Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020)

Abstract

Childhood obstructive sleep apnea (OSA) is 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 in children.1 OSA is one of the most serious sleep-disordered breathing (SDB) diseases in children. Because of its high prevalence and serious long-term complications, increasing numbers of families are affected by OSA. In 2012, the American Academy of Pediatrics (AAP) clinical practice guidelines reported that the prevalence of pediatric OSA was 1.2%–5.7%2; in 2010, the prevalence of pediatric OSA in Hong Kong was 4.8%.3 In contrast to OSA in adults, the main cause of upper airway obstruction in children is adenoid and/or tonsil hypertrophy. Obesity, craniofacial malformation, neuromuscular diseases, and other factors may also contribute to the onset of pediatric OSA.4 Without timely diagnosis and effective intervention, pediatric OSA can lead to a series of serious complications, such as maxillofacial dysplasia, behavioral abnormalities, learning disabilities, growth restriction, neurocognitive impairment, endocrine metabolic disorders, hypertension, and pulmonary hypertension; it can also increase the risk of cardiovascular events in adulthood.5, 6, 7, 8 Therefore, early detection and early diagnosis of pediatric OSA, as well as early intervention to correct this problem, are important considerations for improving patient prognosis. There have been some controversies in the clinical diagnosis and treatment of pediatric OSA in China, which have restricted clinical diagnosis and treatment strategies, while hindering progress regarding diagnosis and treatment. The diagnosis and treatment of pediatric OSA is increasingly hampered by the absence of multi-disciplinary cooperation and guidelines. The numbers of pediatric OSA diagnosis and treatment guidelines and expert consensuses are very limited, both in China and worldwide.1,2,5,9, 10, 11, 12, 13 The draft guidelines for diagnosis and treatment of pediatric obstructive sleep apnea hypopnea syndrome issued in 2007 were mainly established on the basis of expert consensus.1 In the past 10 years, there has been a lack of multi-disciplinary evidence-based diagnosis and treatment guidelines for pediatric OSA in China. Thus, evidence-based clinical practice guidelines are urgently needed. The purpose of the present guidelines is to standardize the clinical diagnosis and treatment decision-making concerning pediatric OSA in China, provide scientific evidence for the diagnosis and treatment of pediatric OSA, promote multi-disciplinary integration, guide clinical practice for relevant medical staff, and ensure the use of a scientific approach for management of pediatric OSA. Table 1 is the list of abbreviations. Table 1 List of abbreviations.