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Age and Upper Airway Obstruction: A Challenge to the Clinical Approach in Pediatric Patients

Luana Nosetti1, Marco Zaffanello2, Francesca De Bernardi3

  • 1Division of Pediatrics, "F. Del Ponte" Hospital, University of Insubria, 21100 Varese, Italy.

International Journal of Environmental Research and Public Health
|May 24, 2020
PubMed

Insights

Causes of obstructive sleep apnea (OSA) in infants under two years old differ by age. Younger infants (<1 year) show more laryngomalacia and reflux, while older infants (>1 year) have more tonsillar/adenoidal hypertrophy and nasal congestion.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Otolaryngology

Background:

  • Obstructive sleep apnea syndrome (OSAS) presents significant challenges in pediatric clinical practice.
  • The etiology of obstructive sleep apnea (OSA) in children under two years old is not well-documented.
  • Upper airway abnormalities are a known risk factor for pediatric morbidity.

Purpose of the Study:

  • To investigate the distinct causes of obstructive sleep apnea (OSA) in infants younger than one year compared to those between one and two years old.
  • To identify specific anatomical and physiological factors contributing to sleep-disordered breathing in different pediatric age groups.
  • To provide insights into the pathophysiology of OSA in infants for improved clinical assessment.

Main Methods:

  • Retrospective observational study of 82 pediatric patients admitted for brief resolved unexplained events (BRUE) or OSA between January 2016 and February 2018.
  • Patients were categorized into two age groups: <1 year (n=59) and >1 year (n=23).
  • Evaluations included nap polysomnography, multichannel intraluminal impedance-pH monitoring, and nasopharyngoscopy.

Main Results:

  • Sleep-disordered breathing prevalence was similar between age groups.
  • Omega-shaped epiglottis, laryngomalacia, and nasal septum deviation were more common in infants <1 year.
  • Tonsillar/adenoidal hypertrophy was more frequent in infants >1 year, while laryngomalacia and gastroesophageal reflux were more prevalent in the younger group.

Conclusions:

  • The primary causes of respiratory sleep disorders vary significantly between infants younger than one year and those between one and two years old.
  • Laryngomalacia and gastroesophageal reflux are key factors in younger infants, whereas tonsillar/adenoidal hypertrophy is more significant in older infants.
  • These findings offer valuable clinical insights for evaluating obstructive sleep-disordered breathing in children under two years of age.

Keywords:
brief resolved unexplained eventgastro-esophageal refluxinfantslaryngomalaciaobstructive sleep disordered breathingpolysomnography

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