Obstructive Sleep Apnea in Adolescence

Abstract

Obstructive sleep apnea (OSA) in adolescent patients is becoming increasingly common with the rise in obesity rates. Management of these patients is less straightforward than management in younger children or older adults, as there are substantial rates of treatment failure following adenotonsillectomy. This may be due to either alternate or multiple anatomic sites of airway collapse. Adenotonsillectomy remains first-line treatment, although vigilance and close follow-up are required, and formal assessment with repeat polysomnography is often necessary to confirm disease resolution. Second-line therapy for residual OSA is continuous positive airway pressure therapy (CPAP), which is often poorly tolerated in this age group. Due to changes in muscle tone during sleep, culprit sites of airway collapse during sleep are often difficult to visualize during nasal endoscopy performed in the clinic. Drug-induced sleep endoscopy (DISE) is a valuable tool to identify occult or multisite airway obstruction in this population, and guide surgical planning. A comprehensive approach to the patient’s sleep is essential, recognizing the potential contributions of comorbid circadian sleep disorders and poor sleep hygiene.