Obstructive sleep apnea in children peaks around age 4–6 years
Obstructive sleep apnea (OSA) is characterized by partial or complete airway obstruction during sleep. Prevalence is about 1.2%.1 Adenotonsillar hypertrophy and obesity are common risk factors in healthy children.2 The condition is also more common in specific at-risk populations, including children with trisomy 21, neuromuscular disorders, cerebral palsy and craniofacial anomalies.3
Untreated pediatric OSA have can have important short-and long-term consequences
Obstructive sleep apnea can lead to impaired cognition and poor school performance.3 Untreated OSA can also result in failure to thrive, hypertension, metabolic disorders, obesity, and neuropsychiatric and developmental problems.4
Children with OSA can present with symptoms that are different from those in adults
Children frequently present with loud snoring, mouth breathing, apneic episodes and nighttime awakenings.4 Children are more likely than adults to present with behavioural changes, hyperactivity, irritability or enuresis rather than sleepiness.
Polysomnography is the gold standard for diagnosing OSA; however, it is not always required for assessment or treatment initiation
Many children undergo treatment in the absence of polysomnography confirmation when clinical presentation strongly suggests the diagnosis.5 A polysomnogram helps with unclear diagnoses and assesses disease severity. Children with OSA symptoms, risk factors like craniofacial anomalies, or abnormal polysomnogram, if obtained, should be referred to a specialist for further evaluation.
In the presence of adenotonsillar hypertrophy, adenotonsillectomy is an effective treatment option
In milder OSA, intranasal steroids or leukotriene inhibitors may be sufficient treatment and can be considered while awaiting specialist consultation.1 Weight reduction may be beneficial in some children. Adenotonsillectomy is the first-line treatment for moderate to severe OSA in healthy children with adenotonsillar hypertrophy.5 Resolution and improvement in quality of life are likely. Risks include bleeding and pain. More extensive surgery or continuous positive airway pressure therapy may be required in children with underlying (e.g., neuromuscular) disorders or persistent symptoms.4
Footnotes
Competing interests: Elise Graham reports receiving a Western University Department of Otolaryngology Catalyst Grant and Academic Medical Organization of Southwestern Ontario Opportunities Fund Grant (outside the submitted work). Dr. Graham has also served as the chair of the Women in Otolaryngology Section for the Canadian Society of Otolaryngology. No other competing interests were declared.
This article has been peer reviewed.
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/
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- Obstructive sleep apnea in children peaks around age 4–6 years
- Untreated pediatric OSA have can have important short-and long-term consequences
- Children with OSA can present with symptoms that are different from those in adults
- Polysomnography is the gold standard for diagnosing OSA; however, it is not always required for assessment or treatment initiation
- In the presence of adenotonsillar hypertrophy, adenotonsillectomy is an effective treatment option
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