The Medical journal of Australia
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Obstructive sleep apnoea (OSA) determined by polysomnography is highly prevalent, affecting about 25% of men and 10% of women in the United States, although most have few or no symptoms. Symptomatic moderate to severe OSA has major health implications related to daytime sleepiness, such as increased accidents, altered mood and loss of productivity in the workplace. Severe OSA may increase the risk of cardiovascular disease independent of daytime sleepiness. ⋯ However, these services may not always be easy to access. Controlled studies have shown that patients with a high pretest probability of symptomatic, moderate to severe OSA can be managed well in primary care, or by skilled nurses with appropriate medical backup, using simplified ambulatory models of care. The future of sleep apnoea assessment and management will likely include models of care that involve early referral to specialists of patients with complex or atypical presentations, and an upskilled and supported primary care workforce to manage symptomatic, uncomplicated, high pretest probability disease.
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Sleep disorders are very common in childhood and are often amenable to simple advice and parental education. Questions about sleep should be an integral part of every paediatric consultation. Children with underlying syndromes or complex medical conditions often have multiple sleep issues. ⋯ Children with obesity and other comorbid conditions are at increased risk of persisting OSA despite adenotonsillectomy. Topical (nasal) steroids and/or anti-inflammatory agents have a role in the non-surgical treatment of mild OSA. Continuous positive airway pressure and orthodontic interventions are treatment options for treatment of persisting OSA in children.