title: Non-surgical management of obstructive sleep apnoea: a review.
abstract: BACKGROUND
  Obstructive sleep apnoea is common in children and, if untreated, can lead to multiple medical sequelae. The Childhood Adenotonsillectomy Trial demonstrated benefit from early surgical intervention, but rapid access to such treatment is not always available.
  
  
  OBJECTIVE
  To examine the recent literature on non-surgical aspects of the management of paediatric obstructive sleep apnoea (OSA).
  
  
  METHODS
  The English language literature was searched for articles on the conservative management of OSA.
  
  
  RESULTS
  In mild cases of OSA, intra-nasal steroids and other anti-inflammatory medications may give relief in mild cases of OSA, but the long-term safety of these treatments has not been established. Weight loss in obese children has been shown to be effective in selected patients but is limited in practice. Non-invasive ventilation may be effective but compliance can be a major obstacle. Oral appliances are effective by stenting the pharyngeal airway, but research in this area is limited.
  
  
  CONCLUSIONS
  There are number of potential, if not proven, alternative management strategies for children with OSA, which could be considered in the absence of early surgical intervention.
authors.affiliation: a Department of Paediatrics , University Hospital Waterford , Waterford , Ireland.
authors.forename: Laura
authors.initials: L
authors.lastname: Whitla
authors.affiliation: b Otolaryngology, Head and Neck Surgery , University Hospital Waterford , Ireland.
authors.forename: Paul
authors.initials: P
authors.lastname: Lennon
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D004864:Equipment and Supplies; D006801:Humans; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D013256:Steroids / Q000008:administration & dosage; D015431:Weight Loss
chemical_list: D000893:Anti-Inflammatory Agents; D013256:Steroids
keywords: American Academy of Pediatrics, AAP; Childhood Adenotonsillectomy Trial, CHAT; Intranasal steroid; Non-invasive ventilation; Non-surgical management; Obstructive sleep apnoea; Obstructive sleep apnoea, OSA; Oral appliances; Review; apnoea-hypoxia index, AHI; bi-level positive airway pressure, BPAP; continuous positive airway pressure, CPAP; high-flow nasal cannulae, HFNC; non-invasive ventilation, NIV; rapid maxillary expansion, RME; sleep-disordered breathing, SDB