Paediatrics: how to manage obstructive sleep apnoea syndrome

Abstract

Obstructive sleep apnoea syndrome (OSAS) is defined as the intermittent reduction or cessation of airflow due to partial or complete obstruction of the upper airway during sleep. Paediatric OSAS has specific contributing factors, presenting symptoms and management strategies in various age groups. Untreated OSAS can lead to detrimental effects on neurocognitive development and cardiovascular and metabolic functions of a growing child. In the past decade, practice guidelines have been developed to guide the evaluation and management of OSAS. This article provides a narrative review on the current diagnostic and treatment options for paediatric OSAS. Alternative diagnostic tools other than the standard polysomnography are discussed. Adenotonsillectomy is considered the first-line therapy yet it is not suitable for treatment of all OSAS cases. Nocturnal non-invasive positive airway pressure ventilation is effective and could be the priority treatment for patients with complex comorbidities, residual OSAS post-adenotonsillectomy or obesity. However, intolerance and non-adherence are major challenges of positive airway pressure therapy especially in young children. There is increasing evidence for watchful waiting and other gentler alternative treatment options in mild OSAS. The role of anti-inflammatory drugs as the primary or adjunctive treatment is discussed. Other treatment options, including weight reduction, orthodontic procedures and myofunctional therapy, are indicated for selected patients. Nevertheless, the successful management of paediatric OSAS often requires a multidisciplinary team approach.

Comparison of the Effectiveness of Orthodontic Treatment with Adenotonsillectomy Procedures in Children with Obstructive Sleep Apnea (OSA)

“…Adenotonsillectomy improves snoring, OSA, enuresis, behavior, and growth, according to numerous research. Surgery is the chosen course of treatment for moderate to severe juvenile adenoid and/or tonsil hypertrophy when the results of endoscopic examination or evaluation of the upper airway (including the nose, nasopharynx, oropharynx, laryngopharynx, and larynx) are consistent with the condition OSA (according to the 2012 American Academy of Pediatric guidelines) [25][26][27][28][29]. The evaluation of surgical indications should also take into account the child's symptoms and the expectations of the parents.…”

“…It is essential to fully explain to them the realistic expectations for surgical outcomes as a result. It's also crucial to be ready for any Anesthesia-related complications, postoperative respiratory failure, hemorrhage, velopharyngeal insufficiency, nasopharyngeal stenosis, pain, and dehydration are examples of perioperative problems [25,27].…”

“…For the past ten years, children with OSAS who have orofacial anomalies have had access to dental and orthodontic treatment alternatives. Dentists may be involved in the early diagnosis of OSAS in youngsters [27]. Orthodontic therapies, such equipment for mandibular advancement or rapid maxillary expansion (RME) (MADs), can successfully cure juvenile OSA in some children.…”

Childhood snoring has long‐term adverse effects on cardiovascular health

“…Currently, children with primary snoring are not routinely recommended for adenotonsillar surgery, the first‐line treatment for paediatric obstructive sleep apnoea, which has been shown to improve cardiovascular outcomes in children 7 . Other less invasive treatments such as nasal steroids have been shown to improve milder disease 8 and may provide cardiovascular benefits to snoring children. It is important that children are treated as early as possible as studies have shown that both the cardiovascular 9 and neurocognitive 10 sequelae are less severe in pre‐school compared to school‐aged children.…”

Evaluación del tratamiento de ortodoncia y de cirugía en el síndrome de apnea obstructiva del sueño infantil

“…Se utilizan también como tratamiento de la rinitis (126) . Por lo cual, los corticosteroides nasales tales como la budesónida, la fluticasona y la mometasona podrían utilizarse comúnmente en el tratamiento de los TRS pediátricos, pero existen pocos ensayos controlados de alta calidad disponibles (127) .…”