Pediatric Obstructive Sleep Apnea

As in adults, pediatric obstructive sleep apnea (OSA) is characterized by partial or complete obstruction of the upper airway during sleep. However, definitions, prevalence, pathophysiology, and diagnostic procedures differ substantially from adult standards. Pediatric OSA is associated with multiple adverse neurodevelopmental and cardiometabolic consequences. It is common in healthy children and occurs with a higher incidence among obese children, and among kids with syndromic, neurologic, or craniofacial diseases. Medical interventions include weight loss, nasal corticosteroids, and other allergic treatments. Oral devices and continuous positive airway pressure are also used to treat pediatric OSA. Standard surgical treatment is adenotonsillectomy (T&A). Most healthy children respond favorably to adenotonsillectomy as first-line treatment. Tonsillotomy seems to provide comparable results as tonsillectomy with decreased postoperative pain, readmissions to hospital, and complications. Persistent OSA after T&A has frequently been described in obese kids or children with underlying craniofacial deformities or syndromic or other severe comorbidities. In these children, other kinds of surgeries might be helpful.