II. Epidemiology
-
Prevalence in Children
- Snoring: 3-12%
- Obstructive Sleep Apnea: 1-5%
- Onset: Ages 2-8 years old
- Gender predominance: Males and females equally affected
III. Types
- Obstructive Sleep Apnea (OSA)
-
Upper Airway Resistance Syndrome (UARS)
- Disordered breathing despite normal Polysomnogram
IV. Risk Factors
- Black ethnicity
- Obesity
- Neuromuscular disease
- Pectus Excavatum
- Craniofacial abnormalities
- Craniosynostosis (e.g. Apert's Syndrome)
- Micrognathia (e.g. Pierre Robin Syndrome)
- Retrognathia
- Midfacial hypoplasia
- Trisomy 21 (Down Syndrome)
- Macroglossia
- Choanal Atresia
V. Causes
- Large Tonsils, adenoids (Adenotonsillar Hypertrophy)
- Nasoseptal obstruction
- Allergic Rhinitis
VI. Symptoms
- Altered observed sleep-related breathing patterns
- Snoring
- Mouth breathing
- Nocturnal awakenings
- Witnessed apneas or paradoxical breathing
- Behavior changes
- Daytime Sleepiness (less common, but seen in obese children)
- Nocturnal Enuresis
- Decreased attention
- Unusual behavior
- Poor academic performance
- Atypical sleep position
- Hyperextended neck
- Seated with mouth open
- Associated symptoms
- Morning Headache
- Night Sweats
VII. Signs
- Adenotonsillar Hypertrophy
- Craniofacial abnormalities (e.g. Micrognathia)
- Nasal obstruction
- Choanal Atresia or septal deviation in infants
- Turbinate swelling or Nasal Polyps in children
- Chest abnormalities (e.g. Pectus Excavatum)
- Neurologic Exam
- Assess growth
- Obtain height and weight and plot for Growth Velocity
- Assess for Failure to Thrive
- Calculate Body Mass Index for pediatric Obesity
VIII. Imaging
- Lateral neck XRay (consider)
IX. Associated Conditions
X. Complications
- Failure to Thrive
- Pulmonary Hypertension
- Attention Deficit Disorder-like behavior (or other worsening school performance)
XI. Diagnosis
-
Adenotonsillar Hypertrophy with OSA symptoms
- See Tonsillar Hypertrophy Grading Scale
- No further studies needed to indicate Tonsillectomy
- Polysomonogram
- Indications (required in most cases of suspected pediatric OSA)
- Craniofacial abnormalities
- Comorbid conditions
- Unclear diagnosis
- Precautions
- Polysomnogram may be normal despite UARS (above)
- Criteria for Obstructive Sleep Apnea Diagnosis
- Pediatric criteria differs from that for adults
- Apnea-Hypopnea Index >1.5 events per hour of sleep
- Minimum Oxygen Saturation <92%
- Indications (required in most cases of suspected pediatric OSA)
XII. Management
-
Adenotonsillar Hypertrophy
- Adenotonsillectomy is treatment of choice
- Management if Tonsillectomy not effective or indicated
- Continuous positive airway pressure (CPAP)
- See CPAP for Obstructive Sleep Apnea
- Recheck mask fitting every 6 months
- Treat concurrent Allergic Rhinitis
- Nasal Corticosteroids
- Treat recurrent Tonsillitis
- Consider course of antibiotics
- Rapid Maxillary expansion
- Orthodontic device to widen the upper jaw
- Uvulopalatopharyngoplasty (UPPP) Indications
- No longer recommended due to low efficacy in adults
- Oropharyngeal soft tissue obstruction
- See Mallampati Score
- Severe OSA without Adenotonsillar Hypertrophy
- Trisomy 21
- Continuous positive airway pressure (CPAP)
- Indications for sleep medicine referral: higher risk conditions
- Cardiorespiratory failure
- Craniofacial abnormalities or congenital defects
- Attention Deficit Disorder
- Management of severe OSA refractory to above measures
- Tracheotomy
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| Concepts | Disease or Syndrome (T047) |
| English | pediatric sleep apnea, pediatric sleep apnea (diagnosis) |
