Obstructive Sleep Apnea

Chapter 98


Obstructive Sleep Apnea

Karen Kay Thompson, MD, and John Norman Schuen, MD, FAAP


Obstructive sleep apnea (OSA) is characterized by episodes of complete or partial upper-airway obstruction during sleep. When this is accompanied by clinical sequelae, such as daytime sleepiness or hypertension, it can be called OSA syndrome (OSAS).

OSA may cause gas exchange abnormalities, impaired sleep, and long-term sequelae.

The overall incidence of OSAS in the pediatric population is 2%–5%.

OSAS is most common in patients 2–15 years of age, with a peak between 3 and 6 years of age.

Risk factors include a family history, African American race, sinus disease, obesity, asthma, and prematurity, as well as congenital syndromes—particularly those that affect the craniofacial structures or neurological development.

Infant OSAS is distinctly different from childhood and adult OSAS. OSAS in infancy is less common and is often related to specific clinical conditions: gastroesophageal reflux, craniofacial abnormalities, lower-airway structural abnormalities, congenital syndromes, and abnormal neuromotor tone.


OSAS is caused by conditions that result in upper-airway narrowing, increased upper-airway collapsibility, or both.

Enlarged tonsils and adenoids represent the most common etiologic origin for OSAS in childhood.

Increased risk occurs in children with congenital syndromes, craniofacial abnormalities, and neuromuscular disorders, including but not limited to

Down syndrome


Pierre Robin syndrome

Beckwith-Wiedemann syndrome

Muscular dystrophy and spinal muscular atrophy

Cerebral palsy

Several factors can coexist in a child and lead to a complex interaction of various upper-airway (and rarely lower-airway) influences (see Figure 98-1).


Figure 98-1. Multifactorial model of childhood obstructive sleep apnea syndrome (OSAS). UA = upper airway. Modified from Brooks LJ. Obstructive sleep apnea syndrome in infants and children: clinical features and pathophysiology. In: Sheldon S, Feber R, Kryger M, eds. Principles and Practice of Pediatric Sleep Medicine. Philadelphia, PA: Elsevier Saunders; 2005:223–229. Copyright 2005, with permission from Elsevier.

Clinical Features

Sleep symptoms can include

Snoring that is persistent (not just during upper respiratory infections or secondary to allergic rhinitis)

Labored breathing during sleep

Disturbed sleep with frequent gasps, snorts, or pauses

Nocturnal enuresis

Other signs and symptoms may include

Morning headaches

Daytime sleepiness (less common in children than adults)

Difficulty with attention, possibly including attention-deficit/ hyperactivity disorder

Learning impairments

Behavioral concerns

Cardiovascular problems

Poor growth and developmental delay

Diagnostic Considerations

During routine health supervision visits, children should be screened regularly for habitual snoring.

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Aug 22, 2019 | Posted by in PEDIATRICS | Comments Off on Obstructive Sleep Apnea

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