Focus area: Physicians
ERS statement on Obstructive Sleep Disordered Breathing in 1- to 23-month-old children
The European Respiratory Society (ERS) has produced a nice document on diagnosis and management of sleep disordered breathing in 1- to 23-month-old children, focusing on obstructive type.
The Obstructive Sleep Disordered Breathing in children aged < 2 years represents a unique subgroup because of higher frequency of symptoms during wakefulness and impact on somatic growth. There are also differences about the causes of obstruction (syndromes, congenital anatomical abnormalities, genetic diseases), leading to different therapeutic options.
This statement is organised in clinically relevant questions (topics), followed by evidence summary and literary review. There is also a flow-chart that describes a stepwise approach to the management of suspected OSAS (Obstructive Sleep Apnoea Syndrome); it could be useful into clinical practice.
It starts from recognition of children at risk for OSAS (symptoms of upper airway obstruction, anatomical abnormalities or syndromes), analyzing possible presence of comorbidities, to arrive at diagnosis and at assessment of its severity (through polysomnography, nocturnal oximetry and multidisciplinary evaluations). After diagnosis, the statement suggests us when OSAS should be treated (sometimes it is required in emergency, for some malformative or syndromic diseases) and what kind of treatment is the best according to underlying conditions (adenoidectomy, CPAP, NPPV, surgical intervention, tracheostomy). Lastly, must not underestimate the importance of follow-up, both to assess the treatment efficacy both to recognize early its possible failure.
Kaditis AG, Alonso Alvarez ML, Boudewyns A, et al. ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children. Eur Respir J 2017; 50: 1700985