Systematic review of site of obstruction identification and non‐CPAP treatment options for children with persistent pediatric obstructive sleep apnea

Abstract

Drug-induced sleep endoscopy and cine MRI are the most commonly reported tools to identify sites of obstruction for children with persistent OSA; however, these techniques have not yet been clearly linked to outcomes. Evidence for treatment is extremely limited and focuses primarily on lingual tonsillectomy and supraglottoplasty. Also, reports regarding appropriate patient selection and outcomes in obese or otherwise healthy children are scant.

Treatment outcomes of supraglottoplasty for pediatric obstructive sleep apnea: A meta-analysis

“…Manickam et al reviewed 4 studies using supraglottoplasty as a salvage treatment for persistent OSA after adenotonsillectomy [36]. Camacho et al revealed that supraglottoplasty improved the AHI and MinSaO 2 in children with congenital and sleep-exclusive laryngomalacia.…”

“…Two previous reviews have offered valuable insights regarding supraglottoplasty in treating pediatric OSA [36,38]. Manickam et al reviewed 4 studies using supraglottoplasty as a salvage treatment for persistent OSA after adenotonsillectomy [36].…”

“…The pathophysiology of childhood OSA is mainly caused by enlarged adenotonsillar tissues [27,28]; therefore, adenotonsillectomy is the first-line therapy for pediatric OSA worldwide [29e34]. Increasingly, laryngomalacia is recognized as a risk factor for childhood OSA and a potential cause of residual disease after adenotonsillar surgery in children [21,35,36]. Therefore, children with both laryngomalacia and OSA may require supraglottoplasty.…”

Sleep in Down Syndrome

“…However, currently there is limited evidence to support the routine use of these procedures [47]. The benefit of these more aggressive surgical options for OSA specifically in the DS group is also unclear; Merrell and Shott [43] evaluated the use of lateral pharyngoplasty with adenotonsillectomy in the initial treatment of OSA in children with DS and found no additional benefit when compared to adenotonsillectomy alone.…”

“…However, these techniques have not yet been clearly linked to outcomes [47].Therefore, at present conservative treatment with continuous positive airway pressure (CPAP) or less commonly, bi-level (BPAP) therapy, is often preferred for management of residual OSA, preventing the need for further invasive surgical procedures including tracheostomy. Such therapy is however challenging in paediatrics and even more so in patients with DS, where behavioural and intellectual impairment may hinder the establishment and adherence to therapy.…”