What is included in long-term monitoring of childhood obstructive sleep apnea (OSA)?

Updated: Feb 13, 2019
  • Author: Mary E Cataletto, MD; Chief Editor: Denise Serebrisky, MD  more...
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Answer

Some children with severe obstructive apnea continue to have apneas in the immediate postoperative period until surgery-related edema subsides. For these children, continuous positive airway pressure (CPAP) therapy can serve as a bridge treatment after surgery until operative swelling subsides.

In most otherwise healthy children with obstructive sleep apnea, adenotonsillectomy results in complete resolution of the problem, and a postsurgical evaluation in the sleep laboratory is usually not recommended. However, residual mild sleep-disordered breathing is found in more than one third of these patients after adenotonsillectomy, particularly those included in the high-risk category. Thus, adenotonsillectomy alone may not suffice, and polysomnographic evaluation 6-8 weeks after adenotonsillectomy may confirm the need for additional treatment, including the use of intranasal steroids and oral leukotriene modifier therapy or CPAP and/or bilevel positive airway pressure (BiPAP).

Individuals undergoing surgical treatment for moderate-to-severe obstructive sleep apnea should have follow-up polysomnography 2-3 months after their operations to ensure that the surgery successfully eliminated their obstructive apnea. Some patients continue to have significant obstructive apnea after surgery even though their snoring improves dramatically or disappears altogether. This is especially true for individuals who undergo uvulopalatopharyngoplasty (UPPP) alone.

Daytime fatigue and somnolence may persist after successful treatment for obstructive sleep apnea if the patient continues to follow a chaotic sleep schedule at home. Use outpatient contacts as an opportunity to reinforce good sleep hygiene, which is the phrase used to describe the conditions and habits that foster effective, satisfying sleep. Stress the importance of maintaining a regular bedtime and rise time and of allowing an adequate period for overnight sleep.

Patients should maintain a healthy weight with good eating habits and appropriate exercise. Although numerous factors influence the development of obstructive sleep apnea, obesity has been associated with a 4-fold to 5-fold risk in children aged 2-18 years.

Patients treated with noninvasive ventilation require close follow-up by a pediatric pulmonologist and may periodically require a repeat polysomnographic evaluation. Treat patients who are found to have significant hypoxemia during polysomnography as soon as possible with overnight supplemental oxygen until adenotonsillectomy can be performed. Carefully assess the patient when using oxygen because of the rare possibility that significant hypercapnia may develop during the night


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