Obstructive sleep-disordered breathing (OSDB) is a condition that affects 1% to 3% of the pediatric population. These disorders are difficult to diagnosis and left untreated may be serious, including not only medical comorbidities but also cognitive, academic, behavioral, and emotional sequelae. This article is designed to bring awareness of the severity and prevalence to family physicians and pediatricians. It reviews detailed information concerning OSDB, including the predisposing factors, assessment of presenting features, and treatment.
JambhekarSKComGWard-BengnocheW. Obstructive sleep disordered breathing in children: assessment and treatment at Arkansas Children’s Hospital. J Ark Med Soc. 2010;107:65-68.
2.
MarcusCLBrooksLJDraperKA. American Academy of Pediatrics. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130:576-584.
3.
CarrollJLMcColleySAMarcusCLCurtisSLoughlinGM. Inability of clinical history to distinguish primary snoring from obstructive sleep apnea syndrome in children. Chest. 1995;108:610-618.
4.
ParkJGRamarKOlsonEJ. Updates on definition, consequences, and management of obstructive sleep apnea. Mayo Clin Proc. 2011;88:549-555.
5.
BrownJGSchnallPHallgrenJP. Clinical inquires. When (and how) should you evaluate a child for obstructive sleep apnea?J Fam Pract. 2007;56:317-320.
6.
FaruquiFKhubchandaniJPriceJHBolyardDReddyR. Sleep disorders in children: a national assessment of primary care pediatrician practices and perceptions. Pediatrics. 2011;128:539-546.
7.
HowdenLMeyerJ. US Department of Commerce, Economics and Statistics Administration. Age and Sex Composition: 2010 (C2010BR-03). Washington, DC: US Census Bureau; 2011.
8.
ChhanganiBSMelgarTPatelD. Pediatric obstructive sleep apnea. Indian J Pediatr. 2009;77:81-85.
9.
BeebeDWGozalD. Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits. J Sleep Res. 2002;11:1-16.
10.
HalbowerACDegaonkarMBarkerPB. Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury. PLoS Med. 2006;3(8):e301.
11.
Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. American Academy of Pediatrics. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2002;109:704-712.
12.
AminRCarrollJLJeffriesJL. Twenty-four-hour ambulatory blood pressure in children with sleep-disordered breathing. Am J Respir Crit Care Med. 2004;169:950-956.
13.
AminRSKimballTRBeanJA. Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea. Am J Respir Crit Care Med. 2002;165:1395-1399.
14.
GozalDKheirandish-GozalL. Neurocognitive and behavioral morbidity in children with sleep disorders. Curr Opin Pulm Med. 2007;13:505-509.
15.
ZintzarasEKaditisAG. Sleep-disordered breathing and blood pressure in children: a meta-analysis. Arch Pediatr Adolesc Med. 2007;161:172-178.
16.
FlintJKothareSVZihlifM. Association between inadequate sleep and insulin resistance in obese children. J Pediatr. 2007;150:364-369.
17.
GozalDSerperoLDCapdevilaOSKheirandish-GozalL. Systemic inflammation in non-obese children with obstructive sleep apnea. Sleep Med. 2008;9:254-259.
18.
DemeterPPapA. The relationship between gastroesophagel reflux disease and obstructive sleep apnea. J Gasteoenterol. 2004;39:815-820.
19.
Kheirandish-GozalL. Asthma and obstructive sleep apnea. In:Kheirandish-GozalLGozalD eds. Sleep Disordered Breathing in Children: A Comprehensive Clinical Guide to Evaluation and Treatment. New York, NY: Humana Press/Springer; 2012:385-390.
20.
KhayatRJarjouraDPattBYamokoskiTAbrahamW. In-hospital testing for sleep disordered breathing in hospitalized patients with decompensated heart failure—report of prevalence and patient characteristics. J Card Fail. 2009;15:739-746.
21.
BeebeDW. Neurobehavioral morbidity associated with disordered breathing during sleep in children: a comprehensive review. Sleep. 2006;29:1115-1134.
22.
SedkyRCarvalhoKSLippmannS. Attention deficit hyperactivity disorder and sleep disordered breathing in children. J Pediatr Biochem. 2013;3:61-67.
23.
KheirandishLGozalD. Neurocognitive dysfunction in children with sleep disorders. Dev Sci. 2006;9:388-399.
24.
MoreauVRouleauNMorinCM. Sleep of children with attention deficit hyperactivity disorder: actigraphic and parental reports. Behav Sleep Med. 2014;12:69-83.
25.
BeebeDWRisMDKramerMELongEAminR. The association between sleep disordered breathing, academic grades, and cognitive and behavioral functioning among overweight subjects during middle to late childhood. Sleep. 2010;33:1447-1456.
26.
GozalDCrabtreeVMCapdevillaOSWitcherLAKheirandish-GozalL. C-reactive protein, obstructive sleep apnea, and cognitive dysfunction in school-aged children. Am J Respir Crit Care Med. 2007;176:188-193.
27.
SchechterMS. Subcommittee on Obstructive Sleep Apnea Syndrome, Pediatric Pulmonology. Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2002;109:e69.
28.
CrabtreeVVarniJ WGozalD. Health-related quality of life and depressive symptoms in children with suspected sleep-disordered breathing. Sleep. 2004;27:1131-1138.
29.
GozalDSans CapdevilaOMcLaughlin CrabtreeVSerperoLDWitcherLAKheirandish-GozalL. Plasma IGF-1 levels and cognitive dysfunction in children with obstructive sleep apnea. Sleep Med. 2009;10:167-173.
30.
LiAMChanMHYinJ. C-reactive protein in children with obstructive sleep apnea and the effects of treatment. Pediatr Pulmonol. 2008;43:34-40.
MarcusCLCaroleL. Sleep-disordered breathing in children. Am J Respir Crit Care Med. 2001;164:16-30.
33.
MarcusCL. Obstructive sleep apnea syndrome: differences between children and adults. Sleep. 2000;23(suppl 4):S140-S141.
34.
MarcusCLCaroleL. Sleep-disordered breathing in children. Curr Opin Pediatr. 2000;12:208-212.
35.
KatzNTamarEPillarG. Functional aspects and upper airway control during wakefulness and sleep. In:Kheirandish-GozalLGozalD, eds. Sleep Disordered Breathing in Children: A Comprehensive Clinical Guide to Evaluation and Treatment. New York, NY: Humana Press/Springer; 2012:13-24.
36.
MaalejSAouadiSBen MoussaHBourguibaMBen KhederADriraI. Predictive factors of obstructive sleep apnea syndrome in obesity [in French]. Tunis Med. 2010;88:92-96.
37.
O’GormanSHorlockerTHuddlestonJGayPMorgenthalerT. Does self-titrating CPAP therapy improve postoperative outcome in patients at risk for obstructive sleep apnea syndrome? A randomized controlled clinical trial. Chest. 2011;140(4_Meeting Abstracts):1071A.
38.
LamYYChanEYNGDK. The correlation among obesity, apnea-hypopnea index, and tonsil size in children. Chest. 2006;130:1751-1756.
39.
MarcusCLCurtisSKoernerCBJoffeASerwintJRLoughlinGM. Evaluation of pulmonary function and polysomnography in obese children and adolescents. Pediatr Pulmonol. 1996;21:176-183.
40.
SilvestriJMWeese-MayerDEBassMTKennyASHauptmanSAPearsallSM. Polysomnography in obese children with a history of sleep-associated breathing disorders. Pediatr Pulmonol. 1993;16:124-129.
41.
MarcusCLBrooksLJDraperKA; American Academy of Pediatrics. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130:e714-e755.
42.
MaurerJTStuckBA. Update on upper airway evaluation in obstructive sleep apnea [in German]. HNO. 2008;56:1089-1097.
43.
StuckBAMaurerJT. Airway evaluation in obstructive sleep apnea. Sleep Med Rev. 2008;12:411-436.
44.
De BackerJWVosWGVerhulstSLDe BackerW. Novel imaging techniques using computer methods for the evaluation of the upper airway in patients with sleep-disordered breathing: a comprehensive review. Sleep Med Rev. 2008;12:437-447.
45.
AbramsonZSusariaSTroulisMKabanL. Age-related changes of the upper airway assessed by 3-dimensional computed tomography. J Craniofac Surg. 2009;20(suppl 1):657-663.
46.
GottliebDJChaseCVezinaRM. Sleep-disordered breathing symptoms are associated with poorer cognitive function in 5-year-old children. J Pediatr. 2004;145:458-464.
47.
KheirandishLGoldbartADGozalD. Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics. 2006;117:e61-e66.
48.
GoldbartADGoldmanJLVelingMCGozalD. Leukotriene modifier therapy for mild sleep-disordered breathing in children. Am J Respir Crit Care Med. 2005;172:364-370.
49.
MitchellRBKellyJ. Outcome of adenotonsillectomy for obstructive sleep apnea in obese and normal-weight children. Otolaryngol Head Neck Surg. 2007;137:43-48.
50.
GuilleminaultCHuangYSGlamannCLiKChanA. Adenotonsillectomy and obstructive sleep apnea in children: a prospective survey. Otolaryngol Head Neck Surg. 2007;136:169-175.
51.
MitchellRB. Adenotonsillectomy for obstructive sleep apnea in children: outcome evaluated by pre- and postoperative polysomnography. Laryngoscope. 2007;117:1844-1854.
52.
DowneyRPerkinRMMacQuarrieJ. Nasal continuous positive airway pressure use in children with obstructive sleep apnea younger than 2 years of age. Chest. 2000;117:1608-1612.
53.
MarcusCLRosenGDavidson-WardSL. Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatrics. 2006;117:e442-e451.
54.
MassaFGonsalezSLavertyAWallisCLaneR. The use of nasal continuous positive airway pressure to treat obstructive sleep apnea. Arch Dis Child. 2002;87:438-443.
PalombiniLPelayoRGuilleminaultC. Efficacy of automated continuous positive airway pressure in children with sleep-related breathing disorders in an attended setting. Pediatrics. 2004;113:e412-e417.
57.
WatersKAEverettFBrudererJMacNamaraFSullivanCE. The use of nasal CPAP in children. Pediatr Pulmonol. 1995;19(suppl 11):91-93.
58.
WatersKAEverettFMBrudererJWSullivanCE. Obstructive sleep apnea: the use of nasal CPAP in 80 children. Am J Respir Crit Care Med. 1995;152:780-785.
59.
EdingerJDRadtkeRA. Use of in vivo desensitization to treat a patient’s claustrophobic response to nasal CPAP. Sleep. 1993;16:678-680.
60.
WolkoveNBaltzanMKamelHDarbrusinRPalayewM. Long-term compliance with continuous positive airway pressure in patients with obstructive sleep apnea. Can Respir J. 2008;15:365-369.
61.
KirkVGO’DonnellAR. Continuous positive airway pressure for children: a discussion on how to maximize compliance. Sleep Med Rev. 2006;10:119-127.
62.
KoontzKLSliferKJCataldoMDMarcusCL. Improving pediatric compliance with positive airway pressure therapy: the impact of behavioral intervention. Sleep. 2003;26:1010-1015.
63.
RainsJC. Treatment of obstructive sleep apnea in pediatric patients. Behavioral intervention for compliance with nasal continuous positive airway pressure. Clin Pediatr (Phila). 1995;34:535-541.
64.
HarfordKLJambhekarSComG. Behaviorally based adherence program for pediatric patients treated with positive airway pressure. J Clin Child Psychol Psychiatry. 2012;18:151-163.
65.
HarfordKLJambhekarSComG. An in-patient model for positive airway pressure desensitization: a report of 2 pediatric cases. Respir Care. 2012;57:802-807.
66.
HoffsteinV. Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath. 2007;11:1-22.
67.
SchesslJRoseEKorinthenbergRHenschenM. Severe obstructive sleep apnea alleviated by oral appliance in a three-year-old boy. Respiration. 2008;76:112-116.
68.
Al-SamriMMitchellIDrummondDSBjornsonC. Tracheostomy in children: a population-based experience over 17 years. Pediatr Pulmonol. 2010;45:487-493.
