The Asian Paediatric Pulmonology Society (APPS) position statement on childhood obstructive sleep apnea syndrome

Abstract

With recognition of the importance of obstructive sleep apnea syndrome (OSAS) in children, practice guidelines have been developed for the management of OSAS in the USA and Europe. A panel of experts in pediatric OSAS in Asia were appointed by the Asian Paediatric Pulmonology Society (APPS) to prepare a position statement for management of childhood OSAS in Asia. The purpose of this statement is to provide a reference standard in the diagnosis and management of childhood OSAS for doctors working in Asia. The expert panel determined the scope of this statement. Focused literature search related to the key topics was conducted by panel members. The final content of this statement was agreed on by all panel members and approved by the council of APPS. The current statement covered diagnostic approach, diagnostic criteria, management algorithm, drug-induced sleep endoscopy, medical treatment including medications and positive pressure ventilation, surgical treatment including adenotonsillectomy, orthodontic treatment, and orofacial myofunctional therapy (OMT). Diagnostic criteria of childhood OSAS from 1 year to 18 years were presented that include both clinical (criteria A) and polysomnography findings (criteria B) in the diagnosis of childhood OSAS. The use of nocturnal pulse oximetry as a screening tool was suggested using the McGill oximetry score. Management of OSAS with medical treatment, tonsillectomy and adenoidectomy (TandA), positive airway pressure, orthodontic devices, nasal valves, and OMT were reviewed. Management of persistent OSAS after TandA was addressed, and the importance of weight control was emphasized. The position statement provides a guideline to the management of childhood OSAS in Asia.