{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T02:10:13Z","timestamp":1792030213000,"version":"4.4.0"},"reference-count":131,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T00:00:00Z","timestamp":1752192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Obstructive sleep apnea syndrome (OSAS) in children and adolescents is a prevalent and multifactorial disorder associated with significant short- and long-term health consequences. While adenotonsillectomy (AT) remains the first-line treatment, a substantial proportion of patients\u2014especially those with obesity, craniofacial anomalies, or comorbid conditions\u2014exhibit persistent or recurrent symptoms, underscoring the need for individualized and multimodal approaches. This review provides an updated and comprehensive overview of current and emerging treatments for pediatric OSAS, with a focus on both surgical and non-surgical options, including pharmacological, orthodontic, and myofunctional therapies. A narrative synthesis of recent literature was conducted, including systematic reviews, randomized controlled trials, and large cohort studies published in the last 10 years. The review emphasizes evidence-based indications, mechanisms of action, efficacy outcomes, safety profiles, and limitations of each therapeutic modality. Adjunctive and alternative treatments such as rapid maxillary expansion, mandibular advancement devices, myofunctional therapy, intranasal corticosteroids, leukotriene receptor antagonists, and hypoglossal nerve stimulation show promising results in selected patient populations. Personalized treatment plans based on anatomical, functional, and developmental characteristics are essential to optimize outcomes. Combination therapies appear particularly effective in children with residual disease after AT or with specific phenotypes such as Down syndrome or maxillary constriction. Pediatric OSAS requires a tailored, multidisciplinary approach that evolves with the child\u2019s growth and clinical profile. Understanding the full spectrum of available therapies allows clinicians to move beyond a one-size-fits-all model, offering more precise and durable treatment pathways. Emerging strategies may further redefine the therapeutic landscape in the coming years.<\/jats:p>","DOI":"10.3390\/children12070919","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T15:19:31Z","timestamp":1752247171000},"page":"919","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Three Decades of Managing Pediatric Obstructive Sleep Apnea Syndrome: What\u2019s Old, What\u2019s New"],"prefix":"10.3390","volume":"12","author":[{"given":"Beatrice","family":"Panetti","sequence":"first","affiliation":[{"name":"Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Federico","sequence":"additional","affiliation":[{"name":"Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5245-4843","authenticated-orcid":false,"given":"Giuseppe Francesco","family":"Sferrazza Papa","sequence":"additional","affiliation":[{"name":"Department of Neurorehabilitation Sciences, Casa di Cura Igea, 20144 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7336-4292","authenticated-orcid":false,"given":"Paola","family":"Di Filippo","sequence":"additional","affiliation":[{"name":"Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armando","family":"Di Ludovico","sequence":"additional","affiliation":[{"name":"Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Di Pillo","sequence":"additional","affiliation":[{"name":"Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Chiarelli","sequence":"additional","affiliation":[{"name":"Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7925-2934","authenticated-orcid":false,"given":"Alessandra","family":"Scaparrotta","sequence":"additional","affiliation":[{"name":"Unit of Pediatrics, Local Health Authority (ASL), 65126 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6513-3160","authenticated-orcid":false,"given":"Marina","family":"Attanasi","sequence":"additional","affiliation":[{"name":"Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e714","DOI":"10.1542\/peds.2012-1672","article-title":"Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome","volume":"130","author":"Marcus","year":"2012","journal-title":"Pediatrics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s00408-020-00342-5","article-title":"Evaluation and Management of Children with Obstructive Sleep Apnea Syndrome","volume":"198","author":"Bitners","year":"2020","journal-title":"Lung"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1007\/s00405-024-09071-4","article-title":"Association of Adenoid Hypertrophy and Clinical Parameters with Preoperative Polygraphy in Pediatric Patients Undergoing Adenoidectomy","volume":"282","author":"Lein","year":"2025","journal-title":"Eur. 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