Obstructive sleep apnea in children

Abstract

Obstructive sleep apnea (OSA) in children is characterized by intermittent obstruction of the upper airways, which can result in intermittent hypoxia, hypercarbia, increase in respiratory effort and repeated arousals resulting in sleep fragmentation. The prevalence of snoring and OSA in children estimated to range between 3-12% and 1-5%, respectively. The common etiologies of OSA in children are adenotonsillar hypertrophy, allergic rhinitis, and obesity. The clinical scoring instruments that can accurately predict the likelihood of OSA diagnoses in children are generally consist of parental questionnaires that focus on symptoms of nocturnal respiratory disturbance and quality of life, including Thai-version OSA-18 and 6-item questionnaires. Overnight polysomnography (PSG) is the gold standard for OSA diagnosis. PSG provide an objective measure of sleep architecture, disturbances in respiratory parameters, severity and complication of OSA. Adenotonsillectomy is the treatment of choice in pediatric patients with OSA associated with adenotonsillar hypertrophy. Due to the present of glucocorticoid and leukotriene receptors in the adenoid and tonsils, intranasal corticosteroids and leukotriene antagonist should be considered in children with mild OSA. Continuous positive airway pressure (CPAP) is the most efficacious treatment for OSA when adenoids and tonsils are not the contributing factors of upper airway obstruction during sleep, such as obesity or neuromuscular weakness.