Childhood Obstructive Sleep Apnea Syndrome Clinical Practice
Guideline
Summarization of the Diagnosis & Management of Childhood Obstructive Sleep Apnea
Syndrome, 2012
Definition: Obstructive Sleep Apnea Syndrome is “disordered breathing during sleep
characterized by prolonged partial upper airway obstruction and/or intermittent
complete obstruction that disrupts normal ventilation during sleep and normal
sleep patterns.
Prevalence: 1.2-5.7%
Action Statements:
1. Screen for OSAS as part of routine health maintenance visits. If answer is
affirmative or child/adolescent present with signs or symptoms of OSAS,
clinicians should perform a more focused evaluation (Grade B,
RECOMMENDATION)
a. History: Frequent snoring (≥3 nights/week), labored breathing during
sleep, gasps/snorting noises or observed episodes of apnea, sleep
enuresis, sleeping in seated position, cyanosis, headaches upon
wakening, daytime sleepiness, ADD, ADHD, learning problems
b. Physical: Underweight or overweight, tonsillar hypertrophy,
adenoidal facies, micrognathia/retrognathia, high arched palate,
failure to thrive, hypertension
***Sensitivity & specificity of history & physical is poor ***
2. A: If a child or adolescent snores on a regular basis and has any of the
complaints or findings above, clinicians should either:
a. Obtain a polysomnogram (Grade A, RECOMMENDATION) OR
b. Refer the patient to a sleep specialist or otolaryngologist for an more
extensive evaluation (Grade D, OPTION)
B: If polysomnography is not available, then clinicians may order alternative
diagnostic tests, such as nocturnal oximetry, daytime nap polysomnography,
or ambulatory polysomnography (Grade C, OPTION)
3. If a child is determined to have OSAS, has a clinical examination consistent
with adenotonsillar hypertrophy, and does not have a contraindication to
surgery the clinician should recommend adenotonsillectomy as the first line
treatment (Grade B, RECOMMENDATION)
a. If child has OSAS, but does not have adenotonsillar hypertrophy, other
treatment should be considered
b. Clinical judgment is required to determine the benefits of
adenotonsillectomy compared with other treatments
4. Clinicians should monitor high-risk patients undergoing adenotonsillectomy
as inpatients postoperatively.
a. Risk factors: <3 years, severe OSAS on polysomnography, cardiac
complications of OSAS, failure to thrive, obesity, craniofacial
anomalies, neuromuscular disorders, current respiratory infection
5. A: Clinicians should clinically reassess all patients with OSAS for persisting
signs and symptoms are therapy to determine whether further treatment is
recommended (Grade B, RECOMMENDATION)
a. Evaluate 6-8 weeks after treatment
b. If pts are still symptomatic should undergo objective testing or be
referred to a specialist
B: Clinicians should reevaluate high risk patients for persistent OSAS after
adenotonsillectomy, including those who had significantly abnormal baseline
polysomnogram, have sequelae of OSAS, obese, remain symptomatic after
treatment, with an objective test or refer such patients to a sleep specialist
(Grade B, RECOMMENDATION)
6. Clinician should refer patients for CPAP management if symptoms/signs or
objective evidence of OSAS persists after adenotonsillectomy or if
adenotonsillarectomy is not performed (Grade B, RECOMMENDATION)
7. Clinicians should recommend weight loss in addition to other therapy if a
child/adolescent with OSAS is overweight or obese (Grade C,
RECOMMENDATION)
8. Clinicians may prescribe topical intranasal corticosteroids for children with
mild OSAS in whom adenotonsillectomy is contraindicated or for children
with mild post-operative OSAS (Grade B, RECOMMENDATION)