A 5-year-old child has been snoring nightly for 1 year. Parents report observed apneas and the child has been restless during sleep with enuresis. Polysomnography shows an AHI of 8 events/hour. The best definitive management is:
- A Adenotonsillectomy ✓
- B Continuous positive airway pressure (CPAP) therapy
- C Montelukast and intranasal steroids for 3 months
- D Weight loss counselling and sleep hygiene
Correct answer: A. Adenotonsillectomy
Explanation
Pediatric obstructive sleep apnea with AHI ≥5 events/hour in children with adenotonsillar hypertrophy is best treated with adenotonsillectomy as the first-line surgical intervention. This resolves OSA in approximately 70-80% of otherwise healthy, non-obese children. CPAP is an alternative when surgery is contraindicated or for residual OSA post-surgery. Medical therapy with montelukast/intranasal steroids is considered for mild OSA (AHI 1-5) or as temporizing treatment.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.