Effectiveness of Conservative Management Strategies in Reducing Symptoms of Pediatric Obstructive Sleep Apnoea

ABSTRACT: Conservative management strategies for pediatric obstructive sleep apnoea (OSA) have gained increasing importance as alternatives or adjuncts to surgical treatment, particularly in children with mild disease or contraindications to surgery. This narrative review synthesizes the evidence from eight studies evaluating pharmacologic, orthodontic, weight management, and other non-invasive therapies. Combination pharmacologic approaches, such as intranasal steroids with montelukast or leukotriene receptor antagonists, demonstrated significant reductions in the apnea–hypopnea index (AHI) by up to 70% and improvements in symptom scores within treatment durations ranging from six weeks to six months. Rapid maxillary expansion was associated with AHI reduction of 5.7 events/hour and oxygen saturation increases of 2.6% in anatomically suitable children. Continuous positive airway pressure in infants yielded AHI reductions of up to 92%, though adherence challenges limited widespread applicability. Weight loss interventions and oral appliances showed benefits in obese children and those with dental malocclusions, respectively, though long-term sustainability was limited. Overall, conservative measures provided meaningful benefits in symptom reduction and quality of life, with greatest evidence supporting pharmacologic and orthodontic approaches. However, heterogeneity in patient selection, intervention protocols, adherence, and outcome measures restricted generalizability. Future research requires well-designed randomized controlled trials with standardized reporting to determine optimal intervention strategies. Keywords: Obstructive Sleep Apnoea, Pediatrics, Conservative Management, Intranasal Steroids, Rapid Maxillary Expansion, Continuous Positive Airway Pressure