Article

Treatment of obstructive sleep apnea in children: Do we really know how?

University of Louisville, Louisville, Kentucky, United States
Sleep Medicine Reviews (Impact Factor: 8.51). 03/2003; 7(1):61-80. DOI: 10.1053/smrv.2001.0256
Source: PubMed

ABSTRACT

Obstructive sleep apnea syndrome (OSAS) is a frequent, albeit underdiagnosed problem in children. If left untreated, OSAS may lead to substantial morbidities affecting multiple target organs and systems. The immediate consequences of OSAS in children include behavioral disturbance and learning deficits, pulmonary hypertension, as well as compromised somatic growth. However, if not treated promptly and early in the course of the disease, OSAS may also impose long-term adverse effects on neurocognitive and cardiovascular function, thereby providing a strong rationale for effective treatment of this condition. This review provides a detailed description of the current treatment modalities for pediatric OSAS, and uncovers the potential limitations of the available data on these issues. Furthermore, we postulate that OSAS will persist relatively often after tonsillectomy and adenoidectomy, and that critical studies need to be conducted to identify such patients and refine the clinical management algorithm for pediatric OSAS.

Download full-text

Full-text

Available from: David Gozal
    • "The immediate consequences of OSA in children include behavioral disturbance and learning deficits, pulmonary hypertension, as well as compromised somatic growth. However, if not treated promptly and early in the course of the disease, OSA may also impose long-term adverse effects on neurocognitive and cardiovascular function, thereby providing a strong rationale for effective treatment of this condition.[1] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Mandibular retrognathism due to temporomandibular joint (TMJ) ankylosis is one of the important contributing factors to the obstructive sleep apnea(OSA). Such patients suffer from number of apneic or hyponeic events during sleep, snoring, daytime sleepiness, fatigue, inability to concentrate, irritability. At the same time facial asymmetry due TMJ ankylosis lead to a progressive lack of confidence. Distraction osteogenesis is a less invasive surgical technique in the management of OSA, secondary to TMJ ankylosis. This modality not only treats the OSA but also corrects the facial asymmetry at the same time, and the results have been gratifying.
    No preview · Article · Apr 2013
    • "However, not all children who undergo T and A for OSA are cured.[31–33] In a meta-analysis of the published literature, the success rate for T and A in the context of OSA was observed to be approximately 85%.[34] This figure may actually be lower, particularly among obese children with OSA[35–39] or among children with severe OSA.[3538] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Sleep disordered breathing (SDB) in children is common. The impact of SDB on the growth and development of child may have detrimental effects on health, neuropsychological development, quality of life, and economic potential; therefore, SDB in children should be recognized as a public health problem as in the adult population. The coexistence of obesity and obstructive sleep apnea (OSA) not only appears to yield increased morbidity rates and poorer responses to therapy, but also is altogether associated with a distinct and recognizable clinical phenotype. Therapeutic options have somewhat expanded since the initial treatment approaches were conducted, to include not only surgical extraction of hypertrophic adenoids and tonsils, but also nonsurgical alternatives such as continuous positive air pressure, anti-inflammatory agents and oral appliances (OAs). Now, American academy of sleep medicine (AAOSM) has recommended OAs for OSA, hence the therapeutic interventions that are directed at the site of airway obstruction in the maxillofacial region are within the scope of dentistry. Among the physicians treating the children, dentists are more likely to identify adenotonsillar hypertrophy. Hence, the dentist can play an important role in identifying and treating those cases with OAs, who refuse the surgery, or those with structural abnormality in which myofunctional appliances are beneficial.
    No preview · Article · Mar 2010
  • Source
    • "The heterogeneity of the underlying conditions that may benefit from the various surgical approaches precludes any general recommendations, however, and must be individualized to optimize outcomes and avoid tracheotomy [44]. Of nonsurgical therapies, there are only case reports of pediatric experience with pharmacologic agents used in adults as palliative or second-line treatment of OSAS and insufficient evidence to support their use [32]. Systemic corticosteroids were ineffective in a single childhood OSAS study [45]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Obstructive sleep apnea syndrome (OSAS) is a common, under-recognized condition in childhood with significant morbidities if undiagnosed and untreated. The American Academy of Pediatrics recently issued a clinical practice guideline for the diagnosis and management of childhood OSAS. It was accompanied by a comprehensive evidence-based technical report that summarized the available literature supporting the guideline. The current review highlights areas of controversy and uncertainty that limit the development of more definitive standards of practice, updates the reader to several newer publications relevant to diagnosis and treatment of childhood OSAS, and identifies future directions for clinical research.
    Full-text · Article · Mar 2004 · Pediatric Clinics of North America
Show more