Treatment in children with OSA depends on it’s cause. Ryan, an 11 year old is accompanied by his mother at a pediatric sleep specialists office for an evaluation of sleep apnea. He has symptoms of snoring at night and exhibits some daytime symptoms of disrupted sleep including restlessness and poor concentration in school. Ryan is overweight and found to have enlarged tonsils. He undergoes a sleep study and is found to have severe apnea. What treatment should Ryan receive?
Obstructive sleep apnea (OSA) is found in about 1% to 6% of children. Nighttime symptoms of snoring and sleep disturbance often result in daytime psychological changes such as irritability, difficulty with concentration and hyperactivity. While sleepiness is a frequent symptom in adults it is less common in children. Obesity, increased airway resistance, enlarged tonsils and adenoids, genetic structure of the skull and face, and weakness of muscles of breathing may play a role in causing pediatric apnea.
Adenotonsillectomy, or having the tonsils and adenoids removed, is usually the first line approach for treating children with apnea who have evidence of enlarged tonsils. It is generally relatively successful and has low complication rates compared to adults who have the procedure done. Shaving the tonsils rather that removing them is associated with even lower levels of complications. However, it should be noted that many of the studies exploring the benefits versus risks of surgery were done on patients with moderate to severe apnea levels. Success was often determined when the results achieved apneas frequencies of less than 5 per hour. Therefore, the evidence for benefit is lacking, if not less, for more mild cases of apnea (>1/hour is considered positive in children). Sleep studies should be done to diagnose and quantify the severity of apnea before treatment. To ensure surgical success, a sleep study should also be performed once the throat has had a chance to heal.
In children who don’t have enlarged tonsils, treatments like positive airway pressure (CPAP) or oral appliances should be tried before resorting to surgical treatments. In all children that are overweight, weight loss may help to complement other treatments.
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