What is the first-line treatment for pediatric sleep apnea?

Adenotonsillectomy is considered the first-line treatment for pediatric sleep apnea, especially in cases where the condition is primarily associated with adenotonsillar hypertrophy. In many children, the enlargement of the tonsils and adenoids can obstruct the airway during sleep, leading to obstructive sleep apnea. Surgical removal of these structures often resolves the obstructive events and significantly improves sleep quality and overall health, leading to better daytime functioning.

While continuous positive airway pressure (CPAP) is an effective treatment option for adults and can be used in children, it is typically not the first-line approach in pediatric cases. Weight management can help in children who are overweight, as obesity can contribute to the severity of sleep apnea, but it is not a standalone treatment. Oral appliances are also used predominantly for adults to treat mild to moderate obstructive sleep apnea but are less common in children, primarily due to development and anatomical considerations.

Thus, the primary recommendation for pediatric patients with obstructive sleep apnea related to enlarged tonsils or adenoids is adenotonsillectomy, making it the most effective first-line intervention in this demographic.