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[Sleep apneas in children]
1Universitäts-Kinderklinik Zürich Intensivstation/Neonatologie. Daniela.Ghelfi@kispi.unizh.ch
Insights
Breathing disorders in children range from infant apneas due to immature regulation to severe obstructive sleep apnea in young children. Early evaluation and treatment, often including adenotonsillectomy, are crucial for managing these conditions.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Sleep Medicine
Context:
- Breathing disorders in children present unique challenges from the neonatal period through early childhood.
- Immature central respiratory regulation in premature infants can lead to apneas and bradycardias, necessitating medical or mechanical support.
- Upper airway obstruction, particularly in young children, is frequently linked to conditions like adenotonsillar hypertrophy.
Purpose:
- To provide a comprehensive overview of pediatric breathing disorders, encompassing neonatal apneas and childhood obstructive sleep apnea.
- To highlight the diverse causes, clinical presentations, and diagnostic considerations for these conditions.
- To emphasize the importance of timely evaluation and appropriate therapeutic interventions.
Summary:
- Neonatal breathing issues stem from immature respiratory control, requiring interventions like nasal CPAP or ventilation for severe cases.
- Infantile apneas can persist, presenting with concerning symptoms that warrant investigation and management.
- Childhood obstructive sleep apnea, characterized by snoring and upper airway obstruction, often manifests with daytime behavioral and performance issues, with adenotonsillectomy being a common treatment.
Impact:
- Early identification and management of neonatal breathing disturbances can improve outcomes for premature infants.
- Addressing childhood obstructive sleep apnea can resolve nocturnal symptoms and mitigate significant daytime behavioral and developmental problems.
- Understanding the spectrum of pediatric respiratory disorders aids clinicians in providing targeted and effective care.
Abstract:
There are many causes leading to breathing disorders in children. In the newborn period the immature central regulation of breathing can result in a pattern with apneas and bradycardias most commonly seen in the very premature infant. Therefore, during hospital stay many of these very tiny preterms and some of the very ill term infants do have severe apneas and do need medication and or mechanical support (nasal CPAP, positive pressure ventilation). In the first two to three months of life central dysmaturity can persist in some infants and apneas of infancy can occur further on. Infants with prolonged apneas and symptoms like paleness, cyanosis, stiffness or limpness are often investigated, treated or monitored. At the age of two to six, every tenth child is a loud snorer. Every fifth snorer at this age suffers from a severe upper airway obstruction. Factors that decrease pharyngeal size or increase pharyngeal compliance may lead to obstruction. Adenotonsillar hypertrophy is the most common associated condition, craniofacial disorders, central nervous system and neuromuscular problems and less obesity are disposing factors. Children may present nocturnal symptoms like snoring, difficult breathing or disturbed sleep, but most of them have daytime problems as initial complaint such as hyperactivity, behavioral problems, growth failure, poor school performance. Excessive daytime sleepiness is not so common in young children. The childhood obstructive sleep apnea syndrome is a common and serious problem. Children with symptoms suggesting severe obstruction should be evaluated and treated. Most children are cured by adenotonsillectomy whilst some require further therapy.