S10 Management of the child with primary snoring

Summary

This symposium aims to discuss the management of children with an objective diagnosis of primary snoring, considering the natural history of primary snoring, associated comorbidities, and scientific evidence on surgical and non-surgical treatment for this condition.

The natural history of primary snoring and risk factors for disease progression will be presented by Dr. Ersu.

Dr Nixon will discuss the medical management of primary snoring, including evidence for treatment with intranasal corticosteroids. New data on non-surgical treatment of obstructive sleep-disordered breathing without objective assessment by polysomnography will also be presented. 

Dr Chan will address comorbidities in snoring children. Primary snoring, although without polysomnographic evidence of abnormal gas exchange or alterations of sleep architecture, has been found to be associated with cardiovascular and neurocognitive morbidities. Evidence has challenged the benignity of PS which also paves the way for further studies for risk factors identification and treatment options.

The surgical treatment options for children with primary snoring will be presented by Dr Benedek. The main cause of primary snoring in children is (adeno)tonsillar hypertrophy; therefore (adeno)tonsillectomy is considered the first line surgical treatment. Other surgical options for the treatment of primary snoring include surgery of the nose (i.e. nasal turbinate reduction), and multiple types of tonsil surgery (because of the reduced postoperative pain and hemorrhage, tonsillotomy could be an option). Drug induced sleep endoscopy should be considered if there is no evident adenotonsillar hypertrophy and may reveal lower airway obstruction such as flutter/collapse of the epiglottis or laryngomalacia as a cause of

'snoring-like sounds'.

Dr Lildal will look into the future and present some recent insights on the role of biomarkers. Patients with similar severity of OSA, based on AHI, may present different clinical manifestations and co-morbidities, just as a subset of simple snorers may present with comorbid conditions similar to OSA patients. 

The advances in proteomics studies have opened new perspectives in the pursuit of the ideal biomarker in pediatric OSA, showing significant differences in OSA proteome profile compared to controls.

Though the field of biomarkers in pediatric sleep disordered breathing is still at its infancy, candidate markers taking into account the end-organ risk associated with the disease, may hold the key to answering the questions of when and how to treat primary snorers, and how the adequacy of treatment response should be monitored.

Learning Objectives

Upon completion of this CME activity, participants should be able to:

• Recognize the natural history of primary snoring and be able to identify risk factors in an individual child that may predict progression to obstructive sleep apnea
• Recognize the presence of comorbidities in a subset of children with primary snoring and understand how the presence of these comorbidities may affect long-term outcomes and may favor early treatment of primary snoring
• Identify children with primary snoring in whom a watchful waiting policy is justified
• Estimate the value of medical and surgical treatment options for primary snoring
• Recognize the role of biomarkers in the management of primary snoring

Target Audience

Pediatricians, ENT surgeons, sleep technicians

Chair

An Boudewyns (Belgium)

Prevalence and history of primary snoring

Refika Ersu (Canada)

Comorbidities in children with primary snoring

Kate Chan (Hong Kong)

Medical treatment of primary snoring

Gillian Nixon (Australia)

Surgical treatment of primary snoring

Palma Benedek (Hungary)

What can biomarkers tell us in the child with primary snoring?

Tina Lildal (Denmark)