Hanyang Med Rev.  2013 Nov;33(4):246-252. 10.7599/hmr.2013.33.4.246.

Obstructive Sleep Apnea Syndrome in Children

• Oh JI
• Lee SH

• KMID: 2284442
• DOI: http://doi.org/10.7599/hmr.2013.33.4.246

Abstract

Obstructive sleep apnea is characterized by partial or complete upper airway obstruction which leads to reduction of blood oxygenation often accompanied by frequent arousal during sleep. Obstructive sleep apnea in children has many different clinical features, compared with adults. In children, obstructive sleep apnea is mainly caused by enlarged tonsils and adenoids. Other conditions such as obesity, craniofacial abnormality, and neuromuscular disease are also relevant predisposing factors. Pediatric obstructive sleep apnea is associated with various secondary sequelae such as cognitive dysfunction, behavioral problem, attention deficit, reduced sleep-related quality of life and so on. The objective diagnostic test, standard polysomnograhy is often needed to diagnose and stratify the severity of obstructive sleep apnea, because subjective symptoms and signs related to obstructive sleep apnea are not always consistent with the severity of respiratory disturbance. Childhood obstructive sleep apnea should be diagnosed and treated, if clinically suspected, because various symptoms, signs and consequences can be improved with proper management. Adenotonsillectomy is the first-line treatment modality in pediatric obstructive sleep apnea with adenotonsillar hypertrophy. In addition, continuous positive airway pressure, rapid maxillary expansion, weight control, topical steroids, and antileukotrienes may be considered as adjuvant treatment options.

Keyword

Child; Sleep Apnea, Obstructive; Adenoidectomy; Polysomnography; Tonsillectomy

MeSH Terms

Adenoidectomy
Adenoids
Adult
Airway Obstruction
Arousal
Causality
Child
Continuous Positive Airway Pressure
Craniofacial Abnormalities
Diagnostic Tests, Routine
Humans
Hypertrophy
Neuromuscular Diseases
Obesity
Oxygen
Palatal Expansion Technique
Palatine Tonsil
Polysomnography
Quality of Life
Sleep Apnea, Obstructive*
Steroids
Tonsillectomy
Oxygen
Steroids

Reference

1. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012; 130:576–584.

2. Marcus CL. Sleep-disordered breathing in children. Am J Respir Crit Care Med. 2001; 164:16–30.

3. Nixon GM, Brouillette RT. Sleep. 8: paediatric obstructive sleep apnoea. Thorax. 2005; 60:511–516.

4. Brunetti L, Rana S, Lospalluti ML, Pietrafesa A, Francavilla R, Fanelli M, et al. Prevalence of obstructive sleep apnea syndrome in a cohort of 1,207 children of southern Italy. Chest. 2001; 120:1930–1935.

5. Ali NJ, Pitson DJ, Stradling JR. Snoring, sleep disturbance, and behaviour in 4-5 year olds. Arch Dis Child. 1993; 68:360–366.

6. Gislason T, Benediktsdottir B. Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. An epidemiologic study of lower limit of prevalence. Chest. 1995; 107:963–966.

7. Jeans WD, Fernando DC, Maw AR, Leighton BC. A longitudinal study of the growth of the nasopharynx and its contents in normal children. Br J Radiol. 1981; 54:117–121.

8. Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G. Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med. 1999; 159:1527–1532.

9. Remmers JE, deGroot WJ, Sauerland EK, Anch AM. Pathogenesis of upper airway occlusion during sleep. J Appl Physiol. 1978; 44:931–938.

10. Fernbach SK, Brouillette RT, Riggs TW, Hunt CE. Radiologic evaluation of adenoids and tonsils in children with obstructive sleep apnea: plain films and fluoroscopy. Pediatr Radiol. 1983; 13:258–265.

11. Arens R, McDonough JM, Costarino AT, Mahboubi S, Tayag-Kier CE, Maislin G, et al. Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2001; 164:698–703.

12. Brooks LJ, Stephens BM, Bacevice AM. Adenoid size is related to severity but not the number of episodes of obstructive apnea in children. J Pediatr. 1998; 132:682–686.

13. Laurikainen E, Aitasalo K, Erkinjuntti M, Wanne O. Sleep apnea syndrome in children--secondary to adenotonsillar hypertrophy? Acta Otolaryngol Suppl. 1992; 492:38–41.

14. Laurikainen E, Erkinjuntti M, Alihanka J, Rikalainen H, Suonpaa . Radiological parameters of the bony nasopharynx and the adenotonsillar size compared with sleep apnea episodes in children. Int J Pediatr Otorhinolaryngol. 1987; 12:303–310.

15. Choi JH, Kim EJ, Choi J, Kwon SY, Kim TH, Lee SH, et al. Obstructive sleep apnea syndrome: a child is not just a small adult. Ann Otol Rhinol Laryngol. 2010; 119:656–661.

16. Wiegand DA, Latz B, Zwillich CW, Wiegand L. Upper airway resistance and geniohyoid muscle activity in normal men during wakefulness and sleep. J Appl Physiol. 1990; 69:1252–1261.

17. Wiegand L, Zwillich CW, White DP. Collapsibility of the human upper airway during normal sleep. J Appl Physiol. 1989; 66:1800–1808.

18. Bonuck KA, Freeman K, Henderson J. Growth and growth biomarker changes after adenotonsillectomy: systematic review and meta-analysis. Arch Dis Child. 2009; 94:83–91.

19. Marcus CL, Carroll JL, Koerner CB, Hamer A, Lutz J, Loughlin GM. Determinants of growth in children with the obstructive sleep apnea syndrome. J Pediatr. 1994; 125:556–562.

20. Bar A, Tarasiuk A, Segev Y, Phillip M, Tal A. The effect of adenotonsillectomy on serum insulin-like growth factor-I and growth in children with obstructive sleep apnea syndrome. J Pediatr. 1999; 135:76–80.

21. Williams EF 3rd, Woo P, Miller R, Kellman RM. The effects of adenotonsillectomy on growth in young children. Otolaryngol Head Neck Surg. 1991; 104:509–516.

22. Goh DY, Galster P, Marcus CL. Sleep architecture and respiratory disturbances in children with obstructive sleep apnea. Am J Respir Crit Care Med. 2000; 162:682–686.

23. Yamadera W, Chiba S, Itoh H, Ozone M, Takahashi T, Sasaki M, et al. Sleep architectures of obstructive sleep apnea syndrome in the young child. Psychiatry Clin Neurosci. 2000; 54:330–331.

24. Hultcrantz E, Lofstrand Tidestrom B. The development of sleep disordered breathing from 4 to 12 years and dental arch morphology. Int J Pediatr Otorhinolaryngol. 2009; 73:1234–1241.

25. Pirilä-Parkkinen K, Pirttiniemi P, Nieminen P, Tolonen U, Pelttari U, Löppönen H. Dental arch morphology in children with sleep-disordered breathing. Eur J Orthod. 2009; 31:160–167.

26. Chervin RD, Dillon JE, Bassetti C, Ganoczy DA, Pituch KJ. Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep. 1997; 20:1185–1192.

27. Gozal D, Pope DW Jr. Snoring during early childhood and academic performance at ages thirteen to fourteen years. Pediatrics. 2001; 107:1394–1399.

28. Ali NJ, Pitson D, Stradling JR. Sleep disordered breathing: effects of adenotonsillectomy on behaviour and psychological functioning. Eur J Pediatr. 1996; 155:56–62.

29. Stradling JR, Thomas G, Warley AR, Williams P, Freeland A. Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children. Lancet. 1990; 335:249–253.

30. Gozal D. Sleep-disordered breathing and school performance in children. Pediatrics. 1998; 102:616–620.

31. Tal A, Leiberman A, Margulis G, Sofer S. Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment. Pediatr Pulmonol. 1988; 4:139–143.

32. Brouillette RT, Fernbach SK, Hunt CE. Obstructive sleep apnea in infants and children. J Pediatr. 1982; 100:31–40.

33. Marcus CL, Greene MG, Carroll JL. Blood pressure in children with obstructive sleep apnea. Am J Respir Crit Care Med. 1998; 157:1098–1103.

34. American Thoracic Society. Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med. 1996; 153:866–878.

35. Brietzke SE, Katz ES, Roberson DW. Can history and physical examination reliably diagnose pediatric obstructive sleep apnea/hypopnea syndrome? A systematic review of the literature. Otolaryngol Head Neck Surg. 2004; 131:827–832.

36. Carroll JL, McColley SA, Marcus CL, Curtis S, Loughlin GM. Inability of clinical history to distinguish primary snoring from obstructive sleep apnea syndrome in children. Chest. 1995; 108:610–618.

37. Morielli A, Desjardins D, Brouillette RT. Transcutaneous and end-tidal carbon dioxide pressures should be measured during pediatric polysomnography. Am Rev Respir Dis. 1993; 148:1599–1604.

38. Lamm C, Mandeli J, Kattan M. Evaluation of home audiotapes as an abbreviated test for obstructive sleep apnea syndrome (OSAS) in children. Pediatr Pulmonol. 1999; 27:267–272.

39. Sivan Y, Kornecki A, Schonfeld T. Screening obstructive sleep apnoea syndrome by home videotape recording in children. Eur Respir J. 1996; 9:2127–2131.

40. Brouillette RT, Morielli A, Leimanis A, Waters KA, Luciano R, Ducharme FM. Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Pediatrics. 2000; 105:405–412.

41. Jacob SV, Morielli A, Mograss MA, Ducharme FM, Schloss MD, Brouillette RT. Home testing for pediatric obstructive sleep apnea syndrome secondary to adenotonsillar hypertrophy. Pediatr Pulmonol. 1995; 20:241–252.

42. Roland PS, Rosenfeld RM, Brooks LJ, Friedman NR, Jones J, Kim TW, et al. Clinical practice guideline: Polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg. 2011; 145:S1–S15.

43. Uliel S, Tauman R, Greenfeld M, Sivan Y. Normal polysomnographic respiratory values in children and adolescents. Chest. 2004; 125:872–878.

44. Marcus CL, Omlin KJ, Basinki DJ, Bailey SL, Rachal AB, Von Pechmann WS, et al. Normal polysomnographic values for children and adolescents. Am Rev Respir Dis. 1992; 146:1235–1239.

45. American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 2nd ed. Westchester, IL: American Academy of Sleep Medicine;2012.

46. American Academy of Sleep Medicine. The International classificationof sleep disorders: diagnostic and coding manual. 2nd ed. Westchester, IL: American Academy of Sleep Medicine;2005.

47. Wiet GJ, Bower C, Seibert R, Griebel M. Surgical correction of obstructive sleep apnea in the complicated pediatric patient documented by polysomnography. Int J Pediatr Otorhinolaryngol. 1997; 41:133–143.

48. Suen JS, Arnold JE, Brooks LJ. Adenotonsillectomy for treatment of obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg. 1995; 121:525–530.

49. Friedman M, Wilson M, Lin HC, Chang HW. Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2009; 140:800–808.

50. Abdu MH, Feghali JG. Uvulopalatopharyngoplasty in a child with obstructive sleep apnea. A case report. J Laryngol Otol. 1988; 102:546–548.

51. Villa MP, Rizzoli A, Miano S, Malagola C. Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up. Sleep Breath. 2011; 15:179–184.

52. Burstein FD, Cohen SR, Scott PH, Teague GR, Montgomery GL, Kattos AV. Surgical therapy for severe refractory sleep apnea in infants and children: application of the airway zone concept. Plast Reconstr Surg. 1995; 96:34–41.

53. Cohen SR, Simms C, Burstein FD, Thomsen J. Alternatives to tracheostomy in infants and children with obstructive sleep apnea. J Pediatr Surg. 1999; 34:182–186. discussion 7.

54. Marcus CL, Ward SL, Mallory GB, Rosen CL, Beckerman RC, Weese-Mayer DE, et al. Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea. J Pediatr. 1995; 127:88–94.

55. McNamara F, Sullivan CE. Obstructive sleep apnea in infants and its management with nasal continuous positive airway pressure. Chest. 1999; 116:10–16.

56. Li KK, Riley RW, Guilleminault C. An unreported risk in the use of home nasal continuous positive airway pressure and home nasal ventilation in children: mid-face hypoplasia. Chest. 2000; 117:916–918.

57. Alexopoulos EI, Kaditis AG, Kalampouka E, Kostadima E, Angelopoulos NV, Mikraki V, et al. Nasal corticosteroids for children with snoring. Pediatr Pulmonol. 2004; 38:161–167.

58. Goldbart AD, Greenberg-Dotan S, Tal A. Montelukast for children with obstructive sleep apnea: a double-blind, placebo-controlled study. Pediatrics. 2012; 130:e575–e580.