Elsevier

Sleep Medicine Reviews

Volume 13, Issue 2, April 2009, Pages 123-131
Sleep Medicine Reviews

Clinical review
Interventions for obstructive sleep apnea in children: A systematic review

https://doi.org/10.1016/j.smrv.2008.07.006Get rights and content

Summary

Background

Obstructive sleep apnea (OSA) is characterized by habitual snoring, heavy breathing, sleep-related hypoxia and arousals from sleep, and is found in approximately 3% of children.

Objective

To review the efficacy of medical, behavioral, mechanical and surgical interventions in improving OSA in children.

Methods

Bibliographic databases, relevant conference proceedings and trial registers were searched. Randomized controlled trials assessing interventions in children with objectively diagnosed OSA (as per polysomnography; apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) ≥ 1/h) were considered.

Results

The search identified 1690 potentially relevant studies. The five trials that met the inclusion criteria investigated seven different interventions (intranasal steroids, adenotonsillectomy, maxillary distraction, temperature-controlled radiofrequency ablation, oral appliances, continuous and bilevel positive airway pressure therapy). Intranasal steroids had a significant advantage over placebo in decreasing the AHI (one study). Temperature-controlled radiofrequency ablation and adenotonsillectomy were equally effective in reducing the RDI (one study). Continuous and bilevel positive airway pressure therapy was equally effective in reducing the AHI (one study). There was insufficient evidence to support the use of oral appliances.

Conclusions

Despite a broad array of treatment options for OSA, there is limited evidence to support their use. More research is needed before general recommendations can be made.

Section snippets

Background

Obstructive sleep apnea (OSA) in children is a form of sleep-disordered breathing characterized by episodes of partial or complete upper airway obstruction with a reduction in arterial hemoglobin oxygen saturation, hypercapnia and/or respiratory-related arousal. Typical nighttime symptoms include snoring, restless sleep, and increased number of awakenings.1

The etiology of OSA is multifactorial: patency of the upper airways during sleep can be influenced by anatomic and neuromuscular factors.2

Search strategy

Detailed individual search strategies for each of the following bibliographic databases were developed: MEDLINE (1950–present), EMBASE (1988–present), Cochrane Central Register of Controlled Trials (CENTRAL) (1964–present), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982–present), Web of Science (1900–present), and Literatura Latino-Americana e do Caribe de Informação em Ciências da Saúde (LILACS) (1982–present). For identification of ongoing clinical trials, //controlled-trials.com

Study selection

All database searches were performed in August 2007. A flow chart of the process of study identification and inclusion/exclusion is shown in Fig. 1.

Independent review of the 86 potentially relevant studies identified five relevant studies.*17, *23, 24, *25, *26 Eighty-one studies were excluded because they i) were not RCTs (n = 35); ii) studied adults or infants only (n = 15); iii) did not objectively diagnose OSA or included children with an AHI < 1 (n = 24); iv) were duplicate publications of the

Discussion

The current review aimed to evaluate the available evidence on interventions for OSA in children. Despite a broad array of available treatments, there is only limited evidence to support their use. Only five RCTs were identified using a comprehensive database search. The quality of the identified trials was high in one study and medium to low in the remainder.

There are a number of factors that may explain the low number of trials included in this review. Firstly, only studies that used

Conclusions

Despite a broad array of available treatments for OSA in children, there is only limited evidence to support their use. Most concerning, there is very little data from RCTs to support the use of ATE, the current quasi-standard and first-line treatment for OSA. Intranasal steroids appear to have a short-term beneficial effect on the AHI in children with mild to moderate OSA. However, long-term safety data are not available. Surgical therapies for OSA (ATE, temperature-controlled radiofrequency

Conflict of interest statement

None to declare.

Acknowledgements

The authors would like to thank Lisa Tjosvold from the Cochrane Child Health Field, University of Alberta, for her help with putting together the search strategy.

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