Apnées obstructives du sommeil chez l'enfant. Diagnostic et prise en charge

Children obstructive sleep apnoea (OSA) is becoming a public health problem. Its incidence (1-4 %) and severity are constantly increasing, in parallel with obesity. It is defined as a disorder of breathing during sleep characterized by total or partial airway obstruction that leads to total (apnoea) or partial (hypopnoea) disruption of normal ventilation despite of persistent respiratory efforts. This causes hypoxaemia, hypercapnia and sleep fragmentation that can lead to significant morbidity. Children with OSA are at higher risk of developing neurocognitive and behavioral disorders. Cardiovascular and metabolic dysfunctions are also more likely, correlated with OSA's severity. Polysomnography is the gold standard for diagnosis and severity assessment of OSA. Airway enlargement by adenotonsillectomy is the mainstay of therapy. Perioperative complications such as hypoxaemia and obstruction are more common in children with severe OSA. Therefore, a thorough understanding of the pathophysiology of OSA is required. Meticulous preoperative assessment with careful attention to clinical risk factors, a tailored intraoperative and postoperative management are essential to improve the outcome. Careful titration of opioids and wide co-administration of non-opioid analgesics adjuncts are recommended. Non-invasive ventilation by continuous positive pressure is increasingly used in children with severe OSA or in case of residual OSA after adenotonsillectomy.