title: Diagnosis and management of childhood obstructive sleep apnea syndrome.
abstract: OBJECTIVE
  This revised clinical practice guideline, intended for use by primary care clinicians, provides recommendations for the diagnosis and management of the obstructive sleep apnea syndrome (OSAS) in children and adolescents. This practice guideline focuses on uncomplicated childhood OSAS, that is, OSAS associated with adenotonsillar hypertrophy and/or obesity in an otherwise healthy child who is being treated in the primary care setting.
  
  
  METHODS
  Of 3166 articles from 1999-2010, 350 provided relevant data. Most articles were level II-IV. The resulting evidence report was used to formulate recommendations.
  
  
  CONCLUSIONS
  The following recommendations are made. (1) All children/adolescents should be screened for snoring. (2) Polysomnography should be performed in children/adolescents with snoring and symptoms/signs of OSAS; if polysomnography is not available, then alternative diagnostic tests or referral to a specialist for more extensive evaluation may be considered. (3) Adenotonsillectomy is recommended as the first-line treatment of patients with adenotonsillar hypertrophy. (4) High-risk patients should be monitored as inpatients postoperatively. (5) Patients should be reevaluated postoperatively to determine whether further treatment is required. Objective testing should be performed in patients who are high risk or have persistent symptoms/signs of OSAS after therapy. (6) Continuous positive airway pressure is recommended as treatment if adenotonsillectomy is not performed or if OSAS persists postoperatively. (7) Weight loss is recommended in addition to other therapy in patients who are overweight or obese. (8) Intranasal corticosteroids are an option for children with mild OSAS in whom adenotonsillectomy is contraindicated or for mild postoperative OSAS.
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: Stephen Howard
authors.initials: SH
authors.lastname: Sheldon
authors.forename: Karen
authors.initials: K
authors.lastname: Spruyt
authors.forename: Sally Davidson
authors.initials: SD
authors.lastname: Ward
authors.forename: Christopher
authors.initials: C
authors.lastname: Lehmann
authors.forename: Richard N
authors.initials: RN
authors.lastname: Shiffman
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D002648:Child; D045422:Continuous Positive Airway Pressure; D006801:Humans; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000628:therapy*; D014068:Tonsillectomy; D015431:Weight Loss