SLEEP-DISORDERED BREATHING IN THE CHILD

Abstract
Children may suffer several breathing disorders during sleep: primary snoring, apnea, hypopnea and upper airway resistance syndrome. The prevalence of sleep disordered breathing in children is 0.7-9%, with peak incidence in pre-schoolers. It is characterised by partial or complete upper airway obstruction during sleep, causing intermittent hypoxia. Both anatomical (severe nasal obstruction, craniofacial anomalies, hypertrophy of the pharyngeal lymphoid tissue, laryngeal anomalies, etc.) and functional factors (neuromuscular diseases) predispose to obstructive sleep apnea syndrome (OSAS) during childhood. The main cause of OSAS in children is adenotonsillar hypertrophy. The most common clinical manifestations of OSAS are: nocturnal snoring, respiratory pauses, restless sleep and mouth breathing. Nocturnal pulse oximetry and nap polysomnography are useful tools for screening suspected cases of OSAS in children, and the gold-standard for diagnosis is overnight polysomnography in the sleep laboratory. On the contrary of SAOS adults, children usually present: less arousals associated to apnea events, more numerous apneas/hypopneas during REM sleep, and more significant oxihemoglobin dessaturation even in short apneas. The treatment of OSAS may be surgical (adenotonsillectomy, craniofacial abnormalities correction, tracheostomy) or clinical (sleep hygiene, continuous positive airway pressure - CPAP).

Key words
Child, obstructive sleep apnea, snoring, medical education

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