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Treatment of Childhood Obstructive Sleep Apnea

  • Sleep Disorders
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

An array of surgical, medical and orthodontic treatments is available for treating childhood obstructive sleep apnea. Adenotonsillectomy remains the first choice in treatment, with a need for subsequent clinical and polysomnographic reassessment in selected cases to determine residual sleep-disordered breathing. Residual obstructive sleep apnea is more likely in patients with craniofacial abnormalities or obesity. It may require the use of a positive airway pressure breathing device. Topical corticosteroids, leukotriene antagonists, weight reduction, and positional therapy also play a role in ameliorating childhood obstructive sleep apnea. The published evidence for the efficacy of various treatment modalities consists largely of case-controlled studies and case reports.

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References and Recommended Reading

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

  1. Gastaut H, Tassinari C, Duron B: Etude polygraphique des manifestations episodiques (hypniques et respiratoires) du syndrome de Pickwick [in French]. Rev Neurol (Paris) 1965, 112:568–579.

    CAS  Google Scholar 

  2. Jung R, Kuhlo W: Neurophysiological studies of abnormal night sleep and the Pickwickian syndrome. Prog Brain Res 1965, 18:140–159.

    Article  CAS  PubMed  Google Scholar 

  3. Guilleminault C, Eldridge F, Simmons F, et al.: Sleep apnea in eight children. Pediatrics 1976, 58:23–30.

    CAS  PubMed  Google Scholar 

  4. Brunetti L, Rana S, Lospalluti ML, et al.: Prevalence of obstructive sleep apnea syndrome in a cohort of 1207 children of Southern Italy. Chest 2001, 120:1930–1935.

    Article  CAS  PubMed  Google Scholar 

  5. Rosen CL, Larkin EK, Kirchner LH, et al.: Prevalence and risk factors for sleep-disordered breathing in 8 to 11 year old children: association with race and prematurity. J Pediatr 2003, 142:383–389.

    Article  PubMed  Google Scholar 

  6. Reuveni H, Simon T, Tal A, et al.: Health care service utilization in children with obstructive sleep apnea syndrome. Pediatrics 2002, 110:68–72.

    Article  PubMed  Google Scholar 

  7. American Academy of Sleep Medicine: International Classification of Sleep Disorders: Diagnostic and Coding Manual, edn 2. Westchester, IL: American Academy of Sleep Medicine; 2005.

    Google Scholar 

  8. Section on Pediatric Pulmonology: Subcommittee on Obstructive Sleep Apnea Syndrome, American Academy of Pediatrics: Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002, 109:704–712.

    Article  Google Scholar 

  9. Brietzke SE, Gallagher D: The effectiveness of tonsillectomy and adenoidectomy in treatment of pediatric obstructive sleep apnea/hypopnea syndrome: a meta-analysis. Otolaryngol Head Neck Surg 2006, 134:979–984.

    Article  PubMed  Google Scholar 

  10. Donnelly LF: Obstructive sleep apnea in pediatric patients: evaluation with cine MR sleep studies. Radiology 2005, 236(3):768–778.

    Article  PubMed  Google Scholar 

  11. Guilleminault C, Li KK: Maxillomandibular expansion for the treatment of sleep disordered breathing: preliminary result. Laryngoscope 2004, 114:893–896.

    Article  PubMed  Google Scholar 

  12. Nixon GM, Brouillette RT: Obstructive sleep apnea in children: Do intranasal corticosteroids help? Am J Respir Med 2002, 1(3):159–166.

    PubMed  Google Scholar 

  13. Goldbart AD, Goldman JL, Veling MC, et al.: Leukotriene modifier therapy for mild sleep-disordered breathing in children. Am J Respir Crit Care Med 2005, 172:364–370.

    Article  PubMed  Google Scholar 

  14. Kheirandish L, Goldbart AD, Gozal D: Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after adenotonsillectomy and adenoidectomy in children. Pediatrics 2006, 117:e61–e66.

    Article  PubMed  Google Scholar 

  15. Waters KA, Everett FM, Bruderer JW, et al.: Obstructive sleep apnea: the use of nasal CPAP in 80 children. Am J Respir Crit Care Med 1995, 152:780–785.

    CAS  PubMed  Google Scholar 

  16. Marcus CL, Rosen G, Davidson Ward SL, et al.: Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatrics 2006, 117:e442–e451.

    Article  PubMed  Google Scholar 

  17. McGinley B, Halbower A, Schwartz AR, et al.: Effect of a high-flow open nasal cannula system on obstructive sleep apnea in children. Pediatrics 2009, 124:179–188.

    Article  PubMed  Google Scholar 

  18. Villa MP, Bernkopf E, Pagani J, et al.: Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion. Am J Respir Crit Care Med 2002, 165(1):123–127.

    PubMed  Google Scholar 

  19. Davis CL, Tkacz J, Gregoski M, et al.: Aerobic exercise and snoring in overweight children: a randomized controlled trial. Obesity 2006, 14(11):1985–1991.

    Article  PubMed  Google Scholar 

  20. Capdevila OS, Kheirandish-Gozal L, Dayyat E, et al.: Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc 2008, 5:274–282.

    Article  PubMed  Google Scholar 

  21. Halbower AC, Ishman SL, McGinley BM: Childhood sleep-disordered breathing: a clinical update and discussion of technological innovations and challenges. Chest 2007, 32:2030–2041. This article defines childhood OSA and what parameters are considered normal from the sleep and breathing standpoint, summarizes technical requirements of pediatric polysomnography, and critically reviews medical and surgical treatment measures.

    Article  Google Scholar 

  22. Verhulst SL, Van Gaal L, De Backer W, Desager K: The prevalence, anatomical correlates and treatment of sleep-disordered breathing in obese children and adolescents. Sleep Med Rev 2008, 12(5):339–346. This paper reviews the prevalence of polysomnographically determined OSA, anatomic correlates, and medical and surgical treatment measures in obese adolescents.

    Article  PubMed  Google Scholar 

  23. Beebe DW, Lewin D, Zeller M, et al.: Sleep in overweight adolescents: shorter sleep, poorer sleep quality, sleepiness and sleep-disordered breathing. J Pediatr Psychol 2006, 32(1):69–79.

    Article  PubMed  Google Scholar 

  24. Amin R, Anthony L, Somers V, et al.: Growth velocity predicts recurrence of sleep-disordered breathing 1 year after adenotonsillectomy. Am J Respir Crit Care Med 2008, 177(6):654–659. This prospective study examines factors that can predict the recurrence of childhood OSA on long-term follow-up after adenotonsillectomy: gain velocity in body mass index, obesity, and being African American.

    Article  PubMed  Google Scholar 

  25. Kohler MJ, van den Heuvel CJ: Is there a clear link between overweight/obesity and sleep disordered breathing in children? Sleep Med Rev 2008, 12(5):347–361.

    Article  PubMed  Google Scholar 

  26. Tumilehto HP, Seppa JM, Partinen MM, et al.: Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med 2009, 179:320–327.

    Article  Google Scholar 

  27. Foster GD, Borradaile KE, Sanders MH, et al.: A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med 2009, 169:1619–1626.

    Article  PubMed  Google Scholar 

  28. Guiaraes KC, Drager LF, Genta PR, et al.: Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2009, 179:962–966.

    Article  Google Scholar 

  29. Zhang XW, Li Y, Zhou F, et al.: Association of body position with sleep architecture and respiratory disturbances in children with obstructive sleep apnea. Acta Otolaryngol 2007, 127(12):1321–1326.

    Article  PubMed  Google Scholar 

  30. Goldbart AD, Veling MC, Goldman JL, et al.: Glucocorticoid receptor subunit expression in adenotonsillar tissue of children with obstructive sleep apnea. Pediatr Res 2005, 57:232–236.

    Article  CAS  PubMed  Google Scholar 

  31. Goldbart AD, Goldman JL, Li RC, et al.: Differential expression of cysteinyl leukotriene receptors 1 and 2 in tonsils of children with obstructive sleep apnea syndrome or recurrent infection. Chest 2004, 126:13–18.

    Article  CAS  PubMed  Google Scholar 

  32. Kheirandish-Gozal L, Gozal D: Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics 2008, 122:e149–e155.

    Article  PubMed  Google Scholar 

  33. Al-Mazrou KA, Al-Qahtani A, Al-Fayez AI: Effectiveness of transnasal endoscopic powered adenoidectomy in patients with choanal adenoids. Int J Pediatr Otorhinolaryngol 2009, 73(12):1650–1652.

    Article  PubMed  Google Scholar 

  34. Guilleminault C, Li KK, Khramtsov A, et al.: Sleep disordered breathing: surgical outcome in prepubertal children. Laryngoscope 2004, 114:132–137.

    Article  PubMed  Google Scholar 

  35. Carvalho FR, Lentini-Oliveira D, Machado MA, et al.: Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children. Cochrane Database Syst Rev 2007, 18(2):CD005520.

    Google Scholar 

  36. Cozza P, Polimeni A, Ballanti F: A modified monobloc for the treatment of obstructive sleep apnoea in paediatric patients. Eur J Orthod 2004, 26(5):523–530.

    Article  PubMed  Google Scholar 

  37. Ow AT, Cheung LK: Meta-analysis of mandibular distraction osteogenesis: clinical applications and functional outcomes. Plast Reconstr Surg 2008, 121(3):54e–69e.

    Article  PubMed  Google Scholar 

  38. Molina F: Mandibular distraction osteogenesis: a clinical experience of the last 17 years. J Craniofac Surg 2009, 20(suppl 2):1794–1800.

    Article  PubMed  Google Scholar 

  39. Shen W, Jie C, Chen J, et al.: Mandibular distraction osteogenesis to relieve Pierre Robin severe airway obstruction in neonates: indication and operation. J Craniofac Surg 2009, 20(2):1812–1816.

    Article  PubMed  Google Scholar 

  40. McNamara F, Sullivan CE: Obstructive sleep apnea in infants and its management with nasal continuous airway pressure. Chest 1999, 116:10–16.

    Article  CAS  PubMed  Google Scholar 

  41. Guilleminault C, Pelayo R, Clerk A, et al.: Home nasal continuous positive airway pressure in infants with sleep disordered breathing. J Pediatr 1995, 127:905–912.

    Article  CAS  PubMed  Google Scholar 

  42. Aljadeff G, Gozal D, Bailey-Wahl SL, et al.: Effects of overnight supplemental oxygen in obstructive sleep apnea in children. Am J Respir Crit Care Med 1996, 153(1):51–55.

    CAS  PubMed  Google Scholar 

  43. Simakajornboon N, Beckerman RC, Mack C, et al.: Effect of supplemental oxygen on sleep architecture and cardiorespiratory events in preterm infants. Pediatrics 2002, 110(5):884–888.

    Article  PubMed  Google Scholar 

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No potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Departments of Neurology, Pediatrics and the Center for Sleep Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Suresh Kotagal MD

  2. Departments of Neurology, Pediatrics and the Center for Sleep Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Ameet S. Daftary MBBS

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  1. Ameet S. Daftary MBBS
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  2. Suresh Kotagal MD
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Correspondence to Suresh Kotagal MD.

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Daftary, A.S., Kotagal, S. Treatment of Childhood Obstructive Sleep Apnea. Curr Treat Options Neurol 12, 369–378 (2010). https://doi.org/10.1007/s11940-010-0084-7

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  • DOI: https://doi.org/10.1007/s11940-010-0084-7

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