Guideline for the Diagnosis and Management of Obstructive Sleep Apnea in Pediatrics

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David Saracino Freitag
Erika Valentina Prieto Arias
Henry Steban Cruz
Steve Amado Galeano
Shirley Andrea Ramírez Merlano

Abstract

Obstructive sleep apnea (OSA) in the pediatric population is a disorder characterized by episodes of total or partial obstruction of the upper airway, which are associated with alterations in blood gas levels and atypical sleep patterns. This condition can have significant repercussions, including behavioral problems, learning difficulties, growth delays, speech impairments, and cardiovascular complications. Unlike adults, children tend to snore less frequently, and any episode of obstructive sleep apnea (OSA) in this population is considered pathological. From a diagnostic perspective, an apnea-hypopnea index (AHI) greater than 1 event per hour is already classified as abnormal in pediatrics (1). Additionally, children with OSA have a higher risk of developing metabolic disorders such as insulin resistance and dyslipidemia, nocturnal enuresis, and excessive daytime sleepiness. These alterations increase the use of medical services and the associated healthcare costs. It is essential to identify and implement appropriate therapeutic interventions in this population to reduce comorbidities and the long-term consequences of this condition (2).

 

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How to Cite
1.
Saracino Freitag D, Prieto Arias EV, Cruz HS, Amado Galeano S, Ramírez Merlano SA. Guideline for the Diagnosis and Management of Obstructive Sleep Apnea in Pediatrics. Acta otorrinolaringol cir cabeza cuello [Internet]. 2025Feb.28 [cited 2025Mar.3];52(4). Available from: https://revista.acorl.org.co/index.php/acorl/article/view/816
Section
Guías de Manejo

References

Kheirandish-Gozal L, Gozal D. Pediatric OSA syndrome morbidity biomarkers. Chest. 2017;151(2):500-6. doi: 10.1016/j.chest.2016.09.026

Savini S, Ciorba A, Bianchini C, Stomeo F, Corazzi V, Vicini C, et al. Assessment of obstructive sleep apnoea (OSA) in children: An update. Acta Otorhinolaryngol Ital. 2019;39(5):289-97. doi: 10.14639/0392-100x-n0262

Leclere JC, Marianowski R, Monteyrol PJ, Akkari M, Chalumeau F, Fayoux P, et al. Guidelines of the French Society of Otorhinolaryngology. role of the ENT specialist in the diagnosis of childhood obstructive sleep apnea-hypopnea syndrome (OSAHS). part 1: Interview and physical examination. Eur Ann Otorhinolaryngol Head Neck Dis. 2019;136(4):301-5. doi: 10.1016/j.anorl.2019.05.017

Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, et al. Clinical practice guideline: Tonsillectomy in children (update)—executive summary. Otolaryngol Head Neck Surg. 2019;160(2):187-205. doi: 10.1177/0194599818807917

Leclere JC, Marianowski R, Monteyrol PJ, Akkari M, Chalumeau F, Fayoux P, et al. Guidelines of the French Society of Otorhinolaryngology. Role of the ENT specialist in the diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS) in children. Part 2: Diagnostic investigations apart from sleep studies. Eur Ann Otorhinolaryngol Head Neck Dis. 2019;136(4):295-99. doi: 10.1016/j.anorl.2019.05.016

Akkari M, Yildiz S, Marianowski R, Monteyrol PJ, Chalumeau F, Fayoux P, et al. Role of the ENT specialist in the diagnosis of pediatric obstructive sleep apnea-hypopnea syndrome (POSAHS). part 3: Sleep recordings. Eur Ann Otorhinolaryngol Head Neck Dis . 2020;137(5):405-10. doi: 10.1016/j. anorl.2020.02.001

Pateron B, Marianowski R, Monteyrol P-J, Couloigner V, Akkari M, Chalumeau F, et al. French Society of Ent (SFORL) guidelines (short version) on the roles of the various treatment options in childhood obstructive sleep apnea-hypopnea syndrome. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135(4):265-8. doi: 10.1016/j.anorl.2018.04.005

Akkari M, Marianowski R, Chalumeau F, Fayoux P, Leboulanger N, Monteyrol PJ, et al. French society of Otorhinolaryngology and head and Neck Surgery (SFORL) guidelines concerning the role of Otorhinolaryngologists in the management of paediatric obstructive sleep apnoea syndrome: Follow-up protocol for treated children. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135(6):427-31. doi: 10.1016/j.anorl.2018.09.006

Estrada E, Eneli I, Hampl S, Mietus-Snyder M, Mirza N, Rhodes E, et al. Children's Hospital Association consensus statements for comorbidities of childhood obesity. Child Obes. 2014;10(4):304-17. doi: 10.1089/chi.2013.0120. PMID: 25019404; PMCID: PMC4120655.

Raman VT, Jatana KR, Elmaraghy CA, Tobias JD. Guidelines to decrease unanticipated hospital admission following adenotonsillectomy in the pediatric population. Int J Pediatr Otorhinolaryngol. 2014;78(1):19-22. doi: 10.1016/j.ijporl.2013.10.010. PMID: 24239021

Kirk V, Baughn J, D'Andrea L, Friedman N, Galion A, Garetz S, Hassan F, et al. American Academy of Sleep Medicine Position Paper for the use of a home sleep apnea test for the diagnosis of OSA in children. J Clin Sleep Med. 2017;13(10):1199-1203. doi: 10.5664/jcsm.6772.

Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, et al. Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep. 2015;38(5):669-75. doi: 10.5665/sleep.4652. PMID: 25348130.

Rueda JR, Mugueta-Aguinaga I, Vilaró J, Rueda-Etxebarria M. Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Cochrane Database Syst Rev. 2020;11(11). doi: 10.1002/14651858.CD013449.pub2. PMID: 33141943.

Ai S, Li Z, Wang S, Chen S, Chan JW, Au CT, et al. Blood pressure and childhood obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med Rev. 2022;65:101663. doi: 10.1016/j.smrv.2022.101663. PMID: 36087456.

Camacho M, Chang ET, Song SA, Abdullatif J, Zaghi S, Pirelli P, et al. Rapid maxillary expansion for pediatric obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope. 2017;127(7):1712-9. doi: 10.1002/lary.26352. PMID: 27796040.

Hsu B, Emperumal CP, Grbach VX, Padilla M, Enciso R. Effects of respiratory muscle therapy on obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med. 2020;16(5):785-801. doi: 10.5664/jcsm.8318. PMID: 32026802.

Kuhle S, Hoffmann DU, Mitra S, Urschitz MS. Anti-inflammatory medications for obstructive sleep apnoea in children. Cochrane Database Syst Rev. 2020;1(1) doi: 10.1002/14651858.CD007074.pub3. PMID: 31978261.

Lee CF, Hsu WC, Lee CH, Lin MT, Kang KT. Treatment outcomes of supraglottoplasty for pediatric obstructive sleep apnea: a meta-analysis. Int J Pediatr Otorhinolaryngol. 2016;87:18-27. doi: 10.1016/j.ijporl.2016.05.015. PMID: 27368437.

Chinnadurai S, Jordan AK, Sathe NA, Fonnesbeck C, McPheeters ML, Francis DO. Tonsillectomy for obstructive sleep-disordered breathing: a meta-analysis. Pediatrics. 2017;139(2) doi: 10.1542/peds.2016-3491. PMID: 28096514.

Camacho M, Dunn B, Torre C, Sasaki J, Gonzales R, Liu SY, et al. Supraglottoplasty for laryngomalacia with obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope. 2016;126(5):1246-55. doi: 10.1002/lary.25827. PMID: 26691675.

Michelet D, Julien-Marsollier F, Vacher T, Bellon M, Skhiri A, Bruneau B, et al. Accuracy of the sleep-related breathing disorder scale to diagnose obstructive sleep apnea in children: a meta-analysis. Sleep Med. 2019;54:78-85. doi: 10.1016/j.sleep.2018.09.027. PMID: 30529781.

Ehsan Z, Ishman SL, Kimball TR, Zhang N, Zou Y, Amin RS. Longitudinal cardiovascular outcomes of sleep disordered breathing in children: a meta-analysis and systematic review. Sleep. 2017;40(3) doi: 10.1093/sleep/zsx015. PMID: 28329042.

Wang D, Zhou Y, Chen R, Zeng X, Zhang S, Su X, et al. The relationship between obstructive sleep apnea and asthma severity and vice versa: a systematic review and meta-analysis. Eur J Med Res. 2023;28(1):139. doi: 10.1186/s40001-023-01097-4. PMID: 36998095.