Key Points
➤ Obstructive sleep apnea (OSA) is the most common sleep-related
breathing disorder.
➤ While adenotonsillectomy (AT) is first-line management for pediatric OSA,
up to 40% of children may have persistent OSA.
Recommendation 1
➤ We suggest that children with persistent OSA who do not qualify for
site specific upper airway treatment may be considered candidates for
treatment with continuous positive airway pressure (CPAP) (conditional
recommendation, very low quality evidence).
Recommendation 2
➤ We suggest that children with persistent OSA with specific craniofacial
features may be considered candidates for orthodontic/dentofacial
orthopedic treatment (conditional recommendation, very low quality
evidence).
Recommendation 3
➤ We suggest that obese/overweight children with persistent OSA undergo
weight loss intervention (conditional recommendation, very low quality
evidence).
Recommendation 4
➤ We suggest that children with lingual tonsillar hypertrophy and persistent
OSA may be considered candidates for lingual tonsillectomy (conditional
recommendation, very low quality evidence).
Recommendation 5
➤ We suggest that children with sleep-dependent laryngomalacia and
persistent OSA may be considered candidates for supraglottoplasty
(conditional recommendation, very low quality evidence).
Recommendation 6
➤ We suggest that children on intranasal steroids with persistent OSA
may be treated with montelukast (conditional recommendation, very low
quality evidence).
Treatment
