Obstructive sleep apnoea syndrome in children

Obstructive sleep apnoea syndrome (OSAS) is defined as the occurrence of repeated episodes of airway obstruction, partially or completely, during sleep. Screening for this syndrome is essential during the preoperative assessment, beginning with the question: does your child snore? The diagnosis is based on nocturnal and daytime clinical symptoms, and clinical scores to assess the severity of OSAS. Physical examination of the child should identify airway obstruction, and ENT examination must evaluate the severity of this obstruction by nasofibroscopy. Three types of OSAS are described in children: type 1 in young, non-overweight children with adenotonsillar hypertrophy, type 2 in overweight children with less adenotonsillar hypertrophy, type 3 in children with neurological, muscular or skeletal pathologies with craniofacial abnormalities. The achievement of polysomnography depends on the clinical assessment, and is not routinely recommended in type 1 and 2 OSAS. Anaesthetic management of children with moderate OSAS does not differs from the usual one. In severe OSAS, preoperative management may include non-invasive ventilation, and the risk of perioperative respiratory complications is increased. The use of opioids analgesics in children with severe OSAS should be cautious because of increased opioid sensitivity, leading to high risk of respiratory depression.