Physiological effects of obstructive sleep apnea syndrome in childhood

Abstract

Sleep disordered breathing in children refers to a group of respiratory disorders that occur or are exacerbated during sleep. Obstructive sleep apnea syndrome (OSAS) is one of the most significant disorders in this group. OSAS can present in all age groups from early infancy to adolescent years. The cardinal feature of OSAS is limitation of inspiratory flow and volume during sleep resulting in abnormal gas exchange and/or alteration of sleep patterns. When OSAS is a chronic condition it often results in adverse physiological effects that impact on health and development. The present review discusses genesis of OSAS in children and consequent end organ injury with special emphasis on behavior and cognition, cardiovascular function, autonomic regulation, inflammation, endothelial function and metabolic syndrome.

The Effects of Obstructive Sleep Apnea Syndrome on the Dentate Gyrus and Learning and Memory in Children

“…atrophy of widespread brain regions (Macey et al, 2002;Morrell et al, 2003;Huynh et al, 2014), hippocampal damage (Bartlett et al, 2004;Fung et al, 2007), and cognitive deterioration (Décary et al, 2000;Kielb et al, 2012) in OSAS. An early study in children with OSAS (aged 6 -16 years) reported a decrease in neuronal metabolites (N-acetyl aspartate/choline ratio) in the hippocampus and decrements in neuropsychological measures (note that brain-behavioral relationships were not reported in this study; Halbower et al, 2006).…”

“…Recent neuroimaging studies focusing on the brain and using magnetic resonance imaging (MRI) and magnetic resonance spectroscopic imaging have shown significant changes in gray and white matter in both adults and children with OSAS (Macey et al, 2002;Morrell et al, 2010;Chan et al, 2014;Kumar et al, 2014), particularly in hippocampus and prefrontal cortex (Halbower et al, 2006;Torelli et al, 2011;O'Donoghue et al, 2012), which play important roles in memory, executive function, and motor regulation of breathing, respectively. However, the linkages between these findings, neurocognitive abnormalities, and OSAS remain understudied.…”

An Official American Thoracic Society Statement: The Importance of Healthy Sleep. Recommendations and Future Priorities

“…Volumetric measurements suggest that the adenoids and tonsils are significantly increased in children with OSA compared with matched control subjects, concomitant with smaller upper airway and larger soft palate volumes adding additional restriction to the airway lumen size (83,84). Therapy for OSA in children may involve surgery (e.g., adenotonsillectomy), positive pressure ventilation, oral appliances, and weight normalization if indicated.…”

Intracapsular and Extracapsular Tonsillectomy and Adenoidectomy in Pediatric Obstructive Sleep Apnea

“…1 The estimated prevalence of OSAS among children is approximately 1% to 5%. 2 Untreated OSAS in children leads to cardiovascular and metabolic morbidities, cognitive and learning deficits, and behavioral problems, [2][3][4][5][6][7][8][9] which underscores the importance of sleep in childhood and the need for effective treatment of OSAS.…”