SLEEP-DISORDERED BREATHING DIAGNOSIS AND TREATMENTkapak

TREATMENT OF PEDIATRIC OBSTRUCTIVE SLEEP APNEA

Mehmet Fatih Karakuş

Ordu University, Faculty of Medicine, Department of Otorhinolaryngology, Ordu, Türkiye

Karakuş MF. Treatment of Pediatric Obstructive Sleep Apnea. In: Özcan KM, editor. Sleep-Disordered Breathing: Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.205-211.

ABSTRACT

During routine medical consultations for children who appear healthy, clinicians should inquire about sleep duration and quality, snoring, frequent nighttime awakenings, unusual sleep positions, and disturbances in bed linen, as these elements are essential in identifying pediatric obstructive sleep apnea syndrome. Intrinsic and extrinsic anatomical, genetic, or neuromuscular abnormalities that impair the expansion-collapse dynamics of the upper airway each contribute to the development of obstructive sleep apnea syndrome. Although history and physical examination are key components, overnight polysomnography remains the gold standard for diagnosis in pediatric population. An apnea-hypopnea index of 1-5 is classified as mild, 5-10 as moderate, and greater than 10 as severe obstructive sleep apnea syndrome in children. Undiagnosed and untreated pediatric obstructive sleep apnea syndrome may lead to significant long-term complications. In pediatric obstructive sleep apnea patients, both the severity of the disease and the patient’s age must be taken into account when determining the optimal treatment modality -either surgical or non-surgicaland the treatment plan should be tailored according to a thorough, case-bycase analysis. Treatment option should be selected collaboratively with the family, guided by a multidisciplinary team comprising a pediatrician, otorhinolaryngologist, pulmonologist, child psychiatrist, orthodontist, cardiologist, maxillofacial surgeon, and anesthesiologist. Surgical management frequently include adenotonsillectomy in cases of adenotonsillar hypertrophy. Corrective procedures for craniofacial anomalies may be performed in children under two years of age. Non-surgical management options, generally suitable for mild to moderate obstructive sleep apnea, focus on treating controllable factors like obesity, and include pharmacological agents such as leukotriene receptor antagonists and corticosteroids may be used. Continuous positive airway pressure (CPAP) therapy is indicated when surgery is not feasible or if moderate to severe obstructive sleep apnea persists postoperatively. Additionally, intraoral appliances and myofunctional therapy may be useful in a selected group of well-defined cases. In conclusion, it should be emphasized that each undiagnosed and untreated case of pediatric obstructive sleep apnea carries significant health risks at both the patient and society. It must be remembered that the foundation of a healthy society lies in the physical and mental well-being of its individuals themselves.

Keywords: Sleep apnea, obstructive; Child; Tonsillectomy; Mouth; Myofunctional therapy

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