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Pediatric Sleep Respiratory Disorders: A Narrative Review of Epidemiology and Risk Factors
Marta Piotto1, Antonella Gambadauro1, Alessia Rocchi2
1Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy.
Insights
Sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA), affects all ages. Recognizing and treating SDB early is vital to prevent serious health issues.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Genetics
Background:
- Sleep-disordered breathing (SDB) encompasses conditions like obstructive sleep apnea (OSA), affecting all age groups.
- OSA prevalence in children is 2-5%, higher in specific clinical contexts.
- Key OSA phenotypes in children include adenotonsillar hypertrophy, obesity, and congenital-structural abnormalities.
Purpose of the Study:
- To review the different phenotypes of sleep-disordered breathing (SDB) in pediatric populations.
- To highlight the importance of early diagnosis and management of SDB in children.
- To underscore the association of SDB with genetic syndromes and neuromuscular disorders.
Main Methods:
- Literature review of pediatric sleep-disordered breathing.
- Analysis of prevalence data for OSA in general and specific pediatric populations.
- Categorization of OSA phenotypes based on age and etiology.
Main Results:
- Adenotonsillar hypertrophy is the primary cause of OSA in preschoolers.
- Obesity is the leading cause of OSA in adolescents.
- Congenital-structural abnormalities, genetic syndromes, neuromuscular, and lysosomal storage disorders are associated with high OSA prevalence across all ages.
Conclusions:
- SDB, particularly OSA, presents with diverse phenotypes in children.
- Early identification and intervention for SDB are critical for preventing long-term neuro-cognitive, cardiovascular, and metabolic complications.
- Understanding these phenotypes aids in targeted diagnosis and management strategies.
Abstract:
Sleep is a fundamental biological necessity, the lack of which has severe repercussions on the mental and physical well-being in individuals of all ages. The phrase "sleep-disordered breathing (SDB)" indicates a wide array of conditions characterized by snoring and/or respiratory distress due to increased upper airway resistance and pharyngeal collapsibility; these range from primary snoring to obstructive sleep apnea (OSA) and occur in all age groups. In the general pediatric population, the prevalence of OSA varies between 2% and 5%, but in some particular clinical conditions, it can be much higher. While adenotonsillar hypertrophy ("classic phenotype") is the main cause of OSA in preschool age (3-5 years), obesity ("adult phenotype") is the most common cause in adolescence. There is also a "congenital-structural" phenotype that is characterized by a high prevalence of OSA, appearing from the earliest ages of life, supported by morpho-structural abnormalities or craniofacial changes and associated with genetic syndromes such as Pierre Robin syndrome, Prader-Willi, achondroplasia, and Down syndrome. Neuromuscular disorders and lysosomal storage disorders are also frequently accompanied by a high prevalence of OSA in all life ages. Early recognition and proper treatment are crucial to avoid major neuro-cognitive, cardiovascular, and metabolic morbidities.
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