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New guidelines issued by the American Academy of Pediatrics (AAP) call for, among other things, screening all children for obstructive sleep apnea. What prompted these guidelines, and will you add this screening to your exams?
A new clinical practice guideline issued by the American Academy of Pediatrics (AAP) regarding obstructive sleep apnea syndrome (OSAS) in children and adolescents calls for a number of changes in diagnosis and management.
The guideline recommends screening all children for OSAS; performing (or referring for) polysomnography in all children who snore and have signs or symptoms of OSAS; and performing adenotonsillectomy as first-line treatment in children with adenotonsillar hypertrophy.
In addition, AAP recommends postoperative monitoring of high-risk patients as inpatients, reevaluating these children to determine whether further treatment is necessary, and using continuous positive airway pressure if surgery is not performed or if OSAS persists postoperatively. The AAP also advises physicians to recommend weight loss if appropriate and prescribe intranasal corticosteroids to children with mild OSAS in whom surgery is contraindicated or for mild postoperative OSAS.
AAP hopes the new guideline will increase recognition of this widespread problem and minimize treatment delay in order to reduce serious sequelae, including neurocognitive impairment, behavioral problems, failure to thrive, hypertension, cardiac dysfunction, and systemic inflammation.
The AAP report defines OSAS as “a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns” and focuses only on uncomplicated OSAS associated with adenotonsillar hypertrophy and obesity in otherwise healthy children. It excludes children aged younger than 1 year, those with central apnea or hyperventilation syndromes, and those with other medical disorders.
Signs and symptoms of OSAS include snoring 3 or more nights weekly, labored breathing during sleep, gasps and snorting noises during episodes of apnea, sleep enuresis, sleeping seated or with the neck hyperextended, cyanosis, headaches on awakening, daytime sleepiness, attention-deficit/hyperactivity disorder, and learning problems.
Physical examination may reveal a child who is underweight or overweight or who has tonsillar hypertrophy, adenoidal facies, micrognathia or retrognathia, a high-arched palate, failure to thrive, or hypertension.
In compiling the new guideline, AAP reviewed all related material published between 1999 and 2010 and relied primarily on 350 relevant studies. A technical report that describes the procedures involved in developing the recommendations accompanies the guideline.
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