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Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line tre...

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Autores principales: Gozal, David, Tan, Hui-Leng, Kheirandish-Gozal, Leila
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141493/
https://www.ncbi.nlm.nih.gov/pubmed/32213932
http://dx.doi.org/10.3390/jcm9030888
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author Gozal, David
Tan, Hui-Leng
Kheirandish-Gozal, Leila
author_facet Gozal, David
Tan, Hui-Leng
Kheirandish-Gozal, Leila
author_sort Gozal, David
collection PubMed
description Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care.
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spelling pubmed-71414932020-04-15 Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision Gozal, David Tan, Hui-Leng Kheirandish-Gozal, Leila J Clin Med Communication Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care. MDPI 2020-03-24 /pmc/articles/PMC7141493/ /pubmed/32213932 http://dx.doi.org/10.3390/jcm9030888 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Communication
Gozal, David
Tan, Hui-Leng
Kheirandish-Gozal, Leila
Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision
title Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision
title_full Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision
title_fullStr Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision
title_full_unstemmed Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision
title_short Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision
title_sort treatment of obstructive sleep apnea in children: handling the unknown with precision
topic Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141493/
https://www.ncbi.nlm.nih.gov/pubmed/32213932
http://dx.doi.org/10.3390/jcm9030888
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