Abstract
ABSTRACT
Introduction
Screening and treatments for pediatric obstructive sleep apnea (pOSA) often use adult symptoms and conventional surgical approaches. This study tested the hypothesis that symptoms and treatment efficacy for OSA differ across age groups.
Methods
Single‐center cohort study of 0 to 18‐year‐olds who were managed and underwent polysomnography (PSG) in a pediatric‐dedicated sleep medicine center from 2020 to 2024.
Results
Of 491 children, 489 had pOSA, 57.7% were male, the median age was 6 years old (IQR1‐3, 4–9), and 41% already had an adeno‐ or adenotonsillectomy prior to the PSG. Only 15.6% were obese, and 13.2% had an Epworth Sleepiness Score over 10. Snoring was not the most prevalent nocturnal symptom: restlessness (91.6%), chronic insomnia (86.1%), kicking legs (82.0%), and frequent awakening (78.4%) were all more common. Neurocognitive issues, present in 93.7%, were most commonly mood swings (86.5%) and ADHD (51.9%). Of the 270 without surgery before the PSG, 72.2% (
n
= 195) were referred, and 173 had surgery. Positive airway pressure (PAP) was prescribed for 240 (49.1%) patients, 176 (73%) of whom had enough CPAP usage to provide machine‐estimated apnea‐hypopnea index (AHI). After adenotonsillectomy, 27.0% had a post‐operative AHI under 5 events per hour, and 73.1% had improvement in neurocognitive issues while that was 94.9% and 87.2% in those using PAP, respectively. After adjusting for age and AHI, PAP had threefold (aOR 3.85, 95%CI 1.39–10.67) higher odds of improving neurocognitive issues than surgery,
p
= 0.010.
Conclusions
The majority of children with pOSA are not tired or obese. Insomnia and restless sleep are more common than snoring. Daytime neurocognitive issues affect almost all children with pOSA and improve with treatment, especially PAP.