Obstructive sleep apnea syndrome (OSA) in adolescents: therapeutic management

¹ Pediatric Noninvasive Ventilation and Sleep Unit, Necker University Pediatric Hospital, Public Assistance – Paris Hospitals  
² Paris Descartes University  
³ INSERM U955, Team 13, Créteil  
⁴ Pediatric ENT Surgery Department, Necker University Pediatric Hospital, Public Assistance – Paris Hospitals  
⁵ Pediatric Plastic and Maxillofacial Surgery Department, Necker University Pediatric Hospital, Public Assistance – Paris Hospitals  
⁶ Pediatric Neurosurgery Department, Necker University Pediatric Hospital, Public Assistance – Paris Hospitals  
⁷ ASV Santé, Gennevilliers  

Address for correspondence: Brigitte Fauroux – Children’s Noninvasive Ventilation and Sleep Unit – Necker University Pediatric Hospital – 149 rue de Sèvres – 75015 Paris. E-mail: brigitte.fauroux@aphp.fr

Received: 27 July 2017
Accepted: 30 August 2017

Abstract

Obstructive sleep apnea (OSA) in adolescents is characterized by a predominance of OSA type 2 which is associated with overweight/obesity. The treatment of OSA in adolescents depends on the cause of OSA and its risk and / or precipitating factors. Adenotonsillectomy is the cornerstone of OSA treatment in case of hypertrophy of the adenoids and/or tonsils. An anti-inflammatory treatment has proven its efficacy in mild to moderate or mild residual OSA after adenotonsillectomy. Orthodontic treatments such as rapid maxillary expansion or jaw positioning are indicated in case of dentofacial disharmonies. Continuous positive airway pressure (CPAP), is mainly indicated in type-3 OSA, which is associated with craniofacial or upper airway malformations or anomalies and should be performed by a pediatric multidisciplinary team having an expertise in sleep and OSA. Finally, maxillofacial or craniofacial surgery may be indicated in adolescents with type-3 OSA. In conclusion, the treatment of OSA in adolescents is based on the type of OSA, its severity and the medical characteristics of each patient.