Minimizing Risk: Experts share tips on how to manage OSA patients undergoing surgery

Children with OSA

Stacey Ishman, MD, MPH, director of the Center for Snoring and Sleep Surgery at Johns Hopkins Hospital, said that the most critical advance in pediatric sleep medicine has been the recognition that OSA occurs frequently in children. Data suggest that chronic snoring occurs in 5 to 12 percent of children and that about 2 percent have overt OSA on a sleep study, she said. Although OSA is commonly seen in children who are underweight and failing to thrive, Dr. Ishman emphasized current findings that persistent OSA is most common in overweight children.­

For diagnosis, she highlighted diagnostic criteria included in the Academy of Pediatrics (AAP) 2002 guidelines, “Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome.” These include the need to screen all children for snoring, along with further screening in snorers to determine if the snoring is OSA-related.

For treatment, Dr. Ishman highlighted two key recommendations in the AAP guidelines: The first one recommends that high-risk patients be monitored as inpatients after surgery and the second that patients be re-evaluated after surgery to determine if additional treatment is required. For children considered at significantly increased risk (i.e., those with a score of 5 or more), it is recommended that elective surgery such as T&A be postponed; if T&A is performed on these children, it should not be handled at an outpatient facility.

“The most important thing for otolaryngologists to keep in mind is that treatment by adenotonsillectomy of children even with mild OSA can provide significant benefit and that removal of even small tonsils can be curative,” Dr. Ishman said.