[Obstructive sleep apnea-hypopnea syndrome in children]

Obstructive sleep apnea is a sleep respiratory disorder characterized by cessation or reduction in air flow through the nose and mouth, leading to a drop in oxygen saturation in the arterial blood, increased respiratory muscle work, arousals and sleep fragmentation. Pathophysiology of the syndrome is multifactorial, with the major role of addenotonsillar hypertrophy and obesity. The frequency of obstructive sleep apnea (OSA) in children grows, which is partly a secondary phenomenon to the rise in the frequency of obesity. The clinical picture is characterized by numerous symptoms that occur during night sleep and at daytime. Apart from difficulties in breathing, snoring and apnea events, the nocturnal symptoms are non-characteristic and can be easily overlooked, especially when a child sleeps alone in a room. In the clinical picture, daytime symptoms may predominate, their intensity being proportional to the degree of airway obstruction (strictures or collapse) and hypoxia. In the morning, the child wakes up tired, with blocked nose, breathes through the mouth, gets tired easily, have concentration problems, is irritated, demonstrates locomotor hyperactivity, which may resemble ADHD symptoms. Long-term disease leads to exacerbation of all-systemic symptoms, results in cardiovascular complications, induces developmental inhibition and cognitive dysfunction, and is responsible for school/social failures and reduced life quality. Most of these symptoms are reversible (partly or completely) after adenotonsilectomy, which is the therapeutic intervention of choice.