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Pediatric obstructive sleep apnea may persist after adenotonsillectomy and can be challenging to manage.
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Evaluation of persistent disease should focus on identifying the causes of upper airway obstruction––this is often accomplished with drug-induced sleep endoscopy and/or cine MRI.
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Surgical interventions targeted to the site of obstruction may improve polysomnographic parameters.
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Further research is needed to identify which management protocols lead to the best outcomes for children with
Managing the Child with Persistent Sleep Apnea
Section snippets
Key points
Assessment of persistent obstructive sleep apnea
According to the American Academy of Otolaryngology-Head and Neck Surgery Tonsillectomy in Children guidelines, caregivers of patients undergoing adenotonsillectomy should be counseled about the risk of persistent disease and instructed to present for evaluation if obstructive symptoms return following surgery.12 In patients returning for evaluation of persistent obstruction following adenotonsillectomy a detailed history and physical examination should be performed. The provider should inquire
Treatment of persistent obstructive sleep apnea
There are numerous treatment options for children with persistent OSA following adenotonsillectomy. Because data comparing different interventions for persistent disease in children are limited, it can be difficult for providers and caregivers to determine the best option for any given child. Because of this, shared decision-making tools may be useful when discussing management options, as it is essential to obtain input from caregivers (and patients when appropriate).24 Other factors to
Summary
Persistent OSA in children following adenotonsillectomy can be challenging for providers to manage. Evaluation of persistent disease should focus on identifying the causes of upper airway obstruction using physical examination, DISE, and/or cine MRI. Interventions should be tailored to address the patient’s symptoms, sites of obstruction, and preference for surgical versus medical management. Surgical interventions targeted to the site of obstruction may improve PSG and QOL outcomes. Further
References (66)
- et al.
Behavior, neurocognition and quality-of-life in children with sleep-disordered breathing
Int J Pediatr Otorhinolaryngol
(2006) - et al.
Interpretation of the polysomnogram in children
Otolaryngol Clin North Am
(2007) - et al.
Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome
Otolaryngol Head Neck Surg
(2009) - et al.
Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy
J Pediatr
(2006) - et al.
First place--resident clinical science award 1999. Quality of life for children with obstructive sleep apnea
Otolaryngol Head Neck Surg
(2000) - et al.
Validation of the epworth sleepiness scale for children and adolescents using rasch analysis
Sleep Med
(2017) - et al.
Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems
Sleep Med
(2000) - et al.
Beyond adenotonsillectomy: outcomes of sleep endoscopy-directed treatments in pediatric obstructive sleep apnea
Int J Pediatr Otorhinolaryngol
(2014) - et al.
Is tongue-lip adhesion or mandibular distraction more effective in relieving obstructive apnea in infants with robin sequence?
J Oral Maxillofac Surg
(2019) - et al.
Surgical correction of obstructive sleep apnea in the complicated pediatric patient documented by polysomnography
Int J Pediatr Otorhinolaryngol
(1997)
Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea
Otolaryngol Head Neck Surg
Nasal surgery for obstructive sleep apnea syndrome
Otolaryngol Clin North Am
Critical role of myofascial reeducation in pediatric sleep-disordered breathing
Sleep Med
Epidemiology of pediatric obstructive sleep apnea
Proc Am Thorac Soc
Ambulatory blood pressure in children with obstructive sleep apnoea: a community based study
Thorax
Pediatric obstructive sleep apnea: complications, management, and long-term outcomes
Proc Am Thorac Soc
Obstructive sleep apnea in children: a critical update
Nat Sci Sleep
Pediatric obstructive sleep apnea and quality of life: a meta-analysis
Otolaryngol Head Neck Surg
Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study
Am J Respir Crit Care Med
A randomized trial of adenotonsillectomy for childhood sleep apnea
N Engl J Med
Clinical practice guideline: tonsillectomy in children
Otolaryngol Head Neck Surg
Techniques for evaluation and management of tongue-base obstruction in pediatric obstructive sleep apnea
Curr Opin Otolaryngol Head Neck Surg
Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea
Clin Otolaryngol Allied Sci
Systematic review of site of obstruction identification and non-CPAP treatment options for children with persistent pediatric obstructive sleep apnea
Laryngoscope
Does drug-induced sleep endoscopy change the surgical decision in surgically naïve non-syndromic children with snoring/sleep disordered breathing from the standard adenotonsillectomy? A retrospective cohort study
J Otolaryngol Head Neck Surg
Drug-induced sleep endoscopy changes the treatment concept in patients with obstructive sleep apnoea
Biomed Res Int
Drug-induced sleep endoscopy: the VOTE classification
Eur Arch Otorhinolaryngol
Assessment of pediatric obstructive sleep apnea using a drug-induced sleep endoscopy rating scale
Laryngoscope
Cine magnetic resonance imaging: evaluation of persistent airway obstruction after tonsil and adenoidectomy in children with Down syndrome
Laryngoscope
Clinical outcomes after shared decision-making tools with families of children with obstructive sleep apnea without tonsillar hypertrophy
Laryngoscope
Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children
Pediatrics
The effect of montelukast on mild persistent OSA after adenotonsillectomy in children: a preliminary study
Otolaryngol Head Neck Surg
Adherence to nasal positive airway pressure therapy among school-aged children and adolescents with obstructive sleep apnea syndrome
Pediatrics
Cited by (18)
Epiglottopexy for refractory obstructive sleep apnea in children – A single-institution experience
2023, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryManagement of Pediatric Obstructive Sleep Apnea After Failed Tonsillectomy and Adenoidectomy
2022, Advances in PediatricsCitation Excerpt :Postoperative bleeding rates are slightly higher than with AT. If performed as part of a multi-level surgery, care should be taken to avoid connecting the incisions with the palate, as oropharyngeal stenosis can be a devastating complication [1,12,32]. Posterior midline glossectomy is used to treat glossoptosis and macroglossia.
Survey of parental awareness of obstructive sleep apnea among children in Guangdong province, South China
2021, Auris Nasus LarynxCitation Excerpt :Childhood obstructive sleep apnea (OSA) occurs in 6%–12% of children and may have significant physical, behavioral, and neurocognitive sequelae [1]. The most common treatment for pediatric OSA is adenotonsillectomy surgery [2]. Regardless of the high morbidity of OSA, it has been reported that up to 90% of these patients did not receive a prior diagnosis [3].
Swallowing Function After Epiglottopexy in Children
2024, Otolaryngology - Head and Neck Surgery (United States)Sleep Endoscopy and Cine Magnetic Resonance Imaging Evaluation of Children With Persistent Obstructive Sleep Apnea
2023, Otolaryngology - Head and Neck Surgery (United States)Severe Pediatric Sleep Apnea: Drug-Induced Sleep Endoscopy Based Surgery
2023, Indian Journal of Otolaryngology and Head and Neck Surgery
Disclosure Statement: The authors have no relevant disclosures.