Obstructive Sleep Apnea Syndrome (OSAS) exists when the upper airway becomes narrowed to the point of obstruction during sleep. While patients with OSAS generally have large body mass, this is not always the case. Other anatomic variables and/or neuromuscular issues can also be involved. Symptoms and signs of OSAS include loud snoring, daytime sleepiness, frequent headaches (generally in the AM) and witnessed nocturnal gasping and transient obstructions. Evaluation for OSAS includes a detailed history and physical examination, including a trans-nasal endoscopic examination to assess the anatomic features and functional tendencies of the individual patientʼs upper airway. When OSAS is suspected, patients are referred for an overnight sleep study. Aside from weight loss to an appropriate body mass, the “Gold Standard” treatment for OSAS of moderate severity or worse is continuous positive airway pressure (CPAP) therapy, in which a machine is used nightly to apply air under pressure to the upper airway, effectively holding it open and thereby preventing obstruction. The air pressure is generally applied via a mask that is worn over the nose or nose and mouth. Other treatments include oral appliance therapy, which work by pulling the jaw and tongue forward to allow improved airﬂow. Surgery by itself is generally most successful as a curative measure for patients with relatively mild OSAS, and may include removal of the tonsils with or without the adenoid, and uvulopalatopharyngoplasty to shorten the soft palate and widen the oral pharynx. Nasal surgery may also be recommended to serve as an adjunct to these procedures or to lower the upper airwayʼs resistance to airﬂow, allowing CPAP to be applied at a lower and more tolerable pressure. This can sometimes be the difference between success and failure in the treatment of a patient with severe OSAS.
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For more information on pediatric OSAS, click this link.