Airway Obstruction In Children Research Articles

Advanced Diagnostic Techniques in Obstructive Sleep Apnea

Optimal surgical and medical management of obstructive sleep apnea (OSA) requires clinically reliable identification of patterns and sites of upper airway obstruction. A wide variety of modalities has been used to evaluate upper airway obstruction. Drug-induced sleep endoscopy (DISE) and cine MRI are increasingly used to identify upper airway obstruction sites, to characterize airway obstruction patterns, to determine optimum medical and surgical treatment, and to plan individualized surgical management. Here, the authors provide an overview of the applications of DISE and cine MRI in assessing upper airway obstruction in children and adults with OSA.

El pediatra de Atención Primaria y la laringitis aguda

Acute laryngitis/croup is a common disease of viral origin, which is the most frequent cause of upper airway obstruction in childhood. It is characterized by the presence of a variable degree of dog or metal cough, aphonia, stridor and respiratory distress. The estimated incidence is 3-6% of children between 3-6 months and 6 years, with a peak in the second year of life and during the autumn and winter. The main cause is the parainfluenza virus type 1. The diagnosis is made based on the symptoms, barking cough, hoarseness and inspiratory stridor. No other examinations are necessary. Depending on the severity, which will be objectively established with a clinical score, will the treatment be prescribed. Oral corticosteroids are the treatment of choice in all diagnosed children. Pharmacological treatment is corticosteroids and adrenaline in moderate and severe laryngitis. Oral dexamethasone is the corticosteroid of choice in all cases.

Measurement of Upper Airway Volume in Children with Craniofacial Abnormalities.

Previous literature has established a high prevalence of upper airway obstruction in children with craniofacial abnormalities. This study aims to perform quantitative airway volume measurements in patients with craniofacial abnormalities and compare them to age and sex-matched controls. We performed a retrospective review of the records of all children with craniofacial abnormalities who underwent head-and-neck computed tomography (CT) imaging at a single tertiary-care center between 1/1/13 and 12/31/20 using the ICD-10 codes Q75.1, Q75.4, and Q87.0. These patients were then matched by age and sex to patients with isolated craniosynostosis (Q75.0). CT scans were imported into Dolphin Imaging software, and airway volumes were measured for the nasal cavity, nasopharynx, oropharynx, and hypopharynx. The primary outcome was the total airway volume, defined as the sum of these measurements. Thirty subjects with craniofacial syndromes were matched to 30 patients with isolated craniosynostosis (controls). In both groups, 18 subjects (60%) were male (p = 0.99). The average ages for syndromic patients and controls were 12.1 and 12.9 months, respectively (p = 0.84). On average, the total airway volumes of syndromic patients were 25% lower than those of controls (p = 0.02). Syndromic patients had 39% smaller nasal cavity volumes (p < 0.001) and 32% smaller nasopharyngeal volumes (p < 0.01). Significant volume differences were not observed for the oropharynx or hypopharynx. We present a unique technique to measure airway volumes in patients with craniofacial abnormalities. These findings will help practitioners to further understand the anatomy and pathophysiology of disturbed breathing in children with craniofacial syndromes. III Laryngoscope, 134:2915-2921, 2024.

Effects of oral cysteine leukotriene receptor antagonist-montelukast on adenoid lymphoid tissue: a histopathological study under light microscope.

Background: Adenoidal hypertrophy (AH) is one of the most common causes of upper airway obstruction in children. Drug and surgical treatment are the typical treatment of AH. The study on the inflammatory mechanism of AH in children provides a new idea for preoperative intervention and non-surgical treatment with anti-inflammatory drugs such as montelukast sodium (a cysteine leukotriene receptor antagonist). The aim of this study is to evaluate the effect of montelukast sodium on adenoidal lymphoid tissue pathology in children with AH under light microscope. Objective: To study whether there is any change in pathology of the adenoidal lymphoid tissue under the light microscope compared with the control group in children with moderate to severe simple AH treated with montelukast sodium for 1month before operation. Materials and methods: Twenty patients (8 males, 12 females, 3-8 years old) with moderate to severe AH who were prepared for surgical treatment were selected. All the patients were examined by Nasopharyngeal CT and hemocyte analysis before operation. 20 subjects were randomly divided into two groups: One group was given montelukast chewable tablets 5mg/d, qn, for 4 weeks; The control group was given placebo 5mg/d, qn, for 4 weeks. After 4 weeks, the adenoids were removed and examined histopathology. Results: Compared with the control group, the number of lymphocytes in the blood cell analysis of the study group was significantly reduced, with a statistically significant difference (p < 0.05). And the number of germinal centers in adenoid tissue of the study group was relatively reduced, no small cyst was found in the epithelium, and the degree of inflammatory cell infiltration was reduced, with a statistically significant difference (p < 0.05). Conclusion: Montelukast can reduce the number of reactive cells, the number of lymphocytes in blood cells and blood vessels in adenoid lymphoid tissue, which can provide a new idea for preoperative intervention and non-surgical treatment of adenoid hypertrophy in children. However, this is only a pilot study and a longer treatment period is needed to assess the long-term effects of montelukast sodium on adenoid lymphoid tissue. Clinical Trial Registration: www.Chictr.org.cn, identifier ChiCTR2300075040.

Validation of the Paediatric Asthma Score (PAS) in Evaluation of Acute Exacerbation of Asthma in Children

Introduction: Assessing the severity of acute asthma objectively is important to guide treatment. Peak Expiratory Flow Rate (PEFR) is used for this. Paediatric Asthma Score (PAS) is a user-friendly asthma score in children. Our aim was to validate the efficacy of PAS in comparison with PEFR for assessing severity of acute asthma.&#x0D; Methods: The study included 32 children in the age group of five to 14 years, with mild to moderate asthma exacerbation. The PEFR and the PAS were measured before treatment, 15 min, 30 min, and one hour after treatment, and at discharge. Paired t-test was used to establish construct validity by comparing pre-and post-treatment PEFR and PAS. The criterion validity was calculated by correlating pre-and post-treatment PASs with PEFRs.&#x0D; Results: The mean predicted PEFR improved with treatment by 22.35% (p &lt; 0.001) by one hour. Pre- and post-treatment PASs significantly correlated with PEFRs. The correlation of pre-treatment PEFR and PAS was r = -0.491 (p = 0.004), that for post-treatment at 1hour was r = -0.505 (p = 0.003).&#x0D; Conclusions: The study validities the PAS as a measure of severity of asthma. The PAS is thus a simple alternative to the PEFR to estimate airway obstruction in children within the age group to five to 14 years with acute asthma exacerbations.

CXCR7 promotes the migration of fibroblasts derived from patients with acquired laryngotracheal stenosis by NF-κB signaling.

Laryngotracheal stenosis (LTS) is a life-threatening disease that commonly results in airway obstruction in children. Traditional treatments such as laryngotracheal reconstruction and balloon dilation all have the risk of laryngotracheal restenosis. It is of great importance to spare patients the morbidity of LTS and risks of restenosis associated with these treatments. Laboratory and clinical trials have focused on fibrosis, the crucial pathological process of LTS. This study was undertaken to investigate the function of CXC chemokine receptor-7 (CXCR7) in the fibroblasts derived from LTS. RNA sequencing was performed on acquired human LTS and normal trachea tissues to analyze differentially expressed genes. Fibroblasts from LTS and normal trachea tissues were isolated and cultured. CXCR7 knockdown was performed using specific small interfering RNAs (siRNAs) and activated by CXCR7 agonist VUF11207. The assessment of cell proliferation and migration was conducted using EdU proliferation, wound healing, and transwell assays. The assessment of cell proliferation and migration was conducted using EdU proliferation, wound healing, and transwell assays. The expressions of CXCR7, E-cadherin and NF-κB signaling pathway were analyzed by quantitative polymerase chain reaction (qPCR), western blotting, immunohistochemistry, and immunofluorescence. RNA sequencing showed that CXCR7 was among the most differentially expressed genes. LTS had an increased CXCR7 expression but decreased E-cadherin expression in vivo. CXCR7 agonist stimulated the migration of LTS derived fibroblasts significantly in vitro, with no significant influence on the cell proliferation and apoptosis. CXCR7 agonist inhibited the expression of E-cadherin by activating the NF-κB signaling pathway. The effects of CXCR7 on cell migration and E-cadherin expression were blocked by CXCR7 siRNA. LTS had an increased CXCR7 expression but decreased E-cadherin expression. CXCR7 activation inhibited E-cadherin expression by NF-κB signaling pathway and thereby promoted the migration of LTS derived fibroblasts.

Adenoid Hypertrophy and Orthodontic Complications: An Assessment of Parental Knowledge in Saudi Arabia.

Background Adenoid hypertrophy is a common condition that can cause upper airway obstruction in children and adolescents, leading to various complications, including dental and maxillofacial abnormalities. However, parents may have limited knowledge of the orthodontic complications associated with this condition. Objective This study aimed to assess the knowledge and attitude of parents toward the orthodontic complications of untreated adenoid hypertrophy and to promote their awareness about this problem. Method This descriptive cross-sectional study involved 824 parents from all regions of Saudi Arabia. An online questionnaire was used to collect data on parents' demographics, their children's information, and their general knowledge about adenoid hypertrophy, including its symptoms, complications, and treatment. Results The study included 824 parents with a mean age of 36.78 ± 10.87 years, 73.2% of whom were women. Overall, only 6.2% (51.1 parents) had a good level of knowledge about adenoid hypertrophy. Conclusion The study highlights the importance of promoting awareness and educating parents about the orthodontic complications associated with adenoid hypertrophy. Greater awareness and understanding can help parents make better decisions for their children's health and well-being.

A new method for the assessment of adenoid hypertrophy: Respirdynamicsgram (RDG)

Adenoid hypertrophy (AH) is a common cause of airway obstruction in children, which is the etiology of changes in facial growth, obstructive sleep apnea syndrome, and/or more serious problems. Most sequelae can be avoided or reversed by timely diagnosis and treatment. It is difficult to frequently assess the changes in adenoids among children using the commonly available diagnostic tools owing to invasiveness and radiation exposure. A new method called respirdynamicsgram (RDG) is proposed for the assessment and diagnosis of AH. Specifically, RDG is generated by visualizing the respiratory dynamics extracted from nasal airflow through dynamic learning. The morphology of RDG remarkably differs between children with adenoidal hypertrophy (irregular shapes) and healthy children (regular butterfly-like shapes). Three features are utilized to represent the morphology of RDG, including temporal heterogeneity, spatial heterogeneity, and wing shape. These morphology features of RDG are fed into the linear support vector machine for the AH classification task. As a result, the proposed method achieves a mean accuracy of 86.6% over 100 resample folds on a total of 74 subjects. It is shown that RDG has the capability of distinguishing children with AH from healthy children. As it is simple, non-invasive, and secure, it is hopeful that RDG may become an effective method for timely and frequent assessment and diagnosis of AH.

Critical Analysis and Cross-Comparison Between English and Chinese Websites Providing Online Medical Information for Patients With Adenoid Hypertrophy: Cross-sectional Study.

In the information era, patients can easily be misled by inaccurate internet content, thus making not well-informed decisions about medical issues. Adenoid hypertrophy, one of the most common causes of chronic upper airway obstruction in children and adolescents, may lead to serious complications, including sleep apnea and craniofacial change. There have been no critical studies about the quality of websites on adenoid hypertrophy, posing a challenge for users without a medical background to determine which website offers more reliable information. Moreover, the blockage of access to internet search tools such as Google, Yahoo, and others has created an isolated internet environment for the enormous user population in mainland China. Differences in internet legislation, the commercial environment, and culture are also likely to result in varied quality of online health information inside and outside mainland China. To date, no study has compared the quality difference between mainland Chinese and English websites. The aims of this study were to (1) analyze the quality of websites about adenoid hypertrophy accessible by patients, (2) investigate the quality differences between Chinese and English websites, (3) determine which type of website (eg, government-sponsored, health care provider) is more reliable in terms of medical information, and (4) determine whether the blockage of foreign websites is hindering users' accessibility to better-quality websites in mainland China. The first 100 websites (excluding advertisements) displayed on the top three search engines worldwide and in mainland China for the key search term "enlarged adenoids" were collected as the data source. The websites were evaluated based on accessibility, accountability, interactivity, structure, and content quality (accuracy, content coverage, and objectivity). Cohen κ was calculated, and one-way ANOVA and the Kruskal-Wallis test were performed to compare the results between groups and subgroups. The mean score for the content quality of English websites was significantly higher than that of Chinese websites (6.16 vs 4.94, P=.03 for Google, Bing, and Yahoo; 6.16 vs 4.16, P<.001 for Baidu, Sougou, and Bing China). Chinese users who are not influenced by the Internet Censorship System are more likely to access higher-quality online medical information (4.94 vs 4.16, P=.02). In within-group Student-Newman-Keuls q posthoc analysis, professional organization and government-sponsored websites were generally of better quality than other websites for both Chinese and English websites (P<.05). Generally, the English websites on adenoid hypertrophy are of better quality than Chinese websites; thus, Chinese users residing outside of the Chinese mainland are less influenced by inaccurate online medical information.

Secondary analysis of airway obstruction in children with adenoid hypertrophy: Association with jaw size and position

Rising information on the potential of the environment to influence phenotypical expression invited revisiting prior data on the effect of airway obstruction on jaw size, not only position. AimEvaluate the jaw interactions in response to graded airway obstruction and their effect on jaw size. Methods200 consecutively examined mouth-breathing children (age: 6.00 ± 2.62years) were referred by the pediatric otorhinolaryngologist for lateral cephalometric assessment of adenoid hypertrophy. Cephalometric measurements included maxillary and mandibular lengths, inclinations of palatal and mandibular planes and as airway measurement, the shortest distance from soft palate to adenoid (AD). Three severity groups were categorized on airway clearance level: AD1: >6mm, AD2: 2-6 mm, AD3: ≤2mm. All parameters were compared among the groups and to control databases. Statistics included one-way analysis of variance for group differences, linear and multiple regressions for associations and prediction models. ResultsAge was statistically significantly different (p < 0.001) among groups (AD1: 7.72 ± 3.02years; AD2: 5.89 ± 2.42years; AD3: 5.13 ± 2.21years). Cephalometric measurements in AD1 and AD2 were closest to normative data over time; the most severe AD3 diverged from these data. Variation in AD was accounted for by the combination of age and either mandibular length Co-Gn (59.4%) or maxillary length ANS-PNS (43.4%). Predictors of Co-Gn included the combination of ANS-PNS and AD (64.8%), and that of age, AD and palatal plane cant (62.4%). ConclusionThe results suggest that reduced nasopharyngeal clearance affects maxillary and mandibular size, the latter directly influenced by the maxillary changes.

Contributions of telesimulation to the knowledge of mothers about foreign body airway obstruction.

To analyze the contributions of telesimulation to the knowledge of mothers faced with foreign body airway obstruction in children under 1 year of age and identify the related factors. A quasi-experimental study of the pre- and post-test design carried out between April and September 2021 with 49 mothers from a city in São Paulo. It was organized into four stages: pre-test, telesimulation, immediate and late post-test (60 days later). All steps were carried out remotely via the free online platform Google Hangouts® and Google Forms®. Data analyzed by descriptive and analytical statistics. There was a significant difference in the knowledge score between the assessments (p<0.001). Statistically significant relationships were identified between pre-test knowledge and choking experience (p=0.012), promotion of immediate knowledge and another child's choking (p=0.040) and schooling (p=0.006) and promotion of late knowledge with occupation (p=0.012) and choking of another child (p=0.011). There was a significant improvement in knowledge after telesimulation, especially among those who had never experienced a choking situation and had a higher level of education.

A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children.

Rationale: Periextubation corticosteroids are commonly used in children to prevent upper airway obstruction (UAO). However, the best timing and dose combination of corticosteroids is unknown. Objectives: To compare effectiveness of different corticosteroid regimens in preventing UAO and reintubation. Methods: MEDLINE, CINAHL, and Embase search identified randomized trials in children using corticosteroids to prevent UAO. All studies used dexamethasone. The studies were categorized based on timing of initiation of dexamethasone (early use: >12 h before extubation) and the dose (high dose: ⩾0.5 mg/kg/dose). We performed Bayesian network meta-analysis with studies grouped into four regimens: high dose, early use (HE); low dose, early use (LE); high dose, late use (HL); and low dose, late use. Results: Eight trials (n = 903) were included in the analysis. For preventing UAO (odds ratio; 95% credible interval), HE (0.13; 0.04-0.36), HL (0.39; 0.19-0.74), and LE (0.15; 0.04-0.58) regimens appear to be more effective than no dexamethasone (low certainty). HE and LE had the highest probability of being the top-ranked regimens for preventing UAO (surface under the cumulative ranking curve 0.901 and 0.808, respectively). For preventing reintubation, the effect estimate was imprecise for all four dexamethasone regimens compared with no dexamethasone (very low certainty). HE and LE were the top-ranked regimens (surface under the cumulative ranking curve 0.803 and 0.720, respectively) for preventing reintubation. Sensitivity analysis showed that regimens that started >12 hours before extubation were likely more effective than regimens started >6 hours before extubation. Conclusions: Periextubation dexamethasone can prevent postextubation UAO in children, but effectiveness is highly dependent on timing and dosing regimen. Early initiation (ideally >12 h before extubation) appears to be more important than the dose of dexamethasone. Ultimately, the specific steroid strategy should be personalized, considering the potential for adverse events associated with dexamethasone and the individual risk of UAO and reintubation.

Treatment strategies for orofacial myofunctional disorders and malocclusions associated with different sites of upper airway obstruction in children

The impact of respiratory function on children's craniofacial growth has received increasing attention from orthodontists and parents. There is a higher pediatric sleep-disordered breathing risk prevalence in the orthodontic population compared with a general population sample, and orthodontic practitioners need to pay close attention to the respiratory function of their pediatric patients. For children with upper airway obstruction and related dentofacial and functional abnormalities, clinicians should comprehensively consider the site and severity of upper airway obstruction, the clinical feature of malocclusion and other factors to develop an individual, multidisciplinary treatment plan, providing favorable conditions for the development of the children's craniofacial morphology and the whole body.

OUTCOME OF PATIENTS WITH ADENOID HYPERTROPHY UNDERGOING ENDOSCOPIC GUIDED MICRODEBRIDER - ASSISTED ADENOIDECTOMY

Adenoid, a nasopharyngeal lymphoid tissue forming a part of the Waldeyer's ring, was initially described in 1868 by Meyer. Adenoid hypertrophy (AH) can result in upper airway obstruction in children. Children with this condition present with symptoms of chronic nasal obstruction, rhinorrhoea, mouth breathing, snoring, recurrent sinusitis, and recurrent otitis media with effusion. Adenoidectomy is one of the most common surgical procedures performed in children, either alone or in conjunction with tonsillectomy or grommet insertion. The conventional adenoidectomy using curette is performed blindly by most surgeons without visualising the nasopharynx; which leads to uncommon complications such as inadequate adenoid tissue removal, eustachian tube scarring, bleeding and nasopharyngeal stenosis. This has lead to development of alternate surgical methods, which has been made possible with the advent of rigid nasal endoscopes, cold light source, fibre optics and powered instruments.

Airway Obstruction in Children with COVID-19 Presenting with Stridor

Airway Obstruction in Children with COVID-19 Presenting with Stridor

Paediatric tracheobronchomalacia: Incidence, patient characteristics, and predictors of surgical intervention

ObjectivesTracheobronchomalacia (TBM), a condition where an abnormality of the tracheal walls causes collapse during the respiratory cycle, is a common cause of airway obstruction in childhood. TBM can present with a large spectrum of disease severity and underlying pathologies that may be managed medically and surgically, and it is not always clear which patients would most benefit from surgical intervention. We aim to describe the incidence, patient characteristics, and predictors of surgical intervention in a large cohort of paediatric patients. MethodsWe performed a retrospective review of all children diagnosed with TBM to a paediatric Otolaryngology unit in the west of Scotland between 2010 and 2020. Odds ratios for clinical predictors of surgery were calculated using logistic regression with uni- and multivariate analysis. Results249 patients were identified of which 219 proceeded to data collection. Primary malacia was noted in 161 (73.5%) and secondary in 58 (26.5%). Causes of secondary malacia included compression by the innominate artery (11%) and vascular rings (7.8%). Surgical interventions were performed in 28 patients (12.8%) including division of vascular ring, aortopexy, and surgical tracheostomy. Multivariate analysis showed secondary TBM, acute life-threatening events, and difficulty weaning from mechanical ventilation were independent risk factors for surgical intervention. ConclusionsTBM can present with a myriad of airway symptoms and is frequently associated with other airway and mediastinal pathologies necessitating multiple interventions. Children aged <1 year present with a more severe form of the disease and the presence of particular independent risk factors may indicate a need for surgical intervention. Level of evidence4

Correlation between radiographic adenoidnasopharyngeal ratio and clinical symptoms of adenoid hypertrophy in a tertiary health institution in North West Nigeria

Background: Adenoid hypertrophy is the most common cause of nasopharyngeal airway obstruction in children. The radiographic evaluation of the adenoid hypertrophy using the adenoid-nasopharyngeal ratio is a simple, economical, and reliable method in determination of the position, size, and shape of the adenoids. Aims and Objectives: The study was conducted to determine the correlation between radiographic adenoid-nasopharyngeal ratio and clinical symptoms of adenoid hypertrophy. Materials and Methods: This crosssectional prospective study was carried out in the Department of Radiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, North West Nigeria. A total of 90 consecutive patients aged between 3 and 12 years with clinical symptoms of adenoid hypertrophy were included in the study. All the patients had plain radiography of the post-nasal space. The adenoid-nasopharyngeal ratio (ANR), which is the ratio of the adenoid thickness measured from the maximum convexity of the adenoid to the margin of the basiocciput and the nasopharyngeal depth measured from the posterior border of the hard palate to the anteroinferior aspect of the sphenobasioccipital synchondrosis (Fujioka method), was calculated and scores obtained for each patient were graded into mild (0.50–0.62), moderate (0.63–0.75), and severe (0.76–0.88). The clinical symptoms assessed included snoring, mouth breathing, sleep apnea, otitis media, and recurrent upper airway infections. Each symptom was scored on a 4-point scale and the sum of the scores was graded into mild (0–5), moderate (6–10), and severe (11–15). The data were collected using a structured questionnaire and analyzed using Statistical Package for the Social Sciences version 22. Results: A total of 90 patients were involved in the study, their age ranged between 3 and 12 years (mean=6.11±2.77); and male-tofemale ratio was 2:1.5. The mean ANR score was 0.71±0.11 and that of the clinical symptoms score was 8.67±3.23. ANR correlated significantly with the clinical symptoms scores (r=0.901; P&lt;0.0001). The association was significant at ANR grading for mild (χ2=20.91; P=0.003) and severe (χ2=11.39; P=0.022). Conclusion: This study shows that radiographic ANR can predict the degree of nasopharyngeal airway obstruction especially for mild and severe grading. A severe nasopharyngeal airway obstruction as determined by both ANR and symptom’s severity was observed in the 3–5 years age group.

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

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

Patterns of airway obstruction of non-acquired origin in children with and without major congenital anomalies

Major congenital anomalies are known to play a role in the management and prognosis of airway obstruction. Most studies assess acquired forms of airway obstruction. Data on congenital or otherwise non-acquired forms of airway obstruction is sparse. In this retrospective, single-institution cohort study, we sought to evaluate and compare the patterns of airway obstruction in children with and without major congenital anomalies, and to assess the impact of management and outcome, irrespective of aetiology. Fifty-five patients were included, 23 with and 32 without underlying major congenital anomalies. Multilevel airway obstruction (usually affecting the nasopharynx, oropharynx, and the trachea) was more common in children with congenital anomalies (91% vs. 41%, p < .001). Consequently, these children required more frequent and earlier surgical management, especially tracheostomy and adenotonsillar surgery.Conclusions: Major congenital anomalies are associated with multilevel airway obstruction and poor functional prognosis. A simple clinical definition considering impact of major congenital anomalies on development and growth may help guide management plans following endoscopic evaluation of the entire airway and flanked by multidisciplinary discussions.What is Known:• Children with major comorbidities display increased disease severity and more prevalent multilevel airway obstruction• Previous studies include both children with acquired and non-acquired forms of airway obstruction; therefore, the actual impact major comorbidities in children with non-acquired causes of airway obstruction remain unclear.What is New:• A total of 42% children in this study population had major comorbidities with and impact on growth and/or psychomotor development, with a higher prevalence of multilevel airway obstruction and worse rates of functional improvement/recovery.• Children with major comorbidities require tracheostomy more often and earlier than those without major comorbidities, and remain tracheostomy-dependent for a longer time.

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

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.