Check Kids for Sleep Apnea

American Academy of Pediatrics recommends screening all children for snoring and polysomnography for those who regularly snore and have any associated symptoms such as snorting or gasping, daytime sleepiness, or labored breathing during sleep.

Children who frequently snore should be evaluated for obstructive sleep apnea syndrome (OSAS), according to a new guideline from the American Academy of Pediatrics.

Clinicians should evaluate kids who snore for co-occurring symptoms such as labored breathing during sleep or daytime sleepiness, and refer them for polysomnography, Carole Marcus, MBBCh, of Children’s Hospital Philadelphia, and colleagues reported in a new guideline published in Pediatrics.

The current OSAS diagnosis and management guideline is an update of a 2002 document; the researchers evaluated 350 studies conducted between 1999 and 2010 for the new version.

OSAS is a common condition in childhood and can result in severe complications if left untreated, the researchers said.

They recommend that all children and adolescents be screened for snoring as part of routine health maintenance visits, with clinicians asking parents about snoring. Early identification can result in symptom relief, improved quality of life, and decreased healthcare utilization in the long run, they wrote.

Since snoring is common, they noted, clinicians should determine whether follow-up testing is needed by asking about co-occurring symptoms such as labored breathing during sleep, gasps or snorting, or daytime sleepiness.

For patients with any of these additional symptoms, polysomnography is recommended, the researchers said. If polysomnography isn’t available, alternative diagnostic tests — such as nocturnal video recording or nocturnal oximetry — or referral to a specialist may be considered.

Adenotonsillectomy is recommended as first-line treatment if OSAS is found to be caused by adenotonsillar hypertrophy, the researchers said.

Following the procedure, children determined to be at high risk should be monitored as inpatients, they added.

About 6 to 8 weeks after the procedure, clinicians should reevaluate patients to determine whether further treatment is needed. Objective testing should be performed in patients who are at high risk of having persistent signs of OSAS after therapy, they added.

Continuous positive airway pressure is recommended as a treatment if adenotonsillectomy isn’t performed, or if OSAS persists postoperatively, the researchers wrote.

For children whose OSAS stems from being overweight or obese, weight loss is recommended, in addition to other therapy, they added.

Intranasal corticosteroids are an option for children with mild OSAS in whom adenotonsillectomy is contraindicated, or for those who have mild postoperative OSAS.

The researchers concluded that there’s a need for further research into the prevalence of OSAS, sequelae of OSAS, best treatment methods, and the role that obesity plays in the disease.

They called for well-controlled blinded studies, including randomized controlled trials, of treatments to determine the best care for children and adolescents.

The updated guideline excludes infants under 1 year, patients with central apnea or hypoventilation syndromes, and patients with OSAS associated with other medical disorders including Down syndrome, craniofacial anomalies, neuromuscular disease, chronic lung disease, sickle cell disease, metabolic disease, or laryngomalacia.

By Kristina Fiore