title: Management of obstructive sleep apnea in children: A practical approach.
abstract: The management of sleep disordered breathing (SDB) in children differs between institutions, and there is a need for an updated review of current practice. Literature was reviewed using the PubMed database from 1995 to 2015 by four tertiary care providers experienced in the management of children with SDB. Articles were selected for clinical applicability, strength of evidence, and practicality for practicing clinicians. Fifty-five articles were identified by tertiary care providers in pediatric anesthesiology, pediatric pulmonology, sleep medicine, and pediatric otolaryngology. Each reviewed and analyzed literature independently based on their specialties, and a consensus document was created. The consensus was that the majority of children with SDB do not undergo polysomnography (PSG) before adenotonsillectomy (T&A). Indications for PSG are presented, with a practical approach recommended for the otolaryngologist. Clinical practice guidelines are available from leading national societies, but their recommendations differ. T&A is the first-line treatment and is highly effective in normal-weight but not in obese children. The perioperative management of children is challenging and needs to be individualized. Young children, those with severe obstructive sleep apnea, and those with significant comorbidities need to be observed overnight.
authors.affiliation: Corresponding author: Kevin D. Pereira, MD, Division of Pediatric Otolaryngology, Department of Otorhinolaryngology-Head and Neck Surgery, 16 S. Eutaw St., Suite 500, Baltimore, MD 21201. Email: Kpereira@smail.umaryland.edu From the Division of Pediatric Otolaryngology, Department of Otorhinolaryngology-Head and Neck Surgery, Baltimore (Dr. Pereira); the Division of Pulmonary Medicine, University of Texas Houston McGovern Medical School (Dr. Jon); the Division of Pediatric Anesthesiology (Dr. Szmuk) and the Department of Pediatric Otolaryngology (Dr. Mitchell), University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; and the Department of Pediatric Otolaryngology, Otolaryngology Consultants of Memphis (Tennessee) (Dr. Lazar).
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Pereira
authors.forename: Cindy K
authors.initials: CK
authors.lastname: Jon
authors.forename: Peter
authors.initials: P
authors.lastname: Szmuk
authors.forename: Rande H
authors.initials: RH
authors.lastname: Lazar
authors.forename: Ron B
authors.initials: RB
authors.lastname: Mitchell
mesh_terms: D000233:Adenoidectomy / Q000379:methods / Q000592:standards; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D006801:Humans; D010036:Otolaryngology / Q000592:standards; D017286:Polysomnography / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods / Q000592:standards