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Eur Respir J. 2016 Jan;47(1):69-94. doi: 10.1183/13993003.00385-2015. Epub 2015 Nov 5.

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management.

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Pediatric Pulmonology Unit, First Dept of Paediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
Multidisciplinary Sleep Unit, Pulmonology, University Hospital of Burgos and CIBER of Respiratory Diseases (CIBERES), Burgos Foundation for Health Research, Burgos, Spain.
Dept of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.
Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece.
Division of Paediatric Pulmonology, Marmara University, Istanbul, Turkey.
Erasmus MC, Sophia Children's Hospital, Paediatric Intensive Care, Rotterdam, The Netherlands.
Paediatric Pulmonology Unit, Dept of Paediatrics, University Autonoma of Barcelona, Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain.
Sleep and Epilepsy Centre, Neurocentre of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland.
Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Paediatric Sleep Centre, Robert Debré University Hospital, EA 7334 REMES Paris-Diderot University, Paris, France.
Pediatric Pulmonology Unit, First Dept of Paediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece.
Sleep Medicine Centre, Kempenhaeghe Foundation, Heeze, The Netherlands.
Pediatric Sleep Disease Centre, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy.
Paediatric Intensive Care Unit, Dept of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands.
Dept of Ophthalmology, Otolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, São Paulo, Brazil.
Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium.


This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h(-1), those with an AHI of 1-5 episodes·h(-1) and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7).

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