Paediatrics: how to manage obstructive sleep apnoea syndrome

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Obstructive sleep apnoea syndrome (OSAS) is defined as the intermittent reduction or cessation of airflow due to partial or complete obstruction of the upper airway during sleep. Paediatric OSAS has specific contributing factors, presenting symptoms and management strategies in various age groups. Untreated OSAS can lead to detrimental effects on neurocognitive development and cardiovascular and metabolic functions of a growing child. In the past decade, practice guidelines have been developed to guide the evaluation and management of OSAS. This article provides a narrative review on the current diagnostic and treatment options for paediatric OSAS. Alternative diagnostic tools other than the standard polysomnography are discussed. Adenotonsillectomy is considered the first-line therapy yet it is not suitable for treatment of all OSAS cases. Nocturnal non-invasive positive airway pressure ventilation is effective and could be the priority treatment for patients with complex comorbidities, residual OSAS post-adenotonsillectomy or obesity. However, intolerance and non-adherence are major challenges of positive airway pressure therapy especially in young children. There is increasing evidence for watchful waiting and other gentler alternative treatment options in mild OSAS. The role of anti-inflammatory drugs as the primary or adjunctive treatment is discussed. Other treatment options, including weight reduction, orthodontic procedures and myofunctional therapy, are indicated for selected patients. Nevertheless, the successful management of paediatric OSAS often requires a multidisciplinary team approach.

Keywords: adenotonsillectomy, anti-inflammatory drugs, children, obstructive sleep apnoea, obstructive sleep-disordered breathing, polysomnography, positive airway pressure.

Citation: Leung TNH, Cheng JWCH, Chan AKC. Paediatrics: how to manage obstructive sleep apnoea syndrome. Drugs in Context 2021; 10: 2020-12-5. DOI: 10.7573/dic.2020-12-5

Contributions: The principal author Dr Theresa NH Leung and co-author Dr James WCH Cheng have both contributed to literature search, drafting and revising the manuscript. Co-author Professor Anthony KC Chan has contributed to the conception and critical review of the manuscript. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest relevant to this manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at:

Acknowledgements: None.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2021 Leung TNH, Cheng JWCH, Chan AKC. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2021 Leung TNH, Cheng JWCH, Chan AKC. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

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Correspondence: Theresa Ngan Ho Leung, Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong SAR, China. Email:

Provenance: Invited; externally peer reviewed.

Submitted: 14 December 2020; Accepted: 19 February 2021; Publication date: 26 March 2021.

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