AAP Issues New Guidelines for Kids' Snoring
By DR. KITTU JINDAL GARG, ABC News Medical Unit
A new set of practice guidelines released Monday by the American Academy of Pediatrics (AAP) may help parents and pediatricians uncover things that go snore in the night.
Pediatric sleep experts focused on children with a condition known as uncomplicated obstructive sleep apnea, which occurs when breathing is interrupted during sleep and is related to enlarged tonsils or obesity. It is a condition the AAP says affects 1.2 to 5.7 percent of American children. They reviewed evidence from 350 study articles between 1999 and 2010 to create the following recommendations:
- Screening: All children and adolescents should be screened for snoring at their routine health visits.
- Sleep testing: Any children who have symptoms of obstructive sleep apnea, such as habitual snoring, disturbed sleep from intermittent pauses, snorts or gasps, or daytime behavioral problems, should be referred for a sleep study.
- Adenotonsillectomy: Any child with obstructive sleep apnea and enlarged tonsils should be referred to a surgeon to consider tonsil removal surgery.
- High risk: A child undergoing tonsil surgery is considered "high-risk" if he or she is under age 3, has severe sleep apnea on sleep testing, is obese or currently has an infection. These children should be closely monitored in the hospital after surgery for any complications.
- Re-evaluation: After surgery, snoring children should be reassessed to see if their sleep apnea has improved or if they will need any further treatments.
- CPAP: If symptoms do not improve after surgery or if a child is unable to get surgery for some reason, they should be considered for CPAP (continuous positive airway pressure), which is a breathing apparatus, often worn at night, that keeps airways open.
- Weight loss: Weight loss is recommended for any overweight or obese patient in addition to any other treatments.
- Intranasal steroids: Nasal sprays are recommended for patients with mild sleep apnea symptoms, whether in lieu of or after tonsil surgery.
The last set of guidelines for pediatric sleep apnea was released in 2002. The changes reflected in these new guidelines were made in light of research over the past 10 years that has suggested that delayed diagnosis of childhood sleep apnea "can result in severe complications if left untreated," according to the American Academy of Pediatrics report. Examples include cognitive deficits, behavior problems, hypertension and heart problems, failure to thrive and inflammation throughout the body.
With these new guidelines, the AAP hopes that more cases of childhood sleep apnea will be diagnosed sooner and children will receive the proper treatments earlier to prevent these dangerous long-term effects.
"These new guidelines are extremely important," says Dr. Vikas Jain, a sleep specialist at Integris Health in Oklahoma City.
"Pediatric sleep apnea is a rising problem among American children and leads to serious consequences," he says. "The sooner we can diagnose a child with this condition, the sooner we can get these kids started on the right treatments to improve their quality of life and their overall health."