Sleep Apnea: New Guidelines from the American Academy of Pediatrics

 
Link to full article: http://pediatrics.aappublications.org/content/130/3/576.full

Article Review:
In August 2012, the AAP published an online report titled Diagnosis and Management of Childhood Obstructive Sleep Apnea. This report, written for the primary care pediatrician, provides guidelines for the diagnosis and management of uncomplicated children with signs and symptoms of obstructive sleep apnea syndrome (OSAS). It is an evidence-based review derived from 350 published reports over the past eleven years on OSAS.

 These new guidelines involve "key action statements" and include the following:

1. During all well child visits, the pediatrician should ask if the child snores. If the child does snore, then further history should include:
   
    

• Frequency of snoring (nights per week)
• Labored breathing while sleeping
• Choking on breath or brief cessation of breathing that interrupts the normal respiratory rhythm
• Daytime symptoms such as fatigue or headache
• Learning or behavior problems

 

2.  A child who snores and has signs of sleep apnea should be referred for a sleep study or to an Otolaryngologist for further evaluation.

3.  A child with documented OSAS and adenotonsillar hypertrophy on exam should be referred for an adenotonsillectomy.

4.  Patients whose symptoms do not improve after surgery, or who have contraindications for surgery, should be referred for CPAP management.

5.  Obese children with symptoms of OSAS should also be followed closely and counseled on dietary and lifestyle changes.

6.  A trial of intranasal corticosteroids (Fluticasone) may be indicated for children who have contraindications for surgery, or who have persistent symptoms after an adenotonsillectomy is performed.