An overview of management strategies for pediatric obstructive sleep apnea following adenotonsillectomy

Persistent obstructive sleep apnea (OSA) following adenotonsillectomy is a frequently encountered challenge for clinicians including pediatricians, neurologists, otolaryngologists and sleep specialists, and if untreated poses severe health risks to children. This article evaluates the etiology and pathophysiology of persistent pediatric OSA. It also discusses the conditions that predispose some children to persistent OSA following adenotonsillectomy and reviews the different diagnostic modalities and various options for management of persistent pediatric OSA. A PubMed search was performed using the following terms in various combinations: persistent obstructive sleep apnea, pediatric obstructive sleep apnea, positive airway pressure, hypoglossal nerve stimulator, myofunctional therapy, nasal surgery, CPAP tolerance, obesity, Down syndrome, monteleukast, frenulectomy, bariatric surgery, drug induced sleep endoscopy, cine MRI. Persistent OSA following adenotonsillectomy is commonly seen in children. Understanding the anatomic and physiologic mechanisms at play is important to formulate specific management strategies. It is important to have a higher degree of suspicion for persistent OSA after an adenotonsillectomy in children with neurological comorbidities and obesity.