Kosin Med J.  2024 Jun;39(2):89-93. 10.7180/kmj.24.120.

Treatment of pediatric obstructive sleep apnea

• Koh TK
• Kim J

• KMID: 2556805
• DOI: http://doi.org/10.7180/kmj.24.120

Abstract

In the majority of cases, pediatric obstructive sleep apnea (OSA) is associated with adenotonsillar hypertrophy. Therefore, adenotonsillectomy is typically considered as the first line of treatment. However, the severity of pediatric OSA is not always directly correlated with the size of the adenoids and tonsils. Other factors, such as upper airway anatomy or obesity, may interact in a multifactorial manner to contribute to its occurrence. For these reasons, sleep apnea in obese children may resemble the condition in adults. Furthermore, in these cases, if adenotonsillar hypertrophy is present, adenotonsillectomy is likely to be prioritized. Reevaluation should be conducted 6 to 8 weeks post-surgery, and additional treatment for residual sleep apnea should be performed thereafter when necessary.

Keyword

Adenoids; Sleep apnea; Tonsils

Reference

References

1. Kaditis A, Kheirandish-Gozal L, Gozal D. Algorithm for the diagnosis and treatment of pediatric OSA: a proposal of two pediatric sleep centers. Sleep Med. 2012; 13:217–27.

2. Ehsan Z, Ishman SL. Pediatric obstructive sleep apnea. Otolaryngol Clin North Am. 2016; 49:1449–64.

3. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012; 130:576–84.

4. Maksimoski M, Li C. Surgical management of pediatric obstructive sleep apnea beyond tonsillectomy & adenoidectomy: tongue base and larynx. Otolaryngol Clin North Am. 2024; 57:431–45.

5. Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor HG, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med. 2013; 368:2366–76.

6. De Luca Canto G, Pacheco-Pereira C, Aydinoz S, Bhattacharjee R, Tan HL, Kheirandish-Gozal L, et al. Adenotonsillectomy complications: a meta-analysis. Pediatrics. 2015; 136:702–18.

7. Sathe N, Chinnadurai S, McPheeters M, Francis DO. Comparative effectiveness of partial versus total tonsillectomy in children. Otolaryngol Head Neck Surg. 2017; 156:456–63.

8. Parmar A, Baker A, Narang I. Positive airway pressure in pediatric obstructive sleep apnea. Paediatr Respir Rev. 2019; 31:43–51.

9. Weaver TE, Maislin G, Dinges DF, Bloxham T, George CF, Greenberg H, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep. 2007; 30:711–9.

10. O'Donnell AR, Bjornson CL, Bohn SG, Kirk VG. Compliance rates in children using noninvasive continuous positive airway pressure. Sleep. 2006; 29:651–8.

11. Michalsky M, Reichard K, Inge T, Pratt J, Lenders C; American Society for Metabolic and Bariatric Surgery. ASMBS pediatric committee best practice guidelines. Surg Obes Relat Dis. 2012; 8:1–7.

12. Verhulst SL, Franckx H, Van Gaal L, De Backer W, Desager K. The effect of weight loss on sleep-disordered breathing in obese teenagers. Obesity (Silver Spring). 2009; 17:1178–83.

13. Ashrafian H, Toma T, Rowland SP, Harling L, Tan A, Efthimiou E, et al. Bariatric surgery or non-surgical weight loss for obstructive sleep apnoea? A systematic review and comparison of meta-analyses. Obes Surg. 2015; 25:1239–50.

14. Pratt JSA, Browne A, Browne NT, Bruzoni M, Cohen M, Desai A, et al. ASMBS pediatric metabolic and bariatric surgery guidelines, 2018. Surg Obes Relat Dis. 2018; 14:882–901.

15. Kuhle S, Hoffmann DU, Mitra S, Urschitz MS. Anti-inflammatory medications for obstructive sleep apnoea in children. Cochrane Database Syst Rev. 2020; 1:CD007074.

16. Alexopoulos EI, Kaditis AG, Kalampouka E, Kostadima E, Angelopoulos NV, Mikraki V, et al. Nasal corticosteroids for children with snoring. Pediatr Pulmonol. 2004; 38:161–7.

17. Xu H, Yu Z, Mu X. The assessment of midface distraction osteogenesis in treatment of upper airway obstruction. J Craniofac Surg. 2009; 20 Suppl 2:1876–81.

18. Flores RL, Shetye PR, Zeitler D, Bernstein J, Wang E, Grayson BH, et al. Airway changes following Le Fort III distraction osteogenesis for syndromic craniosynostosis: a clinical and cephalometric study. Plast Reconstr Surg. 2009; 124:590–601.

19. Camacho M, Chang ET, Song SA, Abdullatif J, Zaghi S, Pirelli P, et al. Rapid maxillary expansion for pediatric obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope. 2017; 127:1712–9.

20. Bandyopadhyay A, Kaneshiro K, Camacho M. Effect of myofunctional therapy on children with obstructive sleep apnea: a meta-analysis. Sleep Med. 2020; 75:210–7.

21. Lin SY, Su YX, Wu YC, Chang JZ, Tu YK. Management of paediatric obstructive sleep apnoea: a systematic review and network meta-analysis. Int J Paediatr Dent. 2020; 30:156–70.

22. Huang YS, Hsu SC, Guilleminault C, Chuang LC. Myofunctional therapy: role in pediatric OSA. Sleep Med Clin. 2019; 14:135–42.

23. Ignatiuk D, Schaer B, McGinley B. High flow nasal cannula treatment for obstructive sleep apnea in infants and young children. Pediatr Pulmonol. 2020; 55:2791–8.

24. Yu JL, Afolabi-Brown O. Updates on management of pediatric obstructive sleep apnea. Pediatr Investig. 2019; 3:228–35.