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Open AccessCommunication

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

1
Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA
2
Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(3), 888; https://doi.org/10.3390/jcm9030888
Received: 20 February 2020 / Revised: 6 March 2020 / Accepted: 18 March 2020 / Published: 24 March 2020
Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care. View Full-Text
Keywords: sleep disordered breathing; diagnosis; sleep studies; adenotonsillectomy; inflammation; CPAP; orthodontics; obesity sleep disordered breathing; diagnosis; sleep studies; adenotonsillectomy; inflammation; CPAP; orthodontics; obesity
MDPI and ACS Style

Gozal, D.; Tan, H.-L.; Kheirandish-Gozal, L. Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision. J. Clin. Med. 2020, 9, 888.

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