title: Diagnosis and management of childhood obstructive sleep apnea syndrome.
abstract: OBJECTIVE
  This technical report describes the procedures involved in developing recommendations on the management of childhood obstructive sleep apnea syndrome (OSAS).
  
  
  METHODS
  The literature from 1999 through 2011 was evaluated.
  
  
  CONCLUSIONS
  A total of 3166 titles were reviewed, of which 350 provided relevant data. Most articles were level II through IV. The prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor. OSAS was associated with cardiovascular, growth, and neurobehavioral abnormalities and possibly inflammation. Most diagnostic screening tests had low sensitivity and specificity. Treatment of OSAS resulted in improvements in behavior and attention and likely improvement in cognitive abilities. Primary treatment is adenotonsillectomy (AT). Data were insufficient to recommend specific surgical techniques; however, children undergoing partial tonsillectomy should be monitored for possible recurrence of OSAS. Although OSAS improved postoperatively, the proportion of patients who had residual OSAS ranged from 13% to 29% in low-risk populations to 73% when obese children were included and stricter polysomnographic criteria were used. Nevertheless, OSAS may improve after AT even in obese children, thus supporting surgery as a reasonable initial treatment. A significant number of obese patients required intubation or continuous positive airway pressure (CPAP) postoperatively, which reinforces the need for inpatient observation. CPAP was effective in the treatment of OSAS, but adherence is a major barrier. For this reason, CPAP is not recommended as first-line therapy for OSAS when AT is an option. Intranasal steroids may ameliorate mild OSAS, but follow-up is needed. Data were insufficient to recommend rapid maxillary expansion.
authors.forename: Carole L
authors.initials: CL
authors.lastname: Marcus
authors.forename: Lee Jay
authors.initials: LJ
authors.lastname: Brooks
authors.forename: Kari A
authors.initials: KA
authors.lastname: Draper
authors.forename: David
authors.initials: D
authors.lastname: Gozal
authors.forename: Ann Carol
authors.initials: AC
authors.lastname: Halbower
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Jones
authors.forename: Michael S
authors.initials: MS
authors.lastname: Schechter
authors.forename: Sally Davidson
authors.initials: SD
authors.lastname: Ward
authors.forename: Stephen Howard
authors.initials: SH
authors.lastname: Sheldon
authors.forename: Richard N
authors.initials: RN
authors.lastname: Shiffman
authors.forename: Christopher
authors.initials: C
authors.lastname: Lehmann
authors.forename: Karen
authors.initials: K
authors.lastname: Spruyt
mesh_terms: D002648:Child; D002653:Child Behavior Disorders / Q000209:etiology; D003072:Cognition Disorders / Q000209:etiology; D045422:Continuous Positive Airway Pressure; D006801:Humans; D009765:Obesity / Q000150:complications; D017286:Polysomnography; D015995:Prevalence; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*