Expert Consensus Statement: Management of Pediatric Persistent Obstructive Sleep Apnea After Adenotonsillectomy

Authors

Stacey L Ishman
Stephen Maturo
Seth Schwartz
Margo McKenna
Cristina M Baldassari
Mathieu Bergeron
Boris Chernobilsky
Zarmina Ehsan
Lisa Gagnon
Yi-Chun Carol Liu
David F Smith
Jeffrey Stanley
Habib Zalzal
Nui Dhepyasuwan

Publication Date

2-1-2023

Journal

Otolaryngology–Head and Neck Surgery

DOI

10.1002/ohn.159

PMID

36757810

PMCID

PMC10105630

PubMedCentral® Posted Date

2-1-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

pediatric, children, sleep apnea, obstructive sleep apnea, sleep disordered breathing, sleep endoscopy, lingual tonsillectomy, supraglottoplasty, Down’s syndrome, cine MRI, CPAP, tongue base, turbinate surgery, tongue suspension, dental appliance, epiglottopexy, adolescent, allergic rhinitis, sleep study, polysomnography, oximetry, montelukast, nasal steroid, oxygen, shared decision-making, tracheostomy

Abstract

OBJECTIVE: To develop an expert consensus statement regarding persistent pediatric obstructive sleep apnea (OSA) focused on quality improvement and clarification of controversies. Persistent OSA was defined as OSA after adenotonsillectomy or OSA after tonsillectomy when adenoids are not enlarged.

METHODS: An expert panel of clinicians, nominated by stakeholder organizations, used the published consensus statement methodology from the American Academy of Otolaryngology-Head and Neck Surgery to develop statements for a target population of children aged 2-18 years. A medical librarian systematically searched the literature used as a basis for the clinical statements. A modified Delphi method was used to distill expert opinion and compose statements that met a standardized definition of consensus. Duplicate statements were combined prior to the final Delphi survey.

RESULTS: After 3 iterative Delphi surveys, 34 statements met the criteria for consensus, while 18 statements did not. The clinical statements were grouped into 7 categories: general, patient assessment, management of patients with obesity, medical management, drug-induced sleep endoscopy, surgical management, and postoperative care.

CONCLUSION: The panel reached a consensus for 34 statements related to the assessment, management and postoperative care of children with persistent OSA. These statements can be used to establish care algorithms, improve clinical care, and identify areas that would benefit from future research.