Obstructive Sleep Apnea Syndrome in Children (OSAS)
Sleep pathology in children
Children who snore
Snoring is a common but undervalued symptom in childhood. It is not usually as noticeable as in adults. It indicates a slight breathing difficulty. When snoring is a clear symptom accompanying respiratory arrest, we are dealing with Obstructive Sleep Apnea Syndrome. Obstructive Sleep Apnea Syndrome (OSAS) is a common pathology in early childhood and increases in later ages, and can cause severe complications. The main ones are delayed growth, behavioral problems and learning difficulties, in addition to cardiocirculatory and pulmonary repercussions. The first symptom is usually the presence of enuresis, in children who have already controlled their sphincters. It is estimated that between 7 and 10 percent of children are habitual snorers, that is, they snore every night. Snoring can begin at any age, although in infants, unlike in older children, it is more likely to be due to structural abnormalities of the airway. Before puberty, the frequency of snoring is approximately equal in both sexes, while after puberty it predominates in males. OSA is present in children of all ages, from newborns to adolescents. It is estimated that the incidence of obstructive sleep apnea syndrome in children is around 1 to 3%, primarily affecting children between the ages of 2 and 5, a period in which lymphatic tissue is hypertrophied. Clinically, the symptoms that characterize this syndrome in children are habitual snoring, fragmented sleep, and daytime neurobehavioral problems. Daytime sleepiness is not common in children with OSA, although it may be present. Parents may report apathy, little interest in their surroundings, irritability, and fatigue. Mouth and noisy breathing may also be observed. In some extreme cases, growth retardation has been observed, since the hormone responsible for this process is secreted during phases 3 and 4 of sleep, which are distorted in these children due to the multiple awakenings secondary to apnea. In severe forms of OSA, cardiac alterations may also appear, which can lead to the death of the patient.
Causes
The most common cause of OSA in children is adenotonsillar hypertrophy. Other important causes of OSA in childhood are:
– Craniofacial anomalies, such as micrognathia, retrognathia, elevated hard palate, high arched palate, elongated soft palate;
– Various syndromes, such as Pierre-Robin syndrome, Crouzon syndrome, Teacher-Collins syndrome, Apert syndrome and Down syndrome. All of these conditions may present with a very narrow pharyngeal space. Some neuromuscular diseases may also cause childhood OSA: Arnold-Chiari malformation type I and II, myotonic dystrophy, myopathies and other muscular diseases.
– Nasal disorders such as severe septal dysmorphia, infantile nasal polyposis or chronic rhinitis can also cause childhood OSA.
Diagnosis
Diagnosis of childhood OSA is usually made by clinical history, physical examination by an ENT specialist, video or audio recording and polysomnography. Polysomnography is currently the gold standard for confirming the diagnosis and assessing the severity of OSA.
Treatment
Always depending on the cause. Adenotonsillectomy is the most widespread and effective treatment in almost three quarters of cases. It achieves normalization of nocturnal respiratory symptoms, daytime symptoms and reversal of cardiovascular complications and growth retardation in many cases. It is recommended that children who have undergone surgery continue to be evaluated clinically and polysomnographically afterwards. Another therapeutic option is the “CPAP device for children” (CPAP from the English “Continuous Positive Airway Pressure”). Its use should be considered in those children who are awaiting reconstructive surgery, especially in cases of malformation syndromes.