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Minerva Pneumologica 2009 December;48(4):377-87


language: English

Obstructive sleep disordered breathing in children and adolescente

Vlachos-Mayer H. 1, Dorion D. 2, Praud J. P. 1, 2

1 Respiratory Medicine Division, Department of Pediatrics, Université de Sherbrooke, Québec, Canada 2 ENT Division, Department of Surgery, Université de Sherbrooke, Québec, Canada


Obstructive sleep disordered breathing in children (SDB), is a frequent, significant and under diagnosed problem with potentially grave consequences. Neurobehavioral, growth and cardiac sequelae have all been described. With the current, increasing rate of childhood obesity, the clinical presentation, complications and therapy have changed, resulting in an changing approach to childhood SDB. Traditionally, adenotonsillectomy (AT) has long been the treatment of choice for obstructive sleep disordered breathing in children. It is usually considered a safe procedure, which cures 80% of children with SDB. Accumulated data have however challenged this overly simplistic view. Indeed, significant morbidity, mortality and recurrence do take place. In addition, aside from a recurrence of SDB at adolescence in an unknown percentage of cases, some recent results suggest that complete SDB cure is not achieved in as much as 75% of AT cases. Interestingly, several treatment options have been recently proposed for replacing or complementing AT. Continuous positive airway pressure is now suggested in children with persistent SDB after AT; however, compliance and suitability of equipment remain important hurdles, especially in small children and infants. Anti-inflammatory treatments, including nasal glucocorticoids and/or the antileukotriene montelukast, appear to hold great promise. Finally, orthodontic treatments are an appealing option, with recent results in children suggesting that it is possible to improve or perhaps even cure SDB in a durable manner by enlarging the nasal passages and/or the oropharyngeal airspace. In conclusion, while we are currently in the midst of an exciting time with several new treatments being developed for childhood SDB, the primary challenge remains in screening and diagnosing children with clinically significant SDB. A better collaboration with maxillofacial specialists, including orthodontists and/or dentists for diagnosis and treatment is also needed.

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