): e714-55
22926176

OBJECTIVE: This technical report describes the procedures involved in developing recommendations on the management of childhood obstructive sleep apnea syndrome (OSAS).

METHODS: The literature from 1999 through 2011 was evaluated.

RESULTS AND CONCLUSIONS: A total of 3166 titles were reviewed, of which 350 provided relevant data. Most articles were level II through IV. The prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor. OSAS was associated with cardiovascular, growth, and neurobehavioral abnormalities and possibly inflammation. Most diagnostic screening tests had low sensitivity and specificity. Treatment of OSAS resulted in improvements in behavior and attention and likely improvement in cognitive abilities. Primary treatment is adenotonsillectomy (AT). Data were insufficient to recommend specific surgical techniques; however, children undergoing partial tonsillectomy should be monitored for possible recurrence of OSAS. Although OSAS improved postoperatively, the proportion of patients who had residual OSAS ranged from 13% to 29% in low-risk populations to 73% when obese children were included and stricter polysomnographic criteria were used. Nevertheless, OSAS may improve after AT even in obese children, thus supporting surgery as a reasonable initial treatment. A significant number of obese patients required intubation or continuous positive airway pressure (CPAP) postoperatively, which reinforces the need for inpatient observation. CPAP was effective in the treatment of OSAS, but adherence is a major barrier. For this reason, CPAP is not recommended as first-line therapy for OSAS when AT is an option. Intranasal steroids may ameliorate mild OSAS, but follow-up is needed. Data were insufficient to recommend rapid maxillary expansion.

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Olive Lee

for those with osa secondary to tonsillar hypertrophy and obesity, is early adenotonsillectomy essential?or should weight control be done prior to adenotonsillectomy?

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