Explore This IssueJuly 2011
—Carole Marcus, MD
Tonsillectomy and adenoidectomy remain the primary treatments for children with OSA, even for those who are obese, Dr. Marcus said. “Sleep apnea is very common in obese children, and data show that many kids will respond well to surgery,” she said. “Even if they are not cured, they will have significant improvement.”
For children who have persistent OSA after surgery, Dr. Marcus is increasingly using continuous positive airway pressure (CPAP). However, as with adults, adherence remains the primary challenge of successful treatment with CPAP.
To better understand the challenges to adherence in these children, Dr. Marcus and colleagues looked at a number of factors, including the severity of OSA, the level of hyperactivity of the child and family issues. They found that the most important indicator of adherence was maternal level of education, with mothers with higher education linked to a child’s increased adherence to CPAP use. Dr. Marcus said this suggests the need to target CPAP compliance educational efforts. Improving adherence is important, she said, because children with better CPAP usage not only have improved sleep but also experience improvement in behaviors and quality of life. These outcomes were found even with suboptimal CPAP adherence.
Another challenge with using CPAP in children, she said, is the difficulty of finding appropriately sized masks. Not only does this interfere with CPAP adherence and optimal outcomes, she said, but ill-fitting masks have also led to the development of craniofacial abnormalities in some infants. More research and machines appropriate for children are needed, she said.
Fielding a question from a physician in the audience who wanted her opinion on treating a child for OSA without a sleep study, Dr. Marcus acknowledged the lack of resources and accessibility that often make it difficult to obtain a sleep study before surgery, but urged physicians to get a sleep study or any objective data prior to surgery.
“A vast majority of kids in this country get surgery without any objective study of any kind, but there is a lot of data showing that in probably 50 percent of those cases, a sleep study would have been normal,” she said.