CHEST Guidelines-Response_chest

Response_chest_16

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In a correspondence published in CHEST (December 2014), Drs. Nadav Traeger and Priya S. Prashad comment on a recent article by Kheirandish-Gozal et al. that explores anti-inflammatory therapy as an alternative to surgery for treating mild pediatric obstructive sleep apnea (OSA). They highlight the significance of anti-inflammatory treatments and suggest a shift in treatment focus for specific patients from surgical to medical approaches. The article by Kheirandish-Gozal et al. stands out for its thorough methodology, involving a large number of subjects and the use of repeated polysomnograms, although Drs. Traeger and Prashad urge further studies to confirm these findings.<br /><br />Traeger and Prashad inquire about the reliability of clinical symptom evaluations post-treatment, questioning whether symptoms can effectively predict the persistence or resolution of OSA in the absence of polysomnogram re-evaluations. They seek clarification on whether clinical symptoms can reliably indicate residual OSA after treatment with anti-inflammatory medication.<br /><br />In response, Drs. David Gozal and Leila Kheirandish-Gozal appreciate the feedback and acknowledge the raised issue as clinically significant. They admit that due to the retrospective nature of their study, a definitive answer cannot be provided. However, they point to past research suggesting that the persistence of clinical symptoms often does not correlate accurately with residual OSA, particularly post-surgical treatments like adenotonsillectomy (T&A). They identify specific high-risk groups, such as obese or older children, who may exhibit residual OSA post-treatment. They advocate for multicenter efforts to develop diagnostic tools that incorporate both clinical symptoms and physical findings to better detect and treat OSA in children.

Keywords

pediatric obstructive sleep apnea

anti-inflammatory therapy

surgery alternative

clinical symptom evaluation

polysomnograms

residual OSA

adenotonsillectomy

high-risk groups

diagnostic tools

multicenter studies