Skip to main content
AAO-HNSF 2023 Annual Meeting & OTO Experience Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.

Pediatric Otolaryngology

Not Just the Tonsils: Managing OSA in Special Pediatric Populations

Tuesday, October 3, 2023
8:00 AM - 9:00 AM East Coast USA Time
Location: 208AB

    Moderator(s)

  • Nikhila P. Raol, MD, MPH

    Associate Professor of Otolaryngology and Pediatrics
    Emory University Department of Pediatrics, Emory University Department of Otolaryngology, Children’s Healthcare of Atlanta
    Atlanta, GA, United States

    • Panelist(s)

  • David F. Smith, MD, PhD, FACS, FAAP

    Associate Professor
    Cincinnati Children's Hospital Medical Center
    Cincinnati, Ohio, United States

  • Derek J. Lam, MD, MPH

    Associate Professor
    Oregon Health & Science University
    Portland, OR, United States

  • MM

    Mary Musso, DO

    Associate Professor
    Baylor College of Medicine, Texas Children's Hospital
    Houston, TX, United States

    • Moderator(s)

  • EK

    Erin M. Kirkham, MD, MPH

    Assistant Professor - Otolaryngology Head & Neck Surgery
    University of Michigan
    ANN ARBOR, MI, United States

    • Panelist(s)

  • An N. Boudewyns, MD PhD

    Associate Professor Pediatric Otorhinolaryngology
    Antwerp University Hospital, University of Antwerp, Belgium
    Edegem, Antwerpen, Belgium

Disclosure(s):
David F. Smith, MD, PhD, FACS, FAAP: No relevant relationships to disclose.
Erin M. Kirkham, MD, MPH: No relevant relationships to disclose.
An N. Boudewyns, MD: No relevant relationships to disclose.
PROGRAM DESCRIPTION: Pediatric obstructive sleep apnea (OSA) affects 3-5% of the general pediatric population in the United States. However, in specific populations, the prevalence can be much higher. For example, in cerebral palsy the prevalence is over 50%, and in Trisomy 21, nearly all patients are diagnosed with OSA during their lifetimes. In otherwise healthy children, adenotonsillectomy is curative in approximately 70% of patients, but in patients with particular diseases and syndromes, the management is more complex and often requires both medical and surgical interventions. In Trisomy 21, adenotonsillectomy results in a 51% decrease in the average apnea-hypopnea index. Simultaneously, these children have a 33% prevalence of periodic limb movement disorders, potentially impacting their sleep quality.

When managing special populations with OSA, care should be taken to ensure that other aspects of the patient’s medical condition are considered. The goals of this panel discussion are to introduce the otolaryngologist to special considerations for managing pediatric OSA in patients with complex diseases and syndromes, and help them determine when referral to specialty care, including sleep medicine and neurology, would be indicated before considering surgery. This panel will discuss key concepts in approaching OSA within the context of a pediatric patient with the particular conditions of Trisomy 21, cerebral palsy, mucopolysaccharidoses, autism, epilepsy, and other genetic syndromes, focusing on 1) surgical OSA management beyond adenotonsillectomy, 2) concomitant non-obstructive sleep disorders that often affect these patients, and 3) factors relating to the underlying disease processes that can impact clinical sequelae associated with OSA. These concepts will be illustrated using high-quality studies from otolaryngology, as well as other specialties.

OUTCOME OBJECTIVE 1: Understand non-anatomic factors impacting OSA in special pediatric populations

OUTCOME OBJECTIVE 2: Recognize the limitations to adenotonsillectomy in these populations

OUTCOME OBJECTIVE 3: Identify which patients would benefit from non-surgical intervention prior to considering surgery.

BACKGROUND STATEMENT: Obstructive sleep apnea has a high prevalence in pediatric populations with certain syndromes/diseases, often sub-optimally treated with T&A. This program will help otolaryngologists gain confidence in approaching these special populations in their practice.