OSA (Obstructive Sleep Apnea) in children is usually due to enlarged tonsils and adenoids. The classical symptoms are loud snoring and mouth breathing.
The peak prevalence is at two to six years of age, but it can be seen in neonates to adolescents. It is thought to occur equally among boys and girls, and can result in significant morbidity and mortality.
High risk groups include children with craniofacial anomalies, cerebral palsy, muscular dystrophy and Down syndrome. OSA can occur in both obese and non obese children.
Symptoms
The presence of OSA cannot be determined by history and physical examination alone. Most children present with a history of snoring and difficulty breathing during sleep. The child sleeps restlessly, and may adopt bizarre sleeping positions. The child’s appearance during sleep can be so alarming that parents often continually stimulate or reposition the child throughout the night. Many parents are not aware of what OSA is.
Physical examination shows enlarged adenoid and tonsil in Lateral Neck X-ray or CT imaging. Nasal Endoscopy can also be tried in children who can cooperate. Usually the child may have an adenoidal facies, and mouth breathing is common.
Diagnosis
Sleep study in children is not practical in a country like India, so I treat them after obtaining good history from parents, physical examination, CT imaging, and Nasal Endoscopy.
Treatment
Tonsillectomy and adenoidectomy (Ts&Ads) cures OSA and associated Snoring in children. It can be done by conventional dissection method or Laser or Coblator.
Laser and Coblator surgery is more expensive, but it has its advantages like less bleeding less pain and early recovery.
Though considered to be minor surgery, T&A can be associated with significant complications. Postoperative complications in children with OSA include upper airway edema, pulmonary edema and respiratory failure, in addition to the usual risks of Ts&Ads. OSA may not resolve fully until six to eight weeks postoperatively.
CPAP
No children will ever tolerate it, honestly, although some physician advises it. How CPAP work unless one removes the obstructive components? It has no logic.
Prognosis
Most children experience a dramatic resolution of their symptoms following Ts&Ads. If not treated they will end up in trouble.
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