Syndrome d'apnée obstructive du sommeil de l'enfant : stratégie thérapeutique

Pediatric obstructive sleep apnea syndrome (OSAS) has a multifactorial origin. For the child with no dysmorphic disorders or comorbidities, its main etiology is pharyngeal soft tissue hypertrophy, a dimensional reduction of the facial skeletal frame restricting the airway, an anomaly of muscular tone, or a combination of these factors. Consequently, proper diagnosis and treatment planning for these children can require several medical specialties, according to the complexity, severity, and persistence of OSAS: ear-nose-throat specialists (ENT), pneumologists/allergologists, dentofacial orthopedists/orthodontists, and physical therapists/speech therapists. A workshop was organized so as to establish the treatment strategy for these young patients, the majority of whom cannot access multidisciplinary teams (as very few exist in France), and to create guidelines for specialists in the field. The workshop comprised an orthodontist, a pediatric ENT specialist, and a physical therapist, who led a working group of about 50 physicians. They exchanged experience, discussed publications, and established decision trees about pediatric OSAS. Three main areas were studied, and conclusions are presented in this article: (1) multidisciplinary diagnosis strategy, (2) therapy according to the patient's age, and (3) treatment modality for patients combining adenotonsillar hypertrophy and maxillary transverse deficiency.