Managing Pediatric OSA Like A Boss

In this episode, Dr. Ron Mitchell, a Pediatric Otolaryngologist, joins our hosts Dr. Gopi Shah and Dr. Ashley Agan to speak about pediatric Obstructive Sleep Apnea (OSA) and its evaluation and management.

Dr. Mitchell starts off the discussion by speaking about the importance of sleep and initial presentations and symptoms of sleep apnea in children, including apneic episodes, fatigue, and inattention as well as studies that recommend tonsillectomy for pediatric OSA. Dr. Mitchell then speaks about a current study underway that looks at OSA in pediatric patients with mild symptoms and the indications of surgery and if it is necessary in all patients. It is analyzing patients undergoing medical therapies, including Montelukast, nasal steroids, and others to evaluate efficacy against surgery. Specific indications and situations are also discussed. Dr. Mitchell notes that initially, with patients with mild symptoms, a sleep study may not be necessary. On the other hand, those undergoing high risk surgery or other developmental delay may need a sleep study, with observation and symptoms being the primary method of evaluation of progress. It is important to assess goals of the family prior to making the decision to obtain a sleep study with shared decision making.

Dr. Mitchell then speaks about the impact of COVID on obtaining sleep studies and the effects on evaluation of pediatric OSA. He then indicates that home sleep studies may not be beneficial to obtain in the pediatric population, unlike in adults. The discussion continues onto the topic of tonsil size and the variable effect it can have on pediatric OSA. The history of tonsillectomies is further discussed with possible causes for the increase in the number of tonsillectomies for sleep related problems.

The discussion rounds out on the important consideration of patients who undergo surgery with tonsillectomy and adenoidectomy with persistent OSA. Dr. Mitchell mentions possible etiologies (adenoid regrowth, nasal obstruction, etc.) which can be evaluated with nasal endoscopy and managed with nasal steroids. Weight loss in overweight and obese patients may also be beneficial. Other important considerations would be in patients with Down Syndrome, due to the difficulty of implementing CPAP and other managements. In these patients, sleep MRI is useful in determining the site of airway obstruction, usually at the tongue base, with additional surgery being useful for them.