Panetti Beatrice, Federico Claudia, Sferrazza Papa Giuseppe Francesco, Di Filippo Paola, Di Ludovico Armando, Di Pillo Sabrina, Chiarelli Francesco, Scaparrotta Alessandra, Attanasi Marina
Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy.
Department of Neurorehabilitation Sciences, Casa di Cura Igea, 20144 Milan, Italy.
Children (Basel). 2025 Jul 11;12(7):919. doi: 10.3390/children12070919.
Obstructive sleep apnea syndrome (OSAS) in children and adolescents is a prevalent and multifactorial disorder associated with significant short- and long-term health consequences. While adenotonsillectomy (AT) remains the first-line treatment, a substantial proportion of patients-especially those with obesity, craniofacial anomalies, or comorbid conditions-exhibit persistent or recurrent symptoms, underscoring the need for individualized and multimodal approaches. This review provides an updated and comprehensive overview of current and emerging treatments for pediatric OSAS, with a focus on both surgical and non-surgical options, including pharmacological, orthodontic, and myofunctional therapies. A narrative synthesis of recent literature was conducted, including systematic reviews, randomized controlled trials, and large cohort studies published in the last 10 years. The review emphasizes evidence-based indications, mechanisms of action, efficacy outcomes, safety profiles, and limitations of each therapeutic modality. Adjunctive and alternative treatments such as rapid maxillary expansion, mandibular advancement devices, myofunctional therapy, intranasal corticosteroids, leukotriene receptor antagonists, and hypoglossal nerve stimulation show promising results in selected patient populations. Personalized treatment plans based on anatomical, functional, and developmental characteristics are essential to optimize outcomes. Combination therapies appear particularly effective in children with residual disease after AT or with specific phenotypes such as Down syndrome or maxillary constriction. Pediatric OSAS requires a tailored, multidisciplinary approach that evolves with the child's growth and clinical profile. Understanding the full spectrum of available therapies allows clinicians to move beyond a one-size-fits-all model, offering more precise and durable treatment pathways. Emerging strategies may further redefine the therapeutic landscape in the coming years.
儿童和青少年阻塞性睡眠呼吸暂停综合征（OSAS）是一种常见的多因素疾病，会对短期和长期健康产生重大影响。虽然腺样体扁桃体切除术（AT）仍然是一线治疗方法，但相当一部分患者——尤其是那些肥胖、颅面畸形或患有合并症的患者——会出现持续或复发症状，这凸显了采用个性化和多模式治疗方法的必要性。本综述提供了关于小儿OSAS当前和新兴治疗方法的最新全面概述，重点关注手术和非手术选择，包括药物治疗、正畸治疗和肌功能治疗。对最近的文献进行了叙述性综合分析，包括过去10年发表的系统评价、随机对照试验和大型队列研究。该综述强调了每种治疗方式的循证适应症、作用机制、疗效结果、安全性概况和局限性。快速上颌扩弓、下颌前移装置、肌功能治疗、鼻内皮质类固醇、白三烯受体拮抗剂和舌下神经刺激等辅助和替代治疗方法在特定患者群体中显示出有前景的结果。基于解剖、功能和发育特征的个性化治疗计划对于优化治疗结果至关重要。联合治疗在AT后有残留疾病的儿童或患有特定表型（如唐氏综合征或上颌狭窄）的儿童中似乎特别有效。小儿OSAS需要一种量身定制的多学科方法，该方法会随着儿童的成长和临床情况而发展。了解所有可用治疗方法的全貌使临床医生能够超越一刀切的模式，提供更精确和持久的治疗途径。未来几年，新兴策略可能会进一步重新定义治疗格局。
