From the Guidelines
Treatment for pediatric snoring, or Sleep-Disordered Breathing (SDB), typically begins with adenotonsillectomy, as it is the most effective treatment for many children with obstructive sleep apnea (OSA) 1. The most recent and highest quality study, published in 2019, recommends tonsillectomy for children with OSA documented by overnight polysomnography (PSG) 1. This study highlights the potential long-lasting health consequences of untreated SDB, including growth failure, neurocognitive functioning impairment, and behavioral issues.
Key Considerations
- Adenotonsillectomy is the first-line treatment for pediatric OSA, especially in cases with adenotonsillar hypertrophy 1.
- PSG is essential for diagnosing OSA and determining the severity of SDB 1.
- Weight management and nasal steroid sprays may be beneficial for some children, but adenotonsillectomy remains the primary treatment for OSA 1.
- Continuous positive airway pressure (CPAP) therapy may be necessary for children with persistent OSA despite adenotonsillectomy or for those who are not surgical candidates 1.
Important Factors
- The clinical benefits of treating SDB in children are well established, and timely intervention is crucial to reduce morbidity and improve quality of life 1.
- Caregivers should be informed about the potential benefits and risks of tonsillectomy, and PSG results should be used to guide treatment decisions 1.
- Children with untreated OSA are at risk for future morbidity or impaired health status, emphasizing the importance of prompt and effective treatment 1.
From the Research
Treatment Options for Pediatric Snoring
The treatment options for pediatric snoring, also known as Sleep-Disordered Breathing, include:
- Adenotonsillectomy, which is the first-line management for OSA with adenotonsillar hypertrophy 2, 3
- Continuous positive airway pressure (CPAP) therapy for severe sleep apnoea cases 3, 4
- Anti-inflammatory medications for mild cases 3, 4
- Maxillofacial and orthodontic treatments for some cases 3, 4
- Surgery, which may not always cure the snoring, thus postoperative follow-up is important 5
Diagnostic Approach
The diagnostic approach for pediatric snoring involves:
- Identification of true cases of habitual snoring 4
- Identification of high-risk patients who should undergo polysomnography in a sleep laboratory 4
- Performance of polysomnography to rule out obstructive sleep apnoea 2, 4
- Reconsideration of surgery in cases with moderate to severe obstructive sleep apnoea 4
Management
The management of pediatric snoring may involve a combination of medical and surgical interventions 6, and a multidisciplinary approach in some cases 3. Primary care providers play an important role in identifying children at risk and referring them to specialists for further evaluation and treatment 2, 4.