Sleep problems and sleep disordered breathing in children with cerebral palsy

Cerebral palsy refers to a group of disorders affecting movement and posture, caused by an impact to the developing brain. Children and young people (CYP) with cerebral palsy (CP) may have multiple associated co-morbidities, including sleep disorders. Sleep disorders, including sleep disordered breathing, are more prevalent among CYP with CP compared to typically developing children due to several contributory factors. Sleep-disordered breathing (SDB) collectively represents several different pathologies, namely obstructive sleep apnoea (OSA), central sleep apnoea (CSA), and hypoventilation. Multiple intrinsic and extrinsic factors contribute to each of these pathologies. Sleep studies (either as polysomnography or cardiorespiratory polygraphy) allow the detection of effort and apnoea, with contemporaneous measurement of oxygen saturations (SpO₂) and transcutaneous carbon dioxide (tcpCO₂). Together these enable the diagnosis of SDB, and the delineation of OSA, CSA and/or hypoventilation. The multifactorial component of SDB among CYP with CP may require intervention ranging from conservative measures (e.g. nasopharyngeal airway, soft collar), surgical options (e.g. adenotonsillectomy), or the initiation of respiratory support. Respiratory support, delivered as Continuous Positive Airway Pressure (CPAP) or Non-Invasive Ventilation (NIV), has a key role in the management of SDB in children with CP though the journey can often be turbulent with a high failure rate. Nonetheless, CYP with CP are being increasingly commenced on respiratory support, often for reasons others than SDB, for example aiding airway clearance in order to reduce the frequency of lower respiratory tract infections. Open discussions between the parents and healthcare professionals are important in setting shared goals for CYP with CP, guided by the primary aim of improving quality of life.