Sleep-disordered breathing in children

Abstract

The first series of children with obstructive sleep apnoea syndrome was reported in 1976. Later it became apparent that children may have breathing disorders during sleep without frank apnoea or 'hypopnoeas'. This pattern could be detected by measuring the oesophageal pressure. This led to the concept of sleep-disordered breathing as a spectrum that combines obstructive sleep apnoea syndrome and the upper airway resistance syndrome. Studies that do not take into account this spectrum may misclassify symptomatic patients as 'primary snorers'. The exact prevalence of sleep-disordered breathing in children is unknown but may be as high as 11%. There is a familial predisposition to sleep-disordered breathing. Nasal obstruction and mouth breathing influence facial growth, which may further lead to difficulty in breathing while asleep. Symptoms include an increase in total sleep time, nonspecific behavioural difficulties, hyperactivity, irritability, bed-wetting and morning headaches. Clinical signs include failure to thrive, increased respiratory effort with nasal flaring and suprasternal or intercostal retractions. Also, abnormal paradoxical inward motion of the chest may occur during sleep. Excessive daytime sleepiness and obesity are not always present. Untreated children may develop cardiovascular complications. The condition is treatable with continuous or bilevel positive airway pressure, and may be cured with surgery.

Melhora da qualidade de vida em crianças após adenoamigdalectomia

“…findings) and who also presented enlarged palatine tonsils (grade II or higher) 7 . Children presenting craniofacial abnormalities and neurological disorders were excluded from this study, as well as those patients referred to surgery to treat recurrent tonsillitis.…”

“…Other important consequences are associated with developmental abnormalities, behavioral disorders, poor school performance and cor pulmonale 6,7 . Although the indications for adenotonsillectomy are well established, there are few studies about the impact of surgery in the quality of life of patients 8 .…”

Resultados na qualidade de vida em longo prazo de crianças submetidas à adenoidectomia/adenotonsilectomia por distúrbios obstrutivos do sono

“…1,2,13 study also showed that although polysomnograhy provides much information about OSDs, it is unable to establish the degree of quality of life improvement following adenotonsillectomy, as perceived by parents.…”

“…It is estimated that up to 3% of children have OSAHS, 1 and that a higher percentage has UARS. 2 OSDs cause a variety of physical conditions and affect the child's quality of life, leading to low weight gain, altered cranio-facial development, [3][4][5] cardiopulmonary sequelae, 3,4 behavioral changes, 3,4,6,7 and poor school performance, 8 all of which have been well documented. Thus an early diagnosis and treatment of OSDs in pediatric patients is paramount to revert or avoid these conditions.…”

Clinical Manifestations

“…19 This condition is called upper airway resistance syndrome. The clinical significance of upper airway resistance syndrome remains controversial and is under investigation.…”