Alternative Approaches to Adenotonsillectomy and Continuous Positive Airway Pressure (CPAP) for the Management of Pediatric Obstructive Sleep Apnea (OSA): A Review

Abstract

<jats:p>Continuous positive airway pressure (CPAP) is considered first-line treatment in the management of pediatric patients without a surgically correctible cause of obstruction who have confirmed moderate-to-severe obstructive sleep apnea (OSA). The evidence supports its reduction on patient morbidity and positive influence on neurobehavioral outcome. Unfortunately, in clinical practice, many patients either refuse CPAP or cannot tolerate it. An update on alternative approaches to CPAP for the management of OSA is discussed in this review, supported by the findings of systematic reviews and recent clinical studies. Alternative approaches to CPAP and adenotonsillectomy for the management of OSA include weight management, positional therapy, pharmacotherapy, high-flow nasal cannula, and the use of orthodontic procedures, such as rapid maxillary expansion and mandibular advancement devices. Surgical procedures for the management of OSA include tongue-base reduction surgery, uvulopalatopharyngoplasty, lingual tonsillectomy, supraglottoplasty, tracheostomy, and hypoglossal nerve stimulation. It is expected that this review will provide an update on the evidence available regarding alternative treatment approaches to CPAP for clinicians who manage patients with pediatric OSA in daily clinical practice.</jats:p>

Rapid maxillary expansion as a treatment for obstructive sleep apnea syndrome in children and adolescents: an evaluation by polysomnography and quality of life

“…Orthopedic movement occurs by opening the still uncalcified palatal suture, up to approximately 12 years of age, or newly calcified, in adolescence. The total effect of the expansion consists of a movement of the maxillary complex, increasing the nasal cavity with improved airflow (Huynh, Desplats, & Almeida, 2016;Pirelli, Saponara, & Guilleminault, 2004;Rana et al, 2020).…”

Clinical and Research Solutions to Manage Obstructive Sleep Apnea: A Review

“…Moreover, new surgical procedures and techniques including mini-invasive septoturbinoplasty and palatal suspension instead of excision are desirable [ 109 ]. To improve long-term treatment success of pediatric OSA, a multi-discipline approach will be preferred in future research [ 110 ].…”

Considerations in Surgical Management of Pediatric Obstructive Sleep Apnea: Tonsillectomy and Beyond

“…The non-surgical treatment options of medical management; including weight loss, non-invasive home ventilation, and various dental and maxillofacial treatments, are beyond the scope of this article. Adjunct surgical treatments include lingual tonsillectomy, tongue base reduction, uvulopalatopharyngoplasty (UPPP), targeted nasal surgery, supraglottoplasty, epiglottopexy, and tracheotomy [60,61]. Before considering further surgical management, the anatomic location of obstruction needs to be determined.…”

“…Nasal decongestants are avoided to minimize alterations in nasal airflow. The airway is then assessed endoscopically from nose to hypopharynx [29,61]. Examination of the trachea and bronchi is not routinely recommended as <5% of children studied had lower airway obstruction.…”