Am Fam Physician. 2025;111(5):476-477
Author disclosure: No relevant financial relationships.
Obstructive sleep apnea (OSA), with repeated episodes of upper airway obstruction during sleep, affects up to 5% of children. Although adenotonsillectomy is the first-line management for OSA in children, up to 40% of children will have five or more apnea or hypopnea episodes per hour (ie, apnea–hypopnea index of 5 or more) while sleeping despite surgery. The risk of persistent OSA is greater in children with an apnea–hypopnea index of 10 or more at baseline (indicating severe OSA), obesity, craniofacial or genetic disorders, or chronic cardiopulmonary and neuromuscular disorders. The American Thoracic Society (ATS) published guidelines on the management of persistent OSA in children after adenotonsillectomy. All recommendations are suggestions that apply to some patients, but they are not strong recommendations because of very low-quality evidence.
• In children 6 years of age to the onset of puberty with persistent OSA despite adenotonsillectomy and posterior crossbite, rapid maxillary expansion can resolve OSA.
• Drug-induced sleep endoscopy can diagnose lingual tonsillar hypertrophy and sleep-dependent laryngomalacia, which can both be addressed through surgical intervention.
• CPAP therapy should be considered in children who are not candidates for other treatments; it can reduce the number of apnea and hypopnea episodes, snoring, and excessive daytime sleepiness, although many patients do not tolerate the intervention.
• Weight loss interventions are suggested for obese children with persistent OSA based on evidence of benefit from observational studies in nonpersistent OSA.
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