Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
Publication Date: August 31, 2012
Last Updated: March 14, 2022
KEY ACTION STATEMENTS
Screening for OSAS
As part of routine health maintenance visits, clinicians should inquire whether the child or adolescent snores. If the answer is affirmative or if a child or adolescent presents with signs or symptoms of OSAS, clinicians should perform a more focused evaluation. (B, Moderate)
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Polysomnography
If a child or adolescent snores on a regular basis and has any of the complaints or findings shown in Table 2, clinicians should either (1) obtain a polysomnogram OR (AModerate)
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refer the patient to a sleep specialist or otolaryngologist for a more extensive evaluation.
- for polysomnography
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- for specialist referral.
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If polysomnography is not available, then clinicians may order alternative diagnostic tests, such as nocturnal video recording, nocturnal oximetry, daytime nap polysomnography, or ambulatory polysomnography. (CWeak)
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Adenotonsillectomy
If a child is determined to have OSAS, has a clinical examination consistent with adenotonsillar hypertrophy, and does not have a contraindication to surgery, the clinician should recommend adenotonsillectomy as the first line of treatment. If the child has OSAS but does not have adenotonsillar hypertrophy, other treatment should be considered (see Key Action Statement 6). Clinical judgment is required to determine the benefits of adenotonsillectomy compared with other treatments in obese children with varying degrees of adenotonsillar hypertrophy. (B, Moderate)
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High-Risk Patients Undergoing Adenotonsillectomy
Clinicians should monitor high-risk patient undergoing adenotonsillectomy as inpatients postoperatively. (B, Moderate)
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Reevaluation
Clinicians should clinically reassess all patients with OSAS for persisting signs and symptoms after therapy to determine whether further treatment is required. (B, Moderate)
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Reevaluation of High-Risk Patients
Clinicians should reevaluate high-risk patients for persistent OSAS after adenotonsillectomy, including those who had a significantly abnormal baseline polysomnogram, have sequelae of OSAS, are obese, or remain symptomatic after treatment, with an objective test (see Key Action Statement 2) or refer such patients to a sleep specialist. (B, Moderate)
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CPAP
Clinicians should refer patients for CPAP management if symptoms/ signs or objective evidence of OSAS persists after adenotonsillectomy or if adenotonsillectomy is not performed. (B, Moderate)
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Weight Loss
Clinicians should recommend weight loss in addition to other therapy if a child/adolescent with OSAS is overweight or obese. (C, Moderate)
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Intranasal Corticosteroids
Clinicians may prescribe topical intranasal corticosteroids for children with mild OSAS in whom adenotonsillectomy is contraindicated or for children with mild postoperative OSAS. (B, Weak)
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Recommendation Grading
Overview
Title
Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
Authoring Organization
American Academy of Pediatrics
Publication Month/Year
August 31, 2012
Last Updated Month/Year
August 21, 2023
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Adolescent, Child, Infant
Health Care Settings
Ambulatory, Emergency care, Hospital, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Diagnosis, Management, Treatment
Keywords
sleep-disordered breathing, adenotonsillectomy, obstructive sleep apnea, continuous positive airway pressure (CPAP), sleep apnea, snoring
Source Citation
Carole L. Marcus, et al. Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome. Pediatrics. 2012; 130 (3): 576-584.