Indian Journal of Sleep Medicine

Register      Login

VOLUME 4 , ISSUE 3 ( July-September, 2009 ) > List of Articles

REVIEW ARTICLE

Sleep disordered breathing in children

Dipti Gothi

Citation Information : Gothi D. Sleep disordered breathing in children. Indian Sleep Med 2009; 4 (3):82-90.

DOI: 10.5005/ijsm-4-3-82

License: CC BY-SA 4.0

Published Online: 01-09-2009

Copyright Statement:  Copyright © 2009; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Sleep disordered breathing (SDB) in children has been recognized over the past two decades due to research and clinical advances in pediatric sleep medicine. Pediatric SDB comprises of central apnoea/hypoventilation, apnoea of prematuriry, the spectrum of obstructive sleep hypoventilation disorders and hypoventilation during sleep due to chronic pulmonary disease. Obstructive sleep hypoventilation syndromes have a clinical range from primary snoring, through upper airway resistance syndrome to obstructive sleep apnoea syndrome (OSAS). Though, the exact prevalence of SDB and obstructive sleep hypoventilation syndrome is not known, the prevalence of OSAS in children varies between 1-4%. Pathophysiology, clinical manifestation, diagnosis and treatment of pediatric SDB which differs from adult SDB is reviewed along with its recent advances.


PDF Share
  1. Nanaware SK, Gothi D and Joshi JM. Sleep Apnea. Indian Journal of Pediatrics 2006; 73:597-601.
  2. Tang JP. Obesity and Obstructive Sleep Apnoea Hypopnoea Syndrome in Singapore Children, Ann Acad Med Singapore 2008; 37:710-4.
  3. Lumeng JC, Chervin RD. Epidemiology of Pediatric Sleep Apnoea. Proc Am Thorac Sc 2008; 5:242-52.
  4. Mazumar H, Arens Raanan. Diagnostic Issues in Pediatric Sleep Apnoea. Proc Am Thorac Soc 2008; 5:263-73.
  5. 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.
  6. American Thoracic Society. Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med. 1996; 153:866–78.
  7. 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; 107:963–66.
  8. Liu X, Ma Y, Wang Y, Jiang Q, Rao X, Lu X, Teng H. Brief report: an epidemiologic survey of the prevalence of sleep disorders among children 2 to 12 years old in Beijing, China. Pediatrics 2005; 115:266–8.
  9. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002;165:1217–1239.
  10. Ali NJ, Pitson DJ, Stradling JR. Snoring, sleep disturbance and behavior in 4-5 year olds. Arch Dis Child 1993; 68:360-6.
  11. Redline S, Tiishler PV, Schluchter M, Aylor J, Clark K, Graham G. Risk factors for sleep disordered breathing in children; Association with Obesity, Race and Respiratory Problems. Am J Respir Crit Care Med 1999; 159:1527- 32.
  12. Marcus CL, Curtis S, Koerner CB, Joffe A, Serwint JR, Loughlin GM, et al. Evaluation of pulmonary function and polysomnography in obese children and adolescents. Pediatr Pulmonol 1996; 21:176-83.
  13. Wing YK, Hui SH, Pak WM, Ho CK, Cheung A, Li AM, et al. A controlled study of sleep related disordered breathing in obese children. Arch Dis Child 2003; 88:1043-7.
  14. Dayyat E, Kheirandish-Gozal L, Gozal D. Childhood obstructive sleep apnea: one or two distinct disease entities? Sleep Med Clin. 2007; 2:433-44.
  15. Capdevila OS, Kheirandish-Gozal L, Dayyat E and Gozal D. Pediatric Obstructive Sleep Apnea: Complications, Management, and Long-term Outcomes The Proceedings of the American Thoracic Society 2008; 5:274-82.
  16. Guilleminault C, Partinen M, Praud JP, Quera-Salva MA, Powell N, Riley R. Morphometric facial changes and obstructive sleep apnea in adolescents. J Pediatr 1989; 114: 997-9.
  17. Gozal D, Wang M, Pope DW Jr. Objective sleepiness measures in pediatric obstructive sleep apnea. Pediatrics 2001; 108:693–7.
  18. Rosen CL. Clinical features of obstructive sleep apnea hypoventilation syndrome in otherwise healthy children. Pediatr Pulmonol 1999; 27:403–9.
  19. Guilleminault C, Korobkin R, Winkle R. A review of 50 children with obstructive sleep apnea syndrome. Lung 1981; 159:275–87.
  20. Brouilette R, Hanson D, David R, Klemka L, Szatkowski A, Fernbach S, et al. A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr 1984; 105:10–4.
  21. Brouillette RT, Fernbach SK, Hunt CE. Obstructive sleep apnea in infants and children. J Pediatr 1982; 100:31–40.
  22. 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.
  23. Nieminen P, Lopponen T, Tolonen U, Lanning P, Knip M, Lopponen H. Growth and biochemical markers of growth in children with snoring and obstructive sleep apnea. Pediatrics 2002; 109:e55.
  24. Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, Liu PL. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32:429–34.
  25. Schechter MS. Pediatric Pulmonology,Subcommittee on Obstructive Sleep Apnea Syndrome American Academy Of Pediatrics Technical Report: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome: Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. Pediatrics 2002;109;e69.
  26. Tang JPL Obesity and Obstructive Sleep Apnoea Hypopnoea Syndrome in Singapore Children Ann Acad Med Singapore 2008; 37:710-4
  27. Gozal D. Sleep disordered breathing and school performance in children. Pediatrics 1998; 102: 616-20.
  28. Dayyat E, Kheirandish-Gozal, L, and Gozal D. Childhood Obstructive Sleep Apnea: One or Two Distinct Disease Entities? Sleep Med Clin. 2007 September; 2(3):433–44.
  29. Melendres MC, Lutz JM, Rubin ED, Marcus CL. Daytime sleepiness and hyperactivity in children with suspected sleepdisordered breathing. Pediatrics 2004; 114:768–775.
  30. Gozal D, Wang M, Pope DW Jr. Objective sleepiness measures in pediatric obstructive sleep apnea. Pediatrics 2001; 108:693–7.
  31. Tauman R, Ivanenko A, O'Brien LM, Gozal D. Plasma Creactive protein levels among children with sleepdisordered breathing. Pediatrics 2004; 113:e564–9.
  32. Larkin EK, Rosen CL, Kirchner HL, Storfer-Isser A, Emancipator JL, Johnson NL, et al. Variation of C-reactive protein levels in adolescents: association with sleepdisordered breathing and sleep duration. Circulation 2005; 111:1978–84.
  33. Kheirandish-Gozal L, Capdevila OS, Tauman R, Gozal D. Plasma C-reactive protein in non-obese children with obstructive sleep apnea before and after adenotonsillectomy. J Clin Sleep Med 2006; 2:301–4.
  34. Redline S, Storfer-Isser A, Rosen CL, Johnson NL, Kirchner HL, Emancipator J, et al. Association between metabolic syndrome and sleep-disordered breathing in adolescents. Am J Respir Crit Care Med 2007; 176:401–8.
  35. Monahan KJ, Larkin EK, Rosen CL, Graham G, Redline S. Utility of noninvasive pharyngometry in epidemiologic studies of childhood sleep-disordered breathing. Am J Respir Crit Care Med 2002; 165:1499–503.
  36. 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.
  37. Fregosi RF, Quan SF, Kaemingk KL, Morgan WJ, Goodwin JL, Cabrera R, et al. Sleep-disordered breathing, pharyngeal size and soft tissue anatomy in children. J Appl Physiol 2003;95:2030–8.
  38. Marcus CL, McColley SA, Carroll JL, Loughlin GM, Smith PL, Schwartz AR. Upper airway collapsibility in children with obstructive sleep apnea syndrome. J Appl Physiol 1994; 77:918–24.
  39. 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.
  40. Goodwin JL, Enright PL, Kaemingk KL, Rosen GM, Morgan WJ, Fregosi RF, et al. Feasibility of using unattended polysomnography in children for research–report of the Tucson Children's Assessment of Sleep Apnea study (TuCASA). Sleep 2001; 24:937–44.
  41. American Thoracic Society. Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 1996; 153:866–878.
  42. Iber C, Ancoli-Israel S, Chesson A, Quan SF. American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester, IL: American Academy of Sleep Medicine; 2007.
  43. Jain A, Sahni JK. Polysomnographic studies in children undergoing adenoidectomy and/or tonsillectomy. J Laryngol Otol 2002; 116:711–5.
  44. Suen JS, Arnold JE, Brooks LJ. Adenotonsillectomy for treatment of obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg 1995; 121:525–30.
  45. Uliel S, Tauman R, Greenfeld M and Sivan Y. Normal Polysomnographic Respiratory Values in Children and Adolescents. Chest 2004; 125;872-8.
  46. Rosen GM, Muckle RP, Mahowald MW, Goding GS, Ullevig C. Postoperative respiratory compromise in children with obstructive sleep apnea syndrome: can it be anticipated? Pediatrics 1994; 93:784–8.
  47. Tal A, Bar A, Leiberman A, Tarasiuk A. Sleep characteristics following adenotonsillectomy in children with obstructive sleep apnea syndrome. Chest 2003; 124:948–53.
  48. Mitchell RB, Kelly J. Outcome of adenotonsillectomy for severe obstructive sleep apnea in children. Int J Pediatr Otorhinolaryngol 2004; 68:1375–9.
  49. Lipton AJ, Gozal D. Treatment of obstructive sleep apnea in children: do we really know how? Sleep Med Rev 2003; 7:61–80.
  50. Tauman R, Gulliver TE, Krishna J. Montgomery-Downs HE, O'Brien LM, Ivanenko A, Gozal D. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr 2006; 149:803–8.
  51. Mitchell RB, Kelly J. Outcome of adenotonsillectomy for obstructive sleep apnea in obese and normal-weight children. Otolaryngol Head Neck Surg 2007; 137:43-8.
  52. Guilleminault C, Li K, Quo S, Inouye RN. A prospective study on the surgical outcomes of children with sleepdisordered breathing. Sleep 2004; 27:95–100.
  53. Contencin P, Guilleminault C, Manach Y. Long-term followup and mechanisms of obstructive sleep apnea (OSAS) and related syndromes through infancy and childhood. Int J Pediatr Otorhinolaryngol 2003; 67:S119–S23.
  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. Waters KA, Everett FM, Bruderer JW, Sullivan CE. Obstructive sleep apnea: the use of nasal CPAP in 80 children. Am J Respir Crit Care Med 1995; 152:780–785.
  56. Brouillette RT, Manoukian JJ, Ducharme FM, Oudjhane K, Earle LG, Ladan S, et al. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr 2001; 138:838–844.
  57. Alexopoulos EI, Kaditis AG, Kalampouka E, Kostadima E, Angelopoulos NV, Mikraki V, et al. Nasal corticosteroids for children with snoring. Pediatr Pulmonol 2004; 38:161–7.
  58. Berlucchi M, Salsi D, Valetti L, Parrinello G, Nicolai P. The role of mometasone furoate aqueous nasal spray in the treatment of adenoidal hypertrophy in the pediatric age group: preliminary results of a prospective, randomized study. Pediatrics 2007; 119:e1392–7.
  59. Goldbart AD, Veling MC, Goldman JL, Li RC, Brittian KR, Gozal D. Glucocorticoid receptor subunit expression in adenotonsillar tissue of children with obstructive sleep apnea. Pediatr Res 2005; 57:232–6.
  60. Villa MP, Bernkopf E, Pagani J, Broia V, Montesano M, Ronchetti R. Randomized controlled study of an oral jawpositioning appliance for the treatment of obstructive sleep apnea in children with malocclusion. Am J Respir Crit Care Med 2002;165:123–7.
  61. Carvalho FR, Lentini-Oliveira D, Machado MA, Prado GF, Prado LB, Saconato H. Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children. Cochrane Database Syst Rev [serial on the Internet]. 2007; 2:CD005520.
  62. Guilleminault C, Winkle R, Korobkin R, Simmons B. Children and nocturnal snoring: evaluation of the effects of sleep related respiratory resistive load and daytime functioning. Eur J Pediatr 1982; 139:165-171.
  63. Downey R III, Perkin RM, MacQuarrie J. Upper airway resistance syndrome: sick, symptomatic but underrecognized. Sleep 1993; 16:620-3.
  64. Guilleminault C, Khramtsov A. Upper airway resistance syndrome in children: a clinical review. Semin Pediatr Neurol. 2001; 8:207-15.
  65. Marcus CL. Sleep-disordered Breathing in Children. Am J Respir Crit Care Med 2001;164:16–30.
  66. Doherty LS, Kiely JL, Deegan PC, Nolan G, McCabe S, Green A.J, et al. Late-onset central hypoventilation syndrome: a family genetic study, Eur Respir J 2007; 29: 312–6.
  67. Katz ES, McGrath S, Marcus CL. Late-onset central hypoventilation with hypothalamic dysfunction: a distinct clinical syndrome. Pediatr Pulmonol 2000; 29:62–8.
  68. Idiopathic congenital central hypoventilation syndrome: diagnosis and management. American Thoracic Society. Am J Respir Crit Care Med 1999; 160: 368–73.
  69. Weese-Mayer DE, Berry-Kravis EM, Zhou L, Maher BS, Silvestri JM, Curran ME, et al. Idiopathic congenital central hypoventilation syndrome: analysis of genes pertinent to early autonomic nervous system embryologic development and identification of mutations in PHOX2B. Am J Med Genet A 2003; 123: 267– 78.
  70. Gothi D, Joshi JM. Late Onset Hypoventilation Syndrome: Is There a Spectrum of Idiopathic Hypoventilation Syndromes? Indian J Chest Dis Allied Sci 2005; 47:293-9.
  71. Chen ML, Keens TG. Congenital central hypoventilation syndrome: not just another rare disorder. Paediatric Respiratory Reviews 2004; 5:182–9.
  72. Bouterline-Young HJ, Smith CA: Respiration of full-term and premature infants. Am J Dis Child 1953; 80:753-5.
  73. Dransfield DA, Spitzer AR, Fox WW: Episodic airway obstruction in premature infants. Am J Dis Child 1983; 137:441-3.
  74. Thach BT, Stark AR. Spontaneous neck flexion and airway obstruction during apneic spells in preterm infants. J Pediatr 1979; 94:275-81.
  75. Milner AD, Boon AW, Saunders RA, Hopkin IE. Upper airway obstruction and apnea in preterm babies. Arch Dis Child 1980; 55:22-5.
  76. Kelly DH, Shannon DC. Treatment of apnea and excessive periodic breathing in the full-term infant. Pediatrics 1981; 68:183-6.
  77. Moyer-Mileur LJ, Nielson DW, Pfeffer KD, Witte MK, Chapman DL. Eliminating sleep-associated hypoxemia improves growth in infants with bronchopulmonary dysplasia. Pediatrics 1996; 98:779–83.
  78. Coffey MJ, Fitzgerald MX, McNicholas WT. Comparison of oxygen desaturation during sleep and exercise in patients with cystic fibrosis. Chest 1991; 100:659–62.
  79. Chipps BE, Mak H, Schuberth KC, Talamo JH, Menkes HA, Scherr MS. Nocturnal oxygen saturation in normal and asthmatic children. Pediatrics 1980; 65:1157–60.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.