Abstract
This review will focus on non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP) therapy in children with obstructive sleep apnea (OSA) due to obesity and underlying syndromes. These children have a high prevalence of OSA and residual OSA after adenotonsillectomy. Therefore, a high proportion of these children are treated with CPAP or NIV. This review will focus on treatment selection tools and will subsequently cover specific issues on CPAP treatment in obese and syndromic children with a major focus on Down syndrome.
Highlights
Obstructive sleep apnea syndrome (OSAS) is a manifestation of sleep-disordered breathing (SDB) in children
OSAS is characterized by prolonged episodes of increased upper airway (UA) resistance and respiratory effort with partial or complete UA obstruction during sleep
The complexity of the pathogenesis of OSAS in these children is illustrated by a high incidence of residual OSAS after adenotonsillectomy (AT) and by a frequent need for additional treatment
Summary
Obstructive sleep apnea syndrome (OSAS) is a manifestation of sleep-disordered breathing (SDB) in children. CPAP or NIV is not a first line treatment in these children It is reserved for children with residual OSA after adenotonsillectomy or other upper airway surgery or in those children who are not surgical candidates. Upper airway evaluation by means of DISE and cine MRI may identify lingual tonsillar hypertrophy and laryngomalacia as the most common anatomical correlates for residual disease. These methods may guide the clinicians to specific surgical interventions or non-surgical treatment modalities such as weight loss, orthodontic treatment, medical treatment and myofunctional therapy and toward CPAP or NIV treatment.
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