Several weeks ago, the American Academy of Pediatrics published a new set of guidelines on the evaluation and management of obstructive sleep apnea (OSA) in children. I did a Q&A session on the Massachusetts General Hospital for Children website regarding the implications of the new guidelines. For your reading pleasure, here is the complete brief article:
Why has the American Academy of Pediatrics (AAP) revised its sleep apnea guidelines?
In the past 10 years, a significant amount of research has demonstrated the relationship between OSA and multiple childhood health problems. Children can have behavioral issues, school performance problems, daytime sleepiness and high blood pressure if OSA is left untreated. In the new policy statement, they have recommended clinical evaluation for persistent snoring or other signs of OSA. If the diagnosis is unclear, an overnight sleep test (or polysomnogram) is recommended. This is the only test which can rule out OSA.
When should I bring my child to the doctor for sleep apnea?
You should see a sleep specialist if your child has any of the following:
– If your child regularly snores (more than 3 nights per week)
– If your child has sleep disruption (is waking up in the middle of the night)
– If it’s difficult to wake an elementary school aged child in the morning
– If your child has difficulties at school because he is sleepy.
How common is sleep apnea in children?
Between 1 to 5 percent of kids have OSA, which doesn’t sound like a lot, but in reality that means 1 in 20 kids at a pediatrician’s office has OSA. Thirty-three percent of obese kids will have OSA, and the percentage is higher if they snore. Unfortunately, OSA is becoming more and more common in the context of the obesity epidemic.
What are the treatment options for sleep apnea?
The AAP recommends adenotonsillectomy as the first line treatment in any child with OSA and enlargement of the tonsils and adenoids. A lot of parents are worried about the surgery, but it is actually quite safe and the benefits are significant. In some kids, however, there is residual OSA after surgery. Thus, all children with OSA who have surgery need to be followed up to see if there symptoms resolve and to make sure that they do not return. If symptoms persist, a sleep study may be helpful. Alternative treatments are available if sleep apnea persists. Weight loss will help in obese kids, and allergy treatments, intranasal steroids, orthodontic work, and continuous positive airway pressure (CPAP) can benefit some kids.
I highlighted a few statements which I want to expand here.
First off, the only way to rule out OSA is to perform a sleep study. Not every child with snoring needs a sleep study. However, children with obesity, daytime sleepiness or hyperactivity, school difficulties, or certain medical conditions (Down syndrome, neuromuscular disease, craniofacial disorders, Prader-Willi syndrome) should definitely be referred for a sleep study.
The other point worth noting is that adenotonsillectomy does not cure OSA in a subset of children, especially if he or she are obese or have other medical issues. Children who have persistent symptoms or previously documented severe OSA should have a follow-up study to ensure that the disorder has resolved.