Articles, Issue 2/2025

On the issue of obstructive sleep apnea in childhood

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D. Nencheva Nencheva-Milichevich1, G. Petrova1,2

1 Clinic of Pediatrics, University Hospital “Aleksandrovska” – Sofia 2 Department of Pediatrics, Medical University – Sofia

Abstract

Sleep disordered breathing (SDB) is a group of conditions where the breathing pattern during sleep is disturbed and is characterized by episodes of apnea, hypopnea, and/or hypoventilation, along with the associated hypoxic syndrome. These disorders range from snoring to obstructive sleep apnea (OSA), depending on the degree of obstruction of the upper airways. Approximately 20% of children who snore have OSA. The most common form of sleep disorders in childhood is obstructive sleep apnea, which involves recurrent episodes of partial or complete obstruction of the upper airways during sleep. Desaturation, hypercapnia, and sleep fragmentation lead to the activation of inflammatory cascades, oxidative stress, and impaired sympathetic nervous system activity. Patients suffer from neurocognitive impairment such as attention deficit, behavioral and emotional changes, and learning difficulties. The cardiovascular system is also affected, with manifestations of endothelial dysfunction, dysregulation of blood pressure, and cardiac remodeling. In children with OSA and obesity, there is a risk of developing metabolic syndrome. The high prevalence and consequences of untreated cases have led to the development of screening programs to identify at-risk groups, along with modern methods for diagnosis, treatment, and follow-up. The gold standard for diagnosing OSA is polysomnography conducted in a specialized laboratory. For children with OSA and adenoidal-tonsillar hypertrophy, adenoidectomy and tonsillectomy are recommended as the treatment of choice. This review presents the current guidelines in diagnosis and behavior.

Key words: obstructive sleep apnea, sleep disordered breathing, apnea-hypopnea index, polysomnography, adenotonsillectomy

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Bibliography

  1. Тасков Д, Миланова М. Скрининг за обструктивна сънна апнея при неврологична популация пациенти. Българска неврология. 2020;21(3):111-4.
  2. Тасков Д. Нарушения на дишането по време на сън при някои неврологични заболявания [автореферат]. София: Медицински университет София; 2021.
  3. Solano-Pérez E, Coso C, Castillo-García M, et al. Diagnosis and treatment of sleep apnea in children: A future perspective is needed. Biomedicines. 2023;11:1708.
  4. Garde A, Gibson N, Samuels M, et al. Recent advances in pediatric sleep disordered breathing. Breathe. 2022;18:220151.
  5. Gozal P, O’Brien LM. Snoring and obstructive sleep apnea in children: Why should we treat? Pediatr Respir Rev. 2004;5 Suppl A:S371-6.
  6. Chang S, Chae K. Obstructive sleep apnea syndrome in children: Epidemiology, pathophysiology, diagnosis and sequelae. Korean J Pediatr. 2010;53(10):863–71.
  7. Verhulst S, Kaditis A. Obstructive sleep apnoea in children. Eur Respir Mon. 2011;7(3):240–7. doi:10.1183/20734735.021810.
  8. Marcus CL, Brooks LJ, Draper KA, Gozal D, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130(3):576–84. doi:10.1542/peds.2012-1671.
  9. Savini S, Ciorba A, Bianchini C, et al. Assessment of obstructive sleep apnoea (OSA) in children: an update. Acta Otorhinolaryngol Ital. 2019;39(5):289–97. doi:10.14639/0392-100X-N0262.
  10. Quinlan C, Beck S. Obstructive sleep apnea syndrome. In: Textbook Pediatric Pulmonology. 2024. p. 603–16.
  11. Polytarchou A, Moudaki A, Van de Perck E, et al. An update on diagnosis and management of obstructive sleep apnoea in the first 2 years of life. Eur Respir Rev. 2024;33:230121. doi:10.1183/16000617.0121-2023.
  12. Lo Bue A, Salvaggio A, Insalaco G. Obstructive sleep apnea in developmental age: A narrative review. Eur J Pediatr. 2020;179:357–65.
  13. Baldassari CM, Lam DJ, Ishman SL, et al. Expert consensus statement: Pediatric drug-induced sleep endoscopy. Otolaryngol Head Neck Surg. 2021;165:578–91.
  14. Love H, Slaven JE, Mitchell RM, et al. Outcomes of OSA in surgically naive young children with and without DISE-identified laryngomalacia. Int J Pediatr Otorhinolaryngol. 2020;138:110351.
  15. Fauroux B, Abel F, Amaddeo A, et al. ERS statement on paediatric long-term noninvasive respiratory support. Eur Respir J. 2022;59:2101404.
  16. Bitners A, Arens R. Evaluation and management of children with obstructive sleep apnea syndrome. Lung. 2020;198(2):257–70. doi:10.1007/s0048-020-00342-5.
  17. Tauber D. Updates on the management of pediatric obstructive sleep apnea. OMI Seminar. 2022. Pediatric Pulmonology.
  18. Gozal D, Kheirandish-Gozal L. The multiple challenges of obstructive sleep apnea in children: Morbidity and treatment. Curr Opin Pediatr. 2008;20(6):654–8. doi:10.1097/MOP.0b013e328316ec2d.
  19. Musso MF, Lindsey HM, Wilde EA, et al. Volumetric brain magnetic resonance imaging analysis in children with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol. 2020;138:110369.
  20. Lushington K, Kennedy D, Martin J, et al. Quality-of-life but not behavior improves 48-months post-adenotonsillectomy in children with SDB. Sleep Med. 2021;81:418–29.
  21. Hai Y, Kou W, Gu Z, et al. Obstructive sleep apnea affects the psychological and behavioural development of children: A case-control study. J Sleep Res. 2024;33(1):e13924.
  22. Kuhle S, Hofmann DU, Mitra S, et al. Anti-inflammatory medications for obstructive sleep apnoea in children. Cochrane Database Syst Rev. 2020;1:CD007074. doi:10.1002/14651858.CD007074.pub3.
  23. Yılmaz M, Onrat E, Altuntaş A, et al. The effects of tonsillectomy and adenoidectomy on pulmonary arterial pressure in children. Am J Otolaryngol. 2005;26(1):18–21. doi:10.1016/j.amjoto.2004.06.008.
  24. Kaditis AG, Alonso Alvarez ML, Boudewyns A, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: Diagnosis and management. Eur Respir J. 2016;47:69–94.
  25. Brooks DM, Kelly A, Sorkin JD, et al. The relationship between sleep-disordered breathing, blood pressure, and urinary cortisol and catecholamines in children. J Clin Sleep Med. 2020;16:907–16.
  26. Chan KCC, Au CT, Hui LL, et al. Childhood OSA is an independent determinant of blood pressure in adulthood: Longitudinal follow-up study. Thorax. 2020;75:422–31.
  27. Redline S, Storfer-Isser A, Rosen CL, et al. Association between metabolic syndrome and sleep-disordered breathing in adolescents. Am J Respir Crit Care Med. 2007;176(4):401–8.
  28. Kuhle S, Hofmann DU, Mitra S, et al. Anti-inflammatory medications for obstructive sleep apnoea in children. Cochrane Database Syst Rev. 2020;1:CD007074. doi:10.1002/14651858.CD007074.pub3.

Address for correspondence

Clinic of Pediatrics, University Hospital “Aleksandrovska” – Sofia
1, “Sv. Georgy Sofiisky”, Str.  1606 , Sofia, Bulgaria

e-mail: diana_nencheva@yahoo.com