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Pediatric obstructive sleep apnea syndrome (OSAS) for the allergist: update on the assessment and management
Michel Alkhalil1, Richard Lockey
1Division of Allergy and Immunology, University of South Florida, James A. Haley Veterans Hospital, Tampa, Florida 33612, USA. malkhali@health.usf.edu
Insights
Pediatric obstructive sleep apnea syndrome (OSAS) is a common condition that can lead to serious health issues. Early diagnosis and treatment, often starting with tonsillectomy and adenoidectomy, are crucial for children
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
- Otolaryngology
Background:
- Sleep-disordered breathing (SDB) encompasses a spectrum from primary snoring to severe obstructive sleep apnea syndrome (OSAS) in children.
- OSAS is increasingly recognized as a significant health concern with potential long-term consequences.
Purpose of the Study:
- To comprehensively review the epidemiology, pathophysiology, risk factors, complications, diagnosis, and treatment of pediatric obstructive sleep apnea syndrome (OSAS).
Main Methods:
- Systematic literature search of Ovid, MEDLINE, and PubMed databases from 1950 to the present.
- Inclusion of articles detailing prevalence, mechanisms, risk factors, complications, and current management of pediatric sleep-disordered breathing (SDB).
Main Results:
- SDB presents as a continuum, with OSAS being a severe form characterized by complete upper airway obstruction.
- Severity is determined by sleep disruption, hypoxemia, hypercapnia, and airflow reduction.
- OSAS is linked to impaired growth, neurocognitive deficits, and cardiovascular morbidity in children.
- Tonsillectomy and adenoidectomy are the primary surgical interventions for pediatric OSAS.
Conclusions:
- Pediatric SDB is prevalent and can cause significant health problems, yet it may be underdiagnosed.
- A high index of suspicion, thorough clinical history, and physical examination are essential for identifying SDB in children.
- Prompt recognition and intervention are vital to mitigate potential health disruptions.
Objective:
The purpose of this article is to provide an understanding of the epidemiology, pathophysiology, risk factors, potentially serious complications, diagnostic modalities, and treatment options available for pediatric obstructive sleep apnea syndrome (OSAS).
Data Sources:
The Ovid, MEDLINE, and PubMed databases from 1950 to the present were searched for relevant articles regarding pediatric OSAS.
Study Selection:
Articles describing the prevalence, mechanisms, risk factors, complications, and most recent updates on assessment and management of pediatric sleep-disordered breathing (SDB) were used for this review.
Results:
The data suggest that SDB may be considered a disease continuum. It ranges in severity from mild obstruction of the upper airway, producing primary snoring, to increased upper airway resistance syndrome (UARS), to continuous episodes of complete upper airway obstruction or OSAS. The degree of sleep disruption, hypoxemia, hypercapnia, and upper airway airflow reduction are main factors in determining the severity of SDB. Mounting evidence implicates OSAS as a risk factor for decreased growth, impaired neurocognitive function, and cardiovascular morbidity. The first treatment of choice for OSAS in children remains tonsillectomy and adenoidectomy.
Conclusions:
Sleep-disordered breathing is common in children and can cause minor as well as major disruption of sleep and health problems requiring intervention. Despite apparent symptoms and potentially severe consequences, SDB may be underdiagnosed and unrecognized. Therefore, a high index of suspicion and detailed clinical history and physical examination should be part of any clinical assessment of a child presenting with breathing difficulty during sleep.
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