Last updated March 14, 2022

Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

KEY ACTION STATEMENTS

Screening for OSAS

As part of routine health maintenance visits, clinicians should inquire whether the child or adolescent snores. If the answer is affirmative or if a child or adolescent presents with signs or symptoms of OSAS, clinicians should perform a more focused evaluation. (B, Moderate)
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Polysomnography

If a child or adolescent snores on a regular basis and has any of the complaints or findings shown in Table 2, clinicians should either (1) obtain a polysomnogram OR (AModerate)
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refer the patient to a sleep specialist or otolaryngologist for a more extensive evaluation.
  • for polysomnography
(AModerate)
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  • for specialist referral.
(DModerate)
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If polysomnography is not available, then clinicians may order alternative diagnostic tests, such as nocturnal video recording, nocturnal oximetry, daytime nap polysomnography, or ambulatory polysomnography. (CWeak)
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Adenotonsillectomy

If a child is determined to have OSAS, has a clinical examination consistent with adenotonsillar hypertrophy, and does not have a contraindication to surgery, the clinician should recommend adenotonsillectomy as the first line of treatment. If the child has OSAS but does not have adenotonsillar hypertrophy, other treatment should be considered (see Key Action Statement 6). Clinical judgment is required to determine the benefits of adenotonsillectomy compared with other treatments in obese children with varying degrees of adenotonsillar hypertrophy. (B, Moderate)
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High-Risk Patients Undergoing Adenotonsillectomy

Clinicians should monitor high-risk patient undergoing adenotonsillectomy as inpatients postoperatively. (B, Moderate)
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Reevaluation

Clinicians should clinically reassess all patients with OSAS for persisting signs and symptoms after therapy to determine whether further treatment is required. (B, Moderate)
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Reevaluation of High-Risk Patients

Clinicians should reevaluate high-risk patients for persistent OSAS after adenotonsillectomy, including those who had a significantly abnormal baseline polysomnogram, have sequelae of OSAS, are obese, or remain symptomatic after treatment, with an objective test (see Key Action Statement 2) or refer such patients to a sleep specialist. (B, Moderate)
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CPAP

Clinicians should refer patients for CPAP management if symptoms/ signs or objective evidence of OSAS persists after adenotonsillectomy or if adenotonsillectomy is not performed. (B, Moderate)
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Weight Loss

Clinicians should recommend weight loss in addition to other therapy if a child/adolescent with OSAS is overweight or obese. (C, Moderate)
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Intranasal Corticosteroids

Clinicians may prescribe topical intranasal corticosteroids for children with mild OSAS in whom adenotonsillectomy is contraindicated or for children with mild postoperative OSAS. (B, Weak)
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Recommendation Grading

Overview

Title

Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

Authoring Organization

Publication Month/Year

August 31, 2012

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Adolescent, Child, Infant

Health Care Settings

Ambulatory, Emergency care, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Management, Treatment

Keywords

sleep-disordered breathing, adenotonsillectomy, obstructive sleep apnea, continuous positive airway pressure (CPAP), sleep apnea, snoring

Source Citation

Carole L. Marcus, et al. Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome. Pediatrics. 2012; 130 (3): 576-584.