AAP urges snoring screening for all children

By Andrew Czyzewski, medwireNews Reporter

All children and adolescents should be screened for snoring as part of routine health-maintenance visits and polysomnography considered for those with co-occurring symptoms such as daytime sleepiness, according to guidelines from the AAP.

The AAP (American Academy of Pediatrics) also recommends adenotonsillectomy as the first-line treatment of patients with adenotonsillar hypertrophy, with high-risk patients monitored postoperatively in hospital.

Report co-author Carole Marcus (Children's Hospital Philadelphia, Pennsylvania, USA) and colleagues sought to update the 2002 guidelines on the diagnosis and management of obstructive sleep apnea syndrome (OSAS) to include 350 evaluated studies conducted between 1999 and 2010.

Most articles were evidence level II through IV and the prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor.

The team recommends that 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.

This should include 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, or failing that alternative diagnostic tests such as nocturnal video recording or nocturnal oximetry.

In terms of treatment, adenotonsillectomy is recommended in the first instance if OSAS is found to be caused by adenotonsillar hypertrophy.

The team notes that although OSAS improved postoperatively, the proportion of patients who had residual OSAS ranged from 13% to 29% in low-risk populations to 73% when obese children were included.

Therefore, high-risk patients should be monitored as inpatients postoperatively about 6 to 8 weeks after the procedure, and clinicians should re-evaluate patients to determine whether further treatment is needed.

Continuous positive airway pressure is recommended as treatment if adenotonsillectomy is not performed or if OSAS persists postoperatively. Intranasal corticosteroids are an option for children with mild OSAS in whom adenotonsillectomy is contraindicated, or for those who have mild postoperative OSAS.

Discussing the findings, Marcus et al say that early identification can ultimately result in symptom relief, improved quality of life, and decreased healthcare utilization in the long run.

They comment in Pediatrics: "There is a great need for further research into the prevalence of OSAS, sequelae of OSAS, best treatment methods, and the role of obesity. In particular, well-controlled, blinded studies, including randomized controlled trials of treatment, are needed to determine the best care for children and adolescents with OSAS."

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