Consensus strategies for diagnosis and management of pediatric osa in brazil: pilot report

Introduction: Obstructive breathing disorders are highly prevalent in the pediatric population, several guidelines proposing management of obstructive sleep apnea (OSA) diagnosis and multi-professional treatment. However, Brazil is a low-resource country with heterogenous access to complex diagnosis strategies, with the needs of adjusted strategies. Aims: to elaborate a multi-professional consensus for the diagnosis and management of OSA in children adapted for the Brazilian reality. Methods: A multi-professional group (otolaryngologists, dentists, speech-language therapists, physiotherapists and psychologists) of 2 universities at Sao Paulo State, Brazil, elaborated a protocol of domains and questions to be submitted to a major group of specialists for consensus analysis, based on the Delphi Method. Results: A multi-professional group of 28 specialists were invited to discuss the questions elaborated by the consensus group. Six domains for consensus elaboration were defined: anamnesis, physical examination, complementary exams of the upper airway, polysomnography or similar, multi-level treatment. For each domain, 4 to 5 questions were elaborated with answers based on best clinical evidence and on real-life feasibility. Conclusion: Delphi method attended the necessity for question elaboration and judgement. Multi-professional discussion showed to be important for defining best clinical practice for the Brazilian reality. Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, et al. Clinical Practice Guideline: Tonsillectomy in Children (Update)-Executive Summary. Otolaryngol Head Neck Surg 160 (2019) 187-205 doi:10.1177/0194599818807917.