Pediatric sleep-disordered breathing in children is a spectrum of primary snoring, upper airway resistance syndrome, obstructive hypoventilation, and obstructive sleep apnea syndrome (OSAS). The prevalence of pediatric OSAS is 1%-3%. Pediatric OSAS is most commonly caused by adenoid and tonsillar hypertrophy, which is correctable by surgery. The gold standard test for diagnosis is polysomnography (PSG). OSA in children is a distinct disorder form that occurs in adults with respect to clinical manifestations, PSG diagnostic criteria, and treatment approaches. In addition, PSG has its own challenges in children. Hence, simplification of approach by appropriate use of alternative diagnostic tests including oximetry scoring systems, questionnaires, and home respiratory polygraphy is highlighted. This will ensure early diagnosis, referral for corrective surgical management versus medical therapy on basis of severity, and performance of PSG in only selective cases.
Chang SJ, Chae KY. Obstructive sleep apnea syndrome in children: epidemiology, pathophysiology, diagnosis and sequelae. Korean J Pediatr 2010;53:863–71.
Marcus CL, Brooks LJ, Draper KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012;130:576–84.
Marcus CL. Pathophysiology of childhood obstructive sleep apnea: current concepts. Respir Physiol 2000;119:143- 54.
Goldbart AD, Tal A. Inflammation and sleep disordered breathing in children: a state-of-the-art review. Pediatr Pulmonol 2008;43):1151–60.
Goldbart AD, Goldman JL, Li RC, Brittian KR, Tauman R, Gozal D. Differential expression of cysteinyl leukotriene receptors 1 and 2 in tonsils of children with obstructive sleep apnea syndrome or recurrent infection. Chest 2004;126:13–8.
Alves RS, Resende MB, Skomro RP, Souza FJ, Reed UC. Sleep and neuromuscular disorders in children. Sleep Med Rev 2009;13:133–48.
Hull J, Aniapravan R, Chan E, et al. British Thoracic Society guideline for respiratory management of children with neuromuscular weakness. Thorax 2012;67 Suppl 1:i1-40.
Mitchell RB. Adenotonsillectomy for obstructive sleep apnea in children: outcome evaluated by pre- and postoperative polysomnography. Laryngoscope 2007;117:1844–54.
Brouillette RT, Hanson D, David R, et al. A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr 1984;105:10–4.
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;108:610–8.
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;131:827–32.
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;27:267–72.
Laurikainen E, Erkinjuntti M, Alihanka J, Rikalainen H, Suonpää J. Radiological parameters of the bony nasopharynx and the adenotonsillar size compared with sleep apnea episodes in children. Int J Pediatr Otorhinolaryngol 1987;12:303–10.
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;132:682–6.
Spruyt K, Gozal D. Pediatric sleep questionnaires as diagnostic or epidemiological tools: a review of currently available instruments. Sleep Med Rev 2011;15:19–32.
Suen JS, Arnold JE, Brooks LJ. Adenotonsillectomy for treatment of obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg 1995;121:525–30.
Chervin RD, Hedger K, Dillon JE, Pituch KJ. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioural problems. Head Neck Surg 2003;128:344– 52.
Chervin RD, Weatherly RA, Garetz SL, et al. Pediatric Sleep Questionnaire. Prediction of sleep apnea and outcomes. Arch Otolaryngol Head Neck Surg 2007;133:216–22.
Montgomery-Downs HE, O'Brien LM, Holbrook CR, Gozal D. Snoring and sleep-disordered breathing in young children: subjective and objective correlates. Sleep 2004;27:87-94.
Owens JA, Dalzell V. Use of the “BEARS” sleep screening tool in a pediatric residents’ continuity clinic: a pilot study. Sleep Med 2005;6:63-9.
Franco RA Jr, Rosenfeld RM, Rao M. First place-resident clinical science award 1999. Quality of life for children with obstructive sleep apnea. Otolaryngol Head Neck Surg 2000;123:9–16.
de Serres LM, Derkay C, Astley S, Deyo RA, Rosenfeld RM, Gates GA. Measuring quality of life in children with obstructive sleep disorders. Arch Otolaryngol Head Neck Surg 2000;126:1423-9.
Sohn H, Rosenfeld RM. Evaluation of sleep-disordered breathing in children. Otolaryngol Sleep Med 2000;1:21-32.
Constantin E, Tewfik TL, Brouillette RT. Can the OSA-18 quality-of-life questionnaire detect obstructive sleep apnea in children? Pediatrics 2010;125:e162–8.
Borgström A, Nerfeldt P, Friberg D. Questionnaire OSA- 18 has poor validity compared to polysomnography in pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2013;77:1864–8.
Ishman SL, Yang CJ, Cohen AP, et al. Is the OSA-18 predictive of obstructive sleep apnea: comparison to polysomnography. Laryngoscope 2015;125:1491–5.
Kadmon G, Shapiro CM, Chung SA, Gozal D. Validation of a pediatric obstructive sleep apnea screening tool. Int J Pediatr Otorhinolaryngol 2013;77:1461–4.
Kadmon G, Chung SA, Shapiro CM. I'M SLEEPY: A short pediatric sleep apnea questionnaire. Int J Pediatr Otorhinolaryngol 2014;78:2116–20.
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;105:405–12.
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;109:704–12.
Nixon GM, Kermack AS, Davis GM, Manoukian JJ, Brown KA, Brouillette RT. Planning adenotonsillectomy in children with obstructive sleep apnea: the role of overnight oximetry. Pediatrics 2004;113:e19–25.
Pediatric Society of New Zealand. Best practise evidence based guidelines (Assessment of Sleep Disordered Breathing in Childhood) guidelines. 2005. Available at: firstname.lastname@example.org. Accessed on 10th Feb 2015.
Pavone M, Cutrera R, Verrillo E, Salerno T, Soldini S, Brouillette RT. Night-to-night consistency of at-home nocturnal pulse oximetry testing for obstructive sleep apnea in children. Pediatr Pulmonol 2013;48:754–60.
Lee TT, Lefebvre CE, Gans NE, Daniel SJ. Quantifying respiratory complications post-adenotonsillectomy in patients with normal or inconclusive overnight oximetry. J Otolaryngol Head Neck Surg 2013;42:50.
Horwood L, Brouillette RT, McGregor CD, Manoukian JJ, Constantin E. Testing for pediatric obstructive sleep apnea when health care resources are rationed. JAMA Otolaryngol Head Neck Surg 2014;140:616–23.
Coverstone AM, Bird M, Sicard M, et al. Overnight pulse oximetry for evaluation of sleep apnea among children with trisomy 21. J Clin Sleep Med 2014;10:1309–15.
Alonso Álvarez Mde L, Terán Santos J, Cordero Guevara J, et al. [Reliability of home respiratory polygraphy for the diagnosis of sleep apnea-hypopnea syndrome: analysis of costs]. [In Spanish] Arch Bronconeumol 2008;44:22.
Masa JF, Corral J, Pereira R, et al. Effectiveness of home respiratory polygraphy for the diagnosis of sleep apnoea and hypopnoea syndrome. Thorax 2011;66:567–73.
Calleja JM, Esnaola S, Rubio R, Durán J. Comparison of a cardiorespiratory device versus polysomnography for diagnosis of sleep apnoea. Eur Respir J 2002;20:1505– 10.
Tan HL, Gozal D, Ramirez HM, Bandla HP, Kheirandish- Gozal L. Overnight polysomnography versus respiratory polygraphy in the diagnosis of pediatric obstructive sleep apnea. Sleep 2014;37:255–60.
Alonso-Álvarez ML, Terán-Santos J, Ordax Carbajo E, et al. Reliability of home respiratory polygraphy for the diagnosis of sleep apnea in children. Chest 2015;147:1020–8.
Mulgrew AT, Fox N, Ayas NT, et al. Diagnosis and initial management of obstructive sleep apnea without polysomnography: a randomized validation study. Ann Intern Med 2007;146:157–66.
Whitelaw WA, Brant RF, Flemons WW. Clinical usefulness of home oximetry compared with polysomnography for assessment of sleep apnea. Am J Respir Crit Care Med 2005;171:188–93.
Xu Z, Cheuk DK, Lee SL. Clinical evaluation in predicting childhood obstructive sleep apnea. Chest 2006;130:1765–71.
Kaditis A, Gozal LK, Gozal D. Algorithm for the diagnosis and treatment of pediatric OSA: a proposal of two pediatric sleep centers. Sleep Med 2012;13:217–27.
Luz Alonso Álvarez L, Canet T, Cubell-Alarco M, et al. [Consensus document on sleep apnea-hypopnea syndrome in children (full version). Sociedad Española de Sueño. El Área de Sueño de la Sociedad Española de Neumología y Cirugía Torácica(SEPAR)]. Arch Bronconeumol 2011;47:2-18.
Peña-Zarza JA, Osona-Rodriguez de Torres B, Gil-Sanchez JA, Figuerola-Mulet J. Utility of the pediatric sleep questionnaire and pulse oximetry as screening tools in pediatric patients with suspected obstructive sleep apnea syndrome. Sleep Disord 2012;2012:819035.
Brown KA. Evaluation of the child with sleep-disordered breathing scheduled for adenotonsillectomy. Sleep Med Clin 2013;8:149–55.
Kheirandish L, Goldbart AD, Gozal D. Intranasal steroids and oral leukotriene modifier therapy in residual sleepdisordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics 2006;117:e61–6.
Goldbart AD, Goldman JL, Veling MC, Gozal D. Leukotriene modifier therapy for mild sleep-disordered breathing in children. Am J Respir Crit Care Med 2005;17:364–70.