OSAS

Obstructive Sleep Apnea (OSA)

Pediatric Obstructive Sleep Apnea Syndrome (OSAS)

  • Definition:

    • OSAS is defined as the occurrence of partial or complete upper airway obstruction (UAO) during sleep.

    • Associated symptoms include:

    • Snoring

    • Labored or obstructed breathing

    • Disrupted sleep patterns.

  • Prevalence:

    • Estimated prevalence in children: 2% to 5%.

    • OSAS can occur at any age.

    • Higher prevalence in:

    • Obese children.

    • Vulnerable populations:

      • Black children

      • Hispanic children

      • Preterm infants.

    • Family history of OSAS may be present.

  • Possible early life influences:

    • Passive smoke inhalation

    • Socioeconomic status

    • Presence of snoring

    • Genetic modifiers causing airway inflammation.

Pathophysiology

  • Major causes of OSAS:

    • Airway narrowing

    • Increased upper airway collapsibility

    • Airway inflammation.

  • Associated conditions causing airway narrowing include:

    • Adenotonsillar hypertrophy

    • Gastroesophageal reflux

    • Obesity

    • Craniofacial anomalies.

  • Reduced motor tone of upper airways can be observed in neurologic disorders, such as:

    • Cerebral palsy

    • Down syndrome.

  • Inflammatory contributing factors:

    • Allergy

    • Asthma

    • Obesity.

  • Mechanism of obstruction:

    • Obstruction of the upper airway during sleep leads to:

    • Cyclic episodes of increased respiratory effort

    • Changes in intrathoracic pressures

    • Oxygen desaturation

    • Hypercapnia

    • Arousal from sleep leading to cycle repetition.

  • Infants are particularly at risk due to anatomical and physiological predispositions resulting in airway obstruction and gas exchange abnormalities.

Clinical Manifestations

  • Common symptoms of OSAS include:

    • Snoring

    • Labored breathing

    • Sweating

    • Restlessness during sleep (either continuous or intermittent).

  • Episodes of increased respiratory effort may occur without audible airflow, often ending in:

    • Snorting

    • Gasping

    • Repositioning

    • Arousal.

  • Additional manifestations:

    • Daytime sleepiness or napping, occasionally reported.

    • Nocturnal enuresis (bedwetting).

  • Consequences of OSAS may include:

    • Cognitive and neurobehavioral impairment

    • Excessive daytime sleepiness

    • Impaired school performance

    • Poor quality of life.

Evaluation and Treatment

  • Initial evaluation:

    • Parents should be asked about the presence of:

    • Snoring

    • Labored breathing

    • Sweating

    • Restlessness during sleep.

  • Screening tools:

    • A variety are available for use.

  • Definitive diagnosis:

    • Polysomnographic sleep study is essential:

    • Diagnosis of OSAS confirmed by:

    • Presence of one or more obstructive events per hour of sleep

    • Obstructive hypoventilation resulting in hypercapnia for greater than 25% of sleep time.

  • Additional evaluations:

    • Imaging of the upper airway may be performed to rule out:

    • Tonsillar enlargement

    • Upper airway narrowing.

  • Treatment options:

    • If OSAS is due to tonsillar enlargement, referral for:

    • Tonsillectomy and Adenoidectomy (T&A) is often treatment of choice.

    • For severely affected children who do not respond to T&A or those with complicating factors such as obesity:

    • Use of continuous positive airway pressure (CPAP)

    • Anti-inflammatories

    • Dental treatments

    • High-flow nasal cannula

    • Weight loss can be considered.

  • Importance of treatment:

    • Treatment is crucial to minimize associated morbidities related to OSAS.