French Society of ENT (SFORL) guidelines (short version) on the roles of the various treatment options in childhood obstructive sleep apnea-hypopnea syndrome

Abstract

Adenotonsillectomy is the reference treatment for childhood OSAHS with adenotonsillar hypertrophy. Respiratory assistance is recommended in children with severe OSAHS without nasal and/or oropharyngeal obstacle, after surgery in case of persistent OSAHS, in case of contraindications to surgery, in complex obstruction related to pharyngolaryngeal or laryngeal pathology or comorbidity, or as an alternative to tracheotomy. Nasal route corticosteroids may be used in childhood OSAHS in with associated nasal obstruction.

Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020)

“…The use of NPPV should be combined with individual conditions and clinical requirements, and there is no restriction or recommendation regarding the age of application. CPAP is considered an effective alternative treatment for children with OSA 23 ; thus, it is used as an important supplementary treatment for children with severe OSA during the perioperative period, 52 as well as a temporary intervention for special children with OSA who are waiting for craniofacial surgery. 21 Children with OSA who are using CPAP or other noninvasive ventilation treatments must complete pressure titration during sleep monitoring; the parameters should be re-evaluated regularly.…”

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

“…There is now little doubt that hypertrophy of upper airway lymphadenoid tissues constitutes the most common factor underlying the presence of obstructive sleep apnea (OSA) in children, a condition that was formally identified as a singular disease only in 1976 by Guilleminault and colleagues [1]. As corollary of such repeatedly confirmed fact, adenotonsillectomy (T&A) has become the initial treatment recommended by the American Academy of Pediatrics (AAP) consensus guidelines for pediatric OSA in 2002 and subsequently in 2012 [2,3], and other guidelines around the world echo such recommendations [4][5][6][7][8][9][10]. In more recent years, and particularly since 2006 when we initially described the relatively high prevalence of residual OSA after T&A [11,12], confirmation and realization that, although the severity of OSA will routinely improve after surgery, it can persist in a significant proportion of patients has definitely settled in [13][14][15][16].…”

Debates in pediatric obstructive sleep apnea treatment

“…Montelukast (possibly in combination with a nasal corticosteroid) can be used in asthmatic children with mild to moderate OSA for three months before reassessment of symptoms. 17 …”

“…Montelukast (possibly in combination with a nasal corticosteroid) can be used in asthmatic children with mild to moderate OSA for three months before reassessment of symptoms. 17 Despite the large body of evidence on the effectiveness of drug therapy, many questions remain unanswered. For example, reportedly, the size of the adenoids of a child can be reduced by the use of intranasal corticosteroids or leukotriene receptor antagonists.…”