Management of obstructive sleep apnea in children

SUMMARY AND RECOMMENDATIONS

●Obstructive sleep apnea (OSA) is characterized by episodes of complete or partial upper airway obstruction during sleep, often resulting in gas exchange abnormalities and disrupted sleep.

●The decision about whether to initiate therapy is made on a case-by-case basis once the diagnosis of OSA is confirmed. 

●For most otherwise healthy children who have OSA and adenotonsillar hypertrophy, we suggest adenotonsillectomy (Grade 2C). Adenotonsillectomy is also an option for children with multifactorial OSA if appreciable adenotonsillar tissue is present. Despite adenotonsillectomy, children may have residual OSA or redevelop OSA in the future. Careful clinical follow-up for signs and symptoms of OSA is advisable.     ->   울아들이 지금 요상태이군영...  수술후에 residual OSA 가 남이 있는 상태...  

●

Several months of watchful waiting with supportive care may be considered in select cases of confirmed mild or moderate OSA, based on the acceptable outcomes for patients followed with watchful waiting in the Childhood Adenotonsillectomy Trial (CHAT). If this approach is chosen, the child should be reevaluated within six months for worsening of clinical symptoms, or reevaluated sooner if symptoms worsen. 

●For children in whom adenotonsillectomy is contraindicated, or those who have OSA with minimal adenotonsillar tissue, or those who have persistent OSA despite adenotonsillectomy, or those for whom there is a strong preference for a nonsurgical approach, we suggest positive airway pressure therapy (Grade 2C). Positive airway pressure can be delivered as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BPAP). 

●Tobacco smoke, other indoor pollutants, and indoor allergens should be avoided by all children with OSA.

●For obese children with OSA, we recommend weight loss as adjunctive therapy (Grade 1B). 

  ->  중요한 이야기인듯합니다.울아들... 비만까지는 아니지만. 키에 비해 몸무게가 많이나가긴 합니당..   또래 아이들보다는 통통한 편이지영.  ㅜㅜ

       

●Supplemental oxygen that is administered at night until definitive therapy can be provided may improve oxygenation in children who have severe OSA-related hypoxemia. When nocturnal supplemental oxygen therapy is necessary, we recommend that it be initiated under monitored conditions with frequent assessment of the arterial carbon dioxide tension (PaCO2) (Grade 1B). 

●Positional therapy using specially designed belts or pillows to avoid supine sleep, or elevation of the head of the bed, may be considered for patients in whom the severity of sleep disordered breathing varies substantially with the sleep position and other OSA treatments are not adequately effective. 

●For most children with OSA, we suggest that intranasal corticosteroids, systemic corticosteroids, or antibiotics NOT be administered as first-line therapy for OSA (Grade 2B). 

중요한 포인트에는 빨간 색으로 표시를 했습니다. 참고가 될듯합니다.     요건 써머리부분이고.. 전체 내용은  함번 더 읽어보고 올릴까합니다.

참고로 이자료는  유료사이트에서 제공하는 전문가를 위한 자료입니다. 인터넷에서 굴러다니는 그런 출처모를 내용은 아니랍니다. 참고하시길..