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Current Sleep Medicine Reports

, Volume 4, Issue 3, pp 243–253 | Cite as

Adenotonsillectomy in Pediatric OSA: Time to Look Elsewhere

  • Hui-Leng Tan
  • Leila Kheirandish-Gozal
  • David Gozal
Sleep Related Breathing Disorders (L Kheirandish-Gozal, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Sleep Related Breathing Disorders

Abstract

Purpose of Review

The treatment options for pediatric OSA have expanded significantly over the past decade. While adenotonsillectomy (T&A) remains the first line of treatment and the intervention of choice for many patients, this review aims to highlight the limitations of T&A and reposition its role in the therapeutic schema by examining the increasing range of alternative options that have become available.

Recent Findings

Among the alternative treatment options of pediatric OSA, we should include anti-inflammatory medical therapy (montelukast and nasal steroids), respiratory support such as continuous positive airway pressure (CPAP) therapy or high flow nasal cannula therapy, newer complementary therapies, such as myofunctional re-education, and anatomically site-specific therapy, such as orthodontic treatment and intra-oral appliances. In addition, beneficial lifestyle interventions, such as weight loss in obese children, also need to be addressed.

Summary

There is no doubt that the definitive nature of T&A surgery still makes it the intervention of choice for many children with OSA, but not all. In addition, T&A is fraught with a relatively high risk of residual OSA, such that a more nuanced approach, better tailored to individual needs, should be contemplated in the context of the emerging options. We propose an algorithm on when to consider the use of alternative therapies to T&A, and which therapies to trial and when.

Keywords

Pediatric obstructive sleep apnea Adenotonsillectomy Anti-inflammatory therapy Myofunctional therapy Intra-oral appliances CPAP High flow oxygen 

Notes

Compliance with Ethical Standards

Conflict of Interest

Hui-Leng Tan declares no conflicts of interest. Leila Kheirandish-Gozal is a section editor for Current Sleep Medicine Reports. David Gozal is a section editor for Current Sleep Medicine Reports.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Hui-Leng Tan
    • 1
  • Leila Kheirandish-Gozal
    • 2
  • David Gozal
    • 2
  1. 1.Department of Paediatric Respiratory MedicineRoyal Brompton HospitalLondonUK
  2. 2.Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences DivisionThe University of ChicagoChicagoUSA

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