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Upper airway resistance syndrome in children: a clinical review
1Stanford University Sleep Disorders Clinic, CA 94305-5547, USA.
Insights
Upper airway resistant syndrome (UARS) is more prevalent in children than obstructive sleep apnea syndrome (OSAS). Diagnosis may require esophageal pressure monitoring, and craniofacial anomalies suggest orthodontic intervention for airway expansion.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Physiology
- Craniofacial Orthodontics
Background:
- Upper airway resistant syndrome (UARS) is more common in children than obstructive sleep apnea syndrome (OSAS).
- Symptoms of UARS vary with age and family history of sleep-disordered breathing.
- Enlarged tonsils and adenoids may coexist with mild craniofacial skeletal anomalies.
Purpose of the Study:
- To highlight the prevalence and diagnostic challenges of UARS in children.
- To emphasize the role of craniofacial structure in pediatric sleep-disordered breathing.
- To advocate for early orthodontic assessment in affected children.
Main Methods:
- Polygraphic recording with nasal cannula/pressure transducer to detect flow limitation.
- Esophageal pressure monitoring for definitive diagnosis when other methods are inconclusive.
- Maxillomandibular examination for craniofacial skeletal assessment.
Main Results:
- UARS presents differently in children compared to adults.
- Abnormal breathing may manifest as tachypnea without oxygen desaturation.
- Flow limitation during sleep is a key indicator, often confirmed by esophageal manometry.
- Craniofacial anomalies are frequently observed in children with UARS.
Conclusions:
- UARS is a significant pediatric sleep disorder requiring specific diagnostic approaches.
- Esophageal pressure monitoring is crucial for confirming UARS.
- Orthodontic evaluation and treatment, including oral cavity expansion, are recommended for children with sleep-disordered breathing and craniofacial anomalies.
Abstract:
Upper airway resistant syndrome (UARS) is more common in children than is obstructive sleep apnea syndrome (OSAS). Age will color the symptoms associated with the syndrome. UARS must be looked for in families with adult sleep-disordered breathing. Polygraphic recording during sleep will show flow limitation with usage of nasal cannula/pressure transducer system, but the abnormal breathing during sleep may be indicated also by burst of tachypnea without saturation drops. Esophageal pressure monitoring may be the only way to confirm a suspected diagnosis. A mild developmental anomaly of the craniofacial skeleton is often seen in these children even in the presence of enlarged tonsils and adenoids. Children with sleep-disordered breathing should have a maxillomandibular examination to assess the need for orthodontic treatment to expand the oral cavity.