Pediatric Obstructive Sleep Apnea Diagnosis and Treatment: What You Need to Know

Pediatric obstructive sleep apnea, a common condition in children, is definitively diagnosed with sleep studies and can be treated through various modalities, depending on disease severity.

Diagnosis

Pediatric OSA affects male and female young children relatively equally but is more prevalent in African American children. Risk factors for the condition include adenotonsillar hypertrophy, obesity, Down syndrome, neuromuscular disorders and positive family history.

Children with OSA can experience many health consequences, such as insulin resistance, blood pressure dysregulation, cognitive impairment and attention disorders.

A pediatric sleep study, or pediatric polysomnography, is critical to definitively diagnosing OSA and evaluating treatment success, Dr. Kalra explains. Sleep study findings and a child’s symptoms are evaluated together to confirm OSA, according to diagnostic criteria established by the American Academy of Sleep Medicine.

The Apnea-Hypopnea Index classifies sleep apnea severity, Dr. Kalra says. It is calculated by dividing the number of times per hour of sleep with complete or partial obstruction by the number of sleep hours.

• < 1: Normal
• 1 to ≤ 5: Mild
• 5 to <10: Moderate
• ≥ 10: Severe

Unfortunately, “We are not looking for sleep disorders as much as we should, leading to underdiagnosis,” Dr. Kalra says.

For example, providers may attribute a child’s symptoms to attention or mood disorders without suspecting a potential sleep problem. Also, there is limited availability of objective sleep studies.

“Children with classic symptoms, risk factors or daytime problems that can be attributed to OSA should be referred to a specialist,” Dr. Kalra advised.

Treatment Options

Medical, dental and surgical approaches are available to treat OSA, but each case requires a personalized approach.

“Pediatric sleep-disordered breathing has a complex pathophysiology, with some factors contributing more heavily than others. This highlights the need for personalized medicine to treat conditions like OSA,” Dr. Kalra notes.

Medical treatments include weight loss, anti-inflammatory medications and continuous positive airway pressure (CPAP).

“Approximately 60% of children with OSA prescribed a CPAP machine, use it regularly,” Dr. Kalra explains, with children aged 6 to 12 having the highest adherence. Several factors that increase the likelihood of adherence include patient education by a trained professional, a right-fitting mask and correct pressure settings.

Dental treatment options include rapid palatal expansion but are approved for use only in children aged 7 to 13.

Adenotonsillectomy is the first-line surgical treatment option for pediatric OSA, but other surgical approaches, such as lingual tonsillectomy, may be used. Preoperative studies, such as DISE and MRI, can help determine the most appropriate surgical approach.

Although adenotonsillectomy is highly effective in an otherwise normal child, its success rate is lower for children with obesity or severe OSA. In these cases, “I advise preparing the patient and their family for the possibility of residual sleep apnea and additional treatment with surgery or a CPAP machine,” Dr. Kalra says.

Overall, tailoring the treatment to the individual characteristics of the patient through shared decision-making with families can help achieve the best treatment outcomes, he concluded.

Reference:

Maninder Kalra. “Personalized management of sleep disordered breathing in children.” Pediatric Grand Rounds Presentation. Nationwide Children’s Hospital. August 29, 2024.

Image credit: Adobe Stock (header); Nationwide Children’s (Dr. Kalra)