Médecine thérapeutique / Pédiatrie


Obstructive sleep apnoea in children: new therapeutic approaches Volume 16, issue 2, Avril-Mai-Juin 2013


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Centre du sommeil et de la vigilance, Hôtel-Dieu, 1, place du Parvis-Notre-Dame, 75181 Paris cedex 04, France, Polyclinique de Bordeaux-Tondu, 145, rue du Tondu, 33000 Bordeaux, France

The peak incidence of obstructive sleep apnoea syndrome (OSAS) occurs between three and seven years of age, when the adenoids and tonsils undergo hypertrophy, resulting in upper airway obstruction during sleep. Obesity, pharyngeal airway tightness and/or a reduction in muscular tone exacerbate the effects of lymphoid hypertrophy. OSAS may occur in healthy children and results in behavioural, neurocognitive, cardiovascular and metabolic complications, justifying therapeutic intervention. OSAS may also occur in children with congenital craniofacial abnormalities. The first line of OSAS treatment is adenotonsillectomy (AT). Although this form of treatment may prove to be useful, it may be insufficient and new therapeutic approaches may be recommended. Oro-nasal drug treatment includes nasal steroids, antileukotriene or antihistaminic drugs (which can be used with AT). Less common surgical approaches include turbinectomy of the inferior turbinates, septoplasty, and dento-facial orthopaedic intervention in particular with, in the case of maxillary malocclusion, rapid maxillary expansion. Weight loss and weight control is an important issue, particularly following surgery. In cases of severe and persisting OSAS, despite AT, nasal continuous positive airway pressure may be suggested as a last resort.