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The childhood obstructive sleep apnea syndrome is a common and serious problem. Adenotonsillectomy remains the mainstay of treatment. Nasal continuous positive airway pressure is effective and well tolerated in those who do not respond to adenotonsillectomy. In selected cases, additional surgery or supplemental oxygen (with careful monitoring) may play a role. New guidelines for pediatric polysomnography should help standardize methods, thus enabling a better comparison of outcomes. More research in this area is sorely needed.