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Christian Guilleminault, MD, BiolD; Ji Hyun Lee, MD; Allison Chan, DO

Arch Pediatr Adolesc Med. 2005;159:775-785.

Objective  To review evidence-based knowledge of pediatric obstructive sleep apnea syndrome (OSAS).

Data Sources and Extraction  We reviewed published articles regarding pediatric OSAS; extracted the clinical symptoms, syndromes, polysomnographic findings and variables, and treatment options, and reviewed the authors’ recommendations.

Data Synthesis  Orthodontic and craniofacial abnormalities related to pediatric OSAS are commonly ignored, despite their impact on public health. One area of controversy involves the use of a respiratory disturbance index to define various abnormalities, but apneas and hypopneas are not the only abnormalities obtained on polysomnograms, which can be diagnostic for sleep-disordered breathing. Adenotonsillectomy is often considered the treatment of choice for pediatric OSAS. However, many clinicians may not discern which patient population is most appropriate for this type of intervention; the isolated finding of small tonsils is not sufficient to rule out the need for surgery. Nasal continuous positive airway pressure can be an effective treatment option, but it entails cooperation and training of the child and the family. A valid but often overlooked alternative, orthodontic treatment, may complement adenotonsillectomy.

Conclusions  Many complaints and syndromes are associated with pediatric OSAS. This diagnosis should be considered in patients who report the presence of such symptoms and syndromes.

Author Affiliation: Stanford University Sleep Disorders Program, Stanford, Calif.

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