Obstructive sleep apnea syndrome in children: Epidemiology, pathophysiology, diagnosis and sequelae

Abstract

The prevalence of pediatric obstructive sleep apnea syndrome (OSAS) is approximately 3% in children. Adenotonsillar hypertrophy is the most common cause of OSAS in children, and obesity, hypotonic neuromuscular diseases, and craniofacial anomalies are other major risk factors. Snoring is the most common presenting complaint in children with OSAS, but the clinical presentation varies according to age. Agitated sleep with frequent postural changes, excessive sweating, or abnormal sleep positions such as hyperextension of neck or abnormal prone position may suggest a sleep-disordered breathing. Night terror, sleepwalking, and enuresis are frequently associated, during slow-wave sleep, with sleep-disordered breathing. Excessive daytime sleepiness becomes apparent in older children, whereas hyperactivity or inattention is usually predominant in younger children. Morning headache and poor appetite may also be present. As the cortical arousal threshold is higher in children, arousals are not easily developed and their sleep architectures are usually more conserved than those of adults. Untreated OSAS in children may result in various problems such as cognitive deficits, attention deficit/hyperactivity disorder, poor academic achievement, and emotional instability. Mild pulmonary hypertension is not uncommon. Rarely, cardiovascular complications such as cor pulmonale, heart failure, and systemic hypertension may develop in untreated cases. Failure to thrive and delayed development are serious problems in younger children with OSAS. Diagnosis of pediatric OSAS should be based on snoring, relevant history of sleep disruption, findings of any narrow or collapsible portions of upper airway, and confirmed by polysomnography. Early diagnosis of pediatric OSAS is critical to prevent complications with appropriate interventions.

Quality of life and sleep in obese adolescents

“…Obesity is a major risk factor for the OSA, with body mass index (BMI), visceral fat and neck circumference being important predictors of its clinical expression. Reduced overall performance in adolescents stems directly from this condition 8,9 .…”

Clinical symptoms and related factors of obstructive sleep apnea among overweight and obese taxi drivers

“…24 Some studies stated that tonsil and adenoid hypertrophy are major risk factors for OSA in children. 5,26 Hypertension status in subjects with OSA and non-OSA had no significant difference. This result was consistent with the study of Wiadnyana et al 17 that concluded the absence of correlation between hypertension and suspected OSA.…”

Need for standard outcome reporting systems in craniosynostosis

“…Patients with OSA usually, but not always, present with suggestive signs and symptoms, such as loud breathing, snoring, poor feeding, hyperactivity, hypersomno- lence, behavorial problems, and poor quality of life 2 or failure to thrive. 6,21,23 However, OSA can be insidious and must be ruled out when any patient with craniosynostosis is evaluated. While there are a variety of traditional ways to assess OSA (Table 2), recently Bannink et al 3 developed the first OSA-specific QOL questionnaire (OSA-18) to address the impact of OSA in patients with syndromic craniosynostosis.…”