Management of Persistent, Post-adenotonsillectomy Obstructive Sleep Apnea in Children

Publication Date: January 31, 2024
Last Updated: February 2, 2024

Treatment

Recommendation 1

We suggest that children with persistent OSA who do not qualify for site specific upper airway treatment may be considered candidates for treatment with continuous positive airway pressure (CPAP). (Very low, Conditional Recommendation)
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Recommendation 2

We suggest that children with persistent OSA with specific craniofacial features may be considered candidates for orthodontic/dentofacial orthopedic treatment. (Very low, Conditional Recommendation)
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Recommendation 3

We suggest that obese/overweight children with persistent OSA undergo weight loss intervention. (Very low, Conditional Recommendation)
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Recommendation 4

We suggest that children with lingual tonsillar hypertrophy and persistent OSA may be considered candidates for lingual tonsillectomy. (Very low, Conditional Recommendation)
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Recommendation 5

We suggest that children with sleep-dependent laryngomalacia and persistent OSA may be considered candidates for supraglottoplasty. (Very low, Conditional Recommendation)
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Recommendation 6

We suggest that children on intranasal steroids with persistent OSA may be treated with montelukast. (Very low, Conditional Recommendation)
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Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Management of Persistent, Post-adenotonsillectomy Obstructive Sleep Apnea in Children

Authoring Organization

American Thoracic Society

Publication Month/Year

January 31, 2024

Last Updated Month/Year

October 4, 2024

Document Type

Guideline

Country of Publication

US

Document Objectives

Provide an evidence-based clinical practice guideline on the management of children with persistent OSA.

Target Patient Population

Children with obstructive sleep apnea post adenotonsillectomy

Target Provider Population

Clinicians, including physicians, dentists, and allied health professionals, caring for children with OSA.

PICO Questions

  1. Should children with persistent OSA be treated with CPAP?

  2. Should children with persistent OSA undergo orthodontic/dentofacial orthopedic treatment?

  3. Should children with obesity and persistent OSA undergo weight loss intervention?

  4. Should children with lingual tonsillar hypertrophy and persistent OSA undergo lingual tonsillectomy?

  5. Should children with obstruction at the supraglottis and persistent OSA undergo supraglottoplasty?

  6. Should children on intranasal steroids with persistent OSA after AT be treated with montelukast?

Inclusion Criteria

Male, Female, Adolescent, Child

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Treatment

Diseases/Conditions (MeSH)

D014068 - Tonsillectomy, D020181 - Sleep Apnea, Obstructive, D012891 - Sleep Apnea Syndromes, D000233 - Adenoidectomy

Keywords

adenotonsillectomy, obstructive sleep apnea, sleep apnea, pediatric sleep apnea

Source Citation

Ehsan Z, Ishman SL, Soghier I, et al. Management of Persistent, Post-adenotonsillectomy Obstructive Sleep Apnea in Children: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2024;209(3):248-261. doi:10.1164/rccm.202310-1857ST

Supplemental Methodology Resources

Data Supplement