AAO-HNSF Primary Care Otolaryngology Handbook

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CHAPTER 1

The diagnosis of sleep-disordered breathing is usually straightforward, based on history and physical examination. However, the diagnosis of OSA requires a PSG, which is typically requested if the diagnosis is in doubt based on the history or the exam does not corroborate the history (e.g., small tonsils, nonobese, with history of loud snoring). Adenotonsillectomy is noted to successfully resolve OSA in 80 percent of children. However, persistent or recurrent disease is more common in children with such conditions as obesity or Down syndrome. Children with medical conditions (e.g., craniofacial disorders, neuromuscular disorders, severe pulmonary disease) may require enhanced periopera- tive care, given the increased risk of complications. Guidelines suggest that children younger than 3 years and those with severe OSA should be monitored overnight in the hospital. For children with persistent or recur- rent OSA, DISE is also used to investigate for additional sites of upper airway obstruction. As of 2019, upper airway stimulation is only available in the setting of clinical trials for children with Down syndrome.

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Primary Care Otolaryngology