Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

• It is very gratifying to see the AAP strongly endorse our practice's message! I am happy that my practice can make state of the art sleep assessment and treatment available to the children of Texas.  JR
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• From the American Academy of Pediatrics

Clinical Practice Guideline

Diagnosis and Management of   

Childhood Obstructive Sleep Apnea 

Syndrome

1. Carole L. Marcus, MBBCh, 
2. Lee Jay Brooks, MD, 
3. Kari A. Draper, MD,
4. David Gozal, MD, 
5. Ann Carol Halbower, MD, 
6. Jacqueline Jones, MD,
7. Michael S. Schechter, MD, MPH, 
8. Stephen Howard Sheldon, DO, 
9. Karen Spruyt, PhD, 
10. Sally Davidson Ward, MD, 
11. Christopher Lehmann, MD, and
12. Richard N. Shiffman, MD

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ABSTRACT

OBJECTIVES: This revised clinical practice guideline, intended for use by primary care clinicians, provides recommendations for the diagnosis and management of the obstructive sleep apnea syndrome (OSAS) in children and adolescents. This practice guideline focuses on uncomplicated childhood OSAS, that is, OSAS associated with adenotonsillar hypertrophy and/or obesity in an otherwise healthy child who is being treated in the primary care setting.

METHODS: Of 3166 articles from 1999–2010, 350 provided relevant data. Most articles were level II–IV. The resulting evidence report was used to formulate recommendations.

RESULTS AND CONCLUSIONS: The following recommendations are made. 

(1) All children/adolescents should be screened for snoring. 

(2) Polysomnography should be performed in children/adolescents with snoring and symptoms/signs of OSAS; if polysomnography is not available, then alternative diagnostic tests or referral to a specialist for more extensive evaluation may be considered. 

(3) Adenotonsillectomy is recommended as the first-line treatment of patients with adenotonsillar hypertrophy

(4) High-risk patients should be monitored as inpatients postoperatively. 

(5) Patients should be reevaluated postoperatively to determine whether further treatment is required. Objective testing should be performed in patients who are high risk or have persistent symptoms/signs of OSAS after therapy. 

(6) Continuous positive airway pressure is recommended as treatment if adenotonsillectomy is not performed or if OSAS persists postoperatively. 

(7) Weight loss is recommended in addition to other therapy in patients who are overweight or obese. 

(8) Intranasal corticosteroids are an option for children with mild OSAS in whom adenotonsillectomy is contraindicated or for mild postoperative OSAS.

This practice guideline focuses on uncomplicated childhood OSAS—that is, the OSAS associated with adenotonsillar hypertrophy and/or obesity in an otherwise healthy child who is being treated in the primary care setting. This guideline specifically excludes infants younger than 1 year of age, patients with central apnea or hypoventilation syndromes, and patients with OSAS associated with other medical disorders, including but not limited to Down syndrome, craniofacial anomalies, neuromuscular disease (including cerebral palsy), chronic lung disease, sickle cell disease, metabolic disease, or laryngomalacia. These important patient populations are too complex to discuss within the scope of this article and require consultation with a pediatric subspecialist.

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