- by Dr Gowher Yusuf
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- Aug 02 2017
New Guidelines for Childhood Sleep Apnea
(Source: Pediatrics. Published online August 27, 2012)
These are among the recommendations included in updated evidence-based guidelines for the diagnosis and management of childhood OSAS.
"Asking about snoring at each health maintenance visit [as well as at other appropriate times, such as when evaluating for tonsillitis] is a sensitive, albeit nonspecific, screening measure that is quick and easy to perform," the guideline authors, led by sleep expert Carole L. Marcus, MBBCh, professor of pediatrics at Children's Hospital of Philadelphia, Pennsylvania, conclude.
Another recommendation included in the new report is that if a pediatric patient snores on a regular basis, or shows symptoms or signs of OSAS, clinicians should obtain an overnight, in-laboratory polysomnogram — the gold standard test that measures a number of physiologic functions — or should refer the patient to a sleep specialist or an otolaryngologist for more extensive evaluation. "Polysomnography will demonstrate the presence or absence of OSAS," the authors write. "Polysomnography also demonstrates the severity of OSAS, which is helpful in planning treatment."
Given the shortage of sleep laboratories with pediatric expertise, polysomnography is not always readily available. If it is not available, clinicians may order alternative testing such as nocturnal video recording, nocturnal oximetry, daytime nap polysomnography, or ambulatory polysomnography, the authors note.
The new guidelines, developed by a subcommittee composed of pediatricians and other experts, focus on uncomplicated childhood OSAS that is associated with adenotonsillar hypertrophy and/or obesity in an otherwise healthy child. They exclude infants younger than 1 year of age, those with central apnea or hypoventilation syndromes, and those with OSAS associated with other medical conditions.
The guidelines committee recommends adenotonsillectomy (AT) as first-line treatment for patients with adenotonsillar hypertrophy. Committee members also suggest that clinicians should refer patients for continuous positive airway pressure (CPAP) management if symptoms or signs of OSAS persist after AT, or if AT is not performed.
Because adherence is an issue with CPAP, it is not recommended as first-line therapy when AT is an option. The guidelines recommend weight loss in addition to other therapy if a child or an adolescent with OSAS is overweight or obese.
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