Interventions for obstructive steep apnea in children: A systematic review

Background: Obstructive steep apnea (OSA) is characterized by habitual snoring, heavy breathing, steep-related hypoxia and arousals from steep, and is found in approximately 3% of children. Objective: To review the efficacy of medical, behavioral, mechanical and surgical interventions in improving OSA in children. Methods: Bibliographic databases, relevant conference proceedings and trial registers were searched. Randomized controlled trials assessing interventions in children with objectively diagnosed OSA (as per polysomnography; apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) >= 1/h) were considered. Results: The search identified 1690 potentially relevant studies. The five trials that met the inclusion criteria investigated seven different interventions (intranasal steroids, adenotonsillectomy, maxillary distraction, temperature-controlled radio-frequency ablation, oral appliances, continuous and bilevel positive airway pressure therapy). Intranasal steroids had a significant advantage over placebo in decreasing the AHI (one study). Temperature-controlled radiofrequency ablation and adenotonsillectomy were equally effective in reducing the RDI (one study). Continuous and bilevel positive airway pressure therapy was equally effective in reducing the AHI (one study). There was insufficient evidence to support the use of oral appliances. Conclusions: Despite a broad array of treatment options for OSA, there is limited evidence to support their use. More research is needed before general recommendations can be made. (C) 2008 Elsevier Ltd. All rights reserved.