What is the best way to manage childhood OSA?

With CPAP often ineffective for children, clinicians could focus on weight loss as a second-line treatment for OSA, expert says

Children and adolescents with obstructive sleep apoena (OSA) who experience no improvement after a tonsillectomy are often stuck on CPAP, despite almost half being non-adherent to the treatment, experts say.

Presenting at the Sleep DownUnder conference in Sydney this month, Professor Indra Narang, paediatrician and director of sleep medicine at The Hospital for Sick Children Toronto, said the childhood obesity epidemic was to blame for the increase in OSA cases.

A study published in Paediatrics & Child Health found 25% of overweight children and adolescents also experienced comorbid OSA.

In addition, experts predicted that 70% of these paediatric OSA cases remained unrecognised or were left untreated.

“This is a huge problem as this wave of children and adolescents with sleep disorders – many untreated and hidden – take it with them into adulthood,” Professor Narang said.

Professor Narang said finding appropriate OSA treatment for children would be an important factor in trying to mitigate the poor educational outcomes and additional weight gain which often affected these patients.

Current first-line treatment for children and adolescents with OSA is often a tonsillectomy, but some children’s OSA persists even after surgery. 

These children will then be treated by CPAP, which is successful when used for four or more hours a night, a difficult task for some children.

Professor Narang said most children stop CPAP treatment because they find the mask uncomfortable, or don’t understand the benefits of the treatment.

“We are seeing significant numbers of persistent OSA in both obese adolescents and children with underlying medical complexity and when the treatment is CPAP we enter a cycle where, despite what we do, 40-50% will remain non-adherent to CPAP for many years,” she said.

Instead, clinicians could focus on weight loss as a second-line treatment for OSA, Professor Narang said.

In morbidly obese teenagers, this weight loss could be facilitated by bariatric surgery, with one US study showing it resolved 100% of all OSA cases in one surgery cohort.

“The one-size-fits all theory where we keep applying CPAP is probably no longer valid and we are applying bariatric surgery more early on in the population with good results.”