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Obstructive sleep apnea syndrome in children
1Stanford University School of Medicine, Palo Alto, Calif.
Insights
Repetitive upper airway obstructions during sleep, even partial, cause snoring and symptoms. Evaluating airway resistance and craniofacial impact is crucial for effective treatment in children.
Area of Science:
- Sleep Medicine
- Pediatric Otolaryngology
- Orthodontics
Background:
- Repetitive partial or complete upper airway obstructions during sleep cause chronic snoring and related symptoms.
- The significance of upper airway resistance increases during sleep may outweigh the number of obstructive sleep apneas.
- Clinical symptoms can manifest even when nocturnal oxygen saturation is not severely affected by partial airway occlusion.
Purpose of the Study:
- To highlight the importance of upper airway resistance and craniofacial morphology in sleep-related breathing disorders.
- To discuss diagnostic tools and treatment options for pediatric sleep-disordered breathing.
- To evaluate the impact of airway occlusion on facial development.
Main Methods:
- Polygraphic evaluation using esophageal pressure measurements and breathing frequency during sleep.
- Assessment of craniofacial morphology and its interaction with airway adequacy.
- Clinical observation of treatment outcomes for tonsillectomy, adenoidectomy, and nasal continuous positive airway pressure.
Main Results:
- Esophageal pressure and breathing frequency are key diagnostic features in prepubertal children.
- Tonsillectomy and adenoidectomy can benefit children with small upper airways during sleep.
- Nasal continuous positive airway pressure effectively treats airway occlusion but does not correct mandibular deficiency.
Conclusions:
- The interplay between upper airway patency and craniofacial structure is critical for managing sleep-disordered breathing.
- Orthodontic interventions may obviate the need for maxillomandibular surgery in pubertal patients.
- Comprehensive evaluation is necessary to address both airway obstruction and associated skeletal discrepancies.
Abstract:
Partial or complete repetitive obstructions of the upper airway during sleep give rise to clinical symptoms associated with heavy, chronic snoring. The number of obstructive sleep apneas during the night may be less important than the repetitive inspiratory increases in upper airway resistance, even if these are associated only with a partial airway collapse. Oxygen saturation may not be severely affected by partial occlusion during nocturnal recording, although clinical symptoms may occur. Esophageal pressure measurements and breathing frequency during sleep are key features in the polygraphic evaluation of prepubertal children. Tonsillectomy and adenoidectomy may be helpful in treating children with small upper airway during sleep. The marked interaction between upper airway adequacy and craniofacial morphology make it critical to evaluate the impact of partial or complete airway occlusion during sleep on facial prognathism. Nasal continuous positive airway pressure is a safe treatment for persistent, partial or complete upper airway occlusion during sleep, but it does not address the mandibular deficiency often seen in symptomatic children. Orthodontic evaluation and treatment may make maxillomandibular surgery unnecessary during the pubertal years.