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Obstructive Sleep Apnoea — RACP Paediatrics MCQ

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ModerateRespiratoryObstructive Sleep ApnoeaRACP Paediatrics

A 6-year-old boy with a history of atopy presents with chronic nasal obstruction, mouth breathing, and snoring. On examination, he has hyponasal speech and an adenoid facies. His parents report he has poor concentration at school. A sleep study shows an obstructive apnoea-hypopnoea index (OAHI) of 8 events/hour. What is the most appropriate management?

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Correct answer: E — Adenotonsillectomy

An OAHI >5 events/hour in a child with clinical features of obstructive sleep apnoea (OSA) and adenotonsillar hypertrophy is an indication for adenotonsillectomy, which is the first-line treatment for moderate-to-severe paediatric OSA. Intranasal steroids and montelukast may have a role in mild OSA or post-operative residual OSA.

Reference: Australasian Sleep Association – 2024 – Position Statement on Paediatric Obstructive Sleep Apnoea