Expert Consensus Statement: Management of Pediatric Persistent Obstructive Sleep Apnea After Adenotonsillectomy

Author:

Ishman Stacey L.1,Maturo Stephen2,Schwartz Seth3,McKenna Margo4,Baldassari Cristina M.5,Bergeron Mathieu6,Chernobilsky Boris7,Ehsan Zarmina8,Gagnon Lisa9,Liu Yi‐Chun Carol10,Smith David F.11,Stanley Jeffrey12,Zalzal Habib13,Dhepyasuwan Nui14

Affiliation:

1. University of Cincinnati College of Medicine Cincinnati Ohio USA

2. Walter Reed National Military Medical Center Bethesda Maryland USA

3. Virginia Mason Medical Center Seattle Washington USA

4. University of Rochester Medical Center/Golisano Children's Hospital Rochester New York USA

5. Eastern Virginia Medical School/Children's Hospital of the King's Daughter Norfolk Virginia USA

6. Sainte‐Justine Hospital University of Montreal Montreal Quebec Canada

7. NYU Langone Health New York New York USA

8. University of Missouri—Kansas City Kansas City Missouri USA

9. Yale University/Connecticut Pediatric Otolaryngology New Haven Connecticut USA

10. Baylor College of Medicine/Texas Children's Hospital Houston Texas USA

11. Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA

12. University of Michigan Health/Michigan Medicine Ann Arbor Michigan USA

13. Children's National Health System Washington District of Columbia USA

14. American Academy of Otolaryngology—Head and Neck Surgery Foundation Alexandria Virginia USA

Abstract

AbstractObjectiveTo develop an expert consensus statement regarding persistent pediatric obstructive sleep apnea (OSA) focused on quality improvement and clarification of controversies. Persistent OSA was defined as OSA after adenotonsillectomy or OSA after tonsillectomy when adenoids are not enlarged.MethodsAn expert panel of clinicians, nominated by stakeholder organizations, used the published consensus statement methodology from the American Academy of Otolaryngology‐Head and Neck Surgery to develop statements for a target population of children aged 2‐18 years. A medical librarian systematically searched the literature used as a basis for the clinical statements. A modified Delphi method was used to distill expert opinion and compose statements that met a standardized definition of consensus. Duplicate statements were combined prior to the final Delphi survey.ResultsAfter 3 iterative Delphi surveys, 34 statements met the criteria for consensus, while 18 statements did not. The clinical statements were grouped into 7 categories: general, patient assessment, management of patients with obesity, medical management, drug‐induced sleep endoscopy, surgical management, and postoperative care.ConclusionThe panel reached a consensus for 34 statements related to the assessment, management and postoperative care of children with persistent OSA. These statements can be used to establish care algorithms, improve clinical care, and identify areas that would benefit from future research.

Publisher

Wiley

Subject

Otorhinolaryngology,Surgery

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