Sleep Apnea—Obstructive Sleep Apnea Syndrome
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- Sleep-disordered breathing encompasses a range of breathing disorders occurring during sleep. These conditions include primary snoring (PS), respiratory events related to arousals (RERA), and obstructive sleep apnea syndrome (OSAS).
- Obstructive apnea is defined as the cessation of airflow at the nose and mouth despite respiratory effort, associated with some gas exchange abnormality and/or loss of regular sleep patterns.
- 8–10% of children snore.
- 1.3–4% of children have sleep apnea.
- 30% of children with Down syndrome have some degree of sleep apnea by the age of 3 years.
- OSAS may be subdivided into mild, moderate, and severe forms.
- Many children with OSAS exhibit partial airway obstruction. This is known as obstructive hypoventilation or hypopnea and is more commonly seen in children than is complete obstruction.
- OSAS is distinct from central apnea (cessation of airflow that is not accompanied by respiratory effort), which indicates brain immaturity or dysfunction.
- Upper airway resistance syndrome is a respiratory disorder characterized by partial airway obstruction and arousals leading to sleep fragmentation and is not associated with gas exchange abnormalities.
- Central apnea up to 20 seconds may be a normal finding in premature or newborn infants during the 1st month of life.
- Periodic breathing: three or more episodes of central apnea lasting at least 3 seconds each, separated by <20 seconds. Periodic breathing may be found in the newborn; however, it should not exceed >4% of sleep time (from a sleep study) and is not associated with bradycardia or hypoxemia.
- In infants, OSAS is uncommon; however, it may exist with craniofacial anomalies, neurologic disorders associated with low muscle tone, laryngomalacia or tracheomalacia, and gastroesophageal reflux.
- Impaired arousal mechanisms also contribute to abnormalities seen in OSAS.
- In older children, OSAS may be associated with obesity. This form may resemble the adult type of OSAS.
- PS or habitual snoring implies snoring that does not lead to abnormalities in gas exchange or sleep fragmentation; however, 20–50% of children with habitual snoring may have OSAS.
Several genetic disorders with associated craniofacial anomalies, hypotonia, and obesity may lead to OSAS. These include the following:
- Pierre Robin syndrome
- Treacher Collins syndrome
- Down syndrome
- Mucopolysaccharide disorders
- Arnold-Chiari malformations
- Prader-Willi syndrome
- Hereditary neuromuscular disorders
Commonly Associated Conditions
- Adenotonsillar hypertrophy
- Craniofacial anomalies including midfacial hypoplasia and mandibular hypoplasia
- Neurologic and neuromuscular disorders that cause hypotonia may underlie poor ventilation during sleep.
- Gastroesophageal reflux
- Metabolic disorders
- Allergic rhinitis, nasal septum deviation, nasal polyps
- Sedatives, seizure medications, and anesthesia