Why Teens with OSA Shouldn’t Be Treated Like Adults, with Binal Kancherla, MD

At SLEEP 2025, the 39th annual meeting of the Associated Professional Sleep Societies, on Monday, June 9th, in Seattle, Binal Kancherla, MD, from Baylor College of Medicine, talked about the trickiness of treating obstructive sleep apnea (OSA) in adolescents. Should you use pediatric or adult criteria?

“I think adolescence is a difficult time in life where there is that transition into adulthood, and a lot of their diagnoses and treatment can look like what adults are doing, but it's not necessarily exactly the same,” Kancherla told HCPLive at the meeting.

Many teenagers want autonomy over their treatments. Since they are still minors, Kancherla said it is important to use a family approach, letting the teen be involved in their treatment plan. Kancherla believes adolescent OSA should be managed with pediatric care.

“Considering teenagers as small adults is not the right thing to do,” she added. “Using pediatric criteria is important because we know that adolescents can continue to grow and develop up to age 18. So many centers, up to at least a minimum of 17 years of age, will use pediatric criteria when treating children. If you're using adult criteria under 17 years, you run the risk of missing certain things in the diagnosis.”

Children have fewer OSA requirements for starting treatment than the adult population. Yet, despite fewer requirements, even just a little bit of sleep apnea in children can lead to long-term growth and development consequences. The same can apply to adolescents.

When it comes to adolescents, developmental and anatomical factors, such as puberty-related changes in airway size, body mass index (BMI), and sleep architecture, can complicate the interpretation of sleep study results. During puberty, children do not just undergo linear growth but also weight gain, and obesity is known as a risk factor for sleep apnea.

Teenagers also experience airway anatomical changes, with the airway developing up to age 13 or 14 years in females and age 16 years in males.

“The important thing to remember is that there can be a high degree of variability in the diagnosis of OSA in these ages, and therefore it's important to do frequent follow-up,” Kancherla said.

References

Majid R, Kancherla B, and Wani A. Adult or Pediatric? Diagnostic and Treatment Dilemmas when Managing Teen OSA. Presented at SLEEP 2025, the 39th annual meeting of the Associated Professional Sleep Societies, on Monday, June 9th, in Seattle, Washington.