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
—Pierre Robin syndrome
—Muscular dystrophy and spinal muscular atrophy
•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.
•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
•Other signs and symptoms may include
—Daytime sleepiness (less common in children than adults)
—Difficulty with attention, possibly including attention-deficit/ hyperactivity disorder
—Poor growth and developmental delay
•During routine health supervision visits, children should be screened regularly for habitual snoring.