Age and Upper Airway Obstruction: A Challenge to the Clinical Approach in Pediatric Patients.

Nosetti Luana,Piacentini Giorgio,Agosti Massimo,Simoncini Daniela,Roberto Giulia,De Bernardi Francesca,Salvatore Silvia,Pietrobelli Angelo,Zaffanello Marco

doi:10.3390/ijerph17103531

Abstract

Upper airway abnormalities increase the risk of pediatric morbidity in infants. A multidisciplinary approach to obstructive sleep apnea syndrome (OSAS) poses challenges to clinical practice. The incidence and causes of OSA are poorly studied in children under 2 years of age. To fill this gap, we performed this retrospective observational study to determine the causes of obstructive sleep apnea (OSA) in children admitted to our hospital between January 2016 and February 2018, after a brief unexplained event (BRUE) or for OSA. We reviewed the medical charts of 82 patients (39 males; BRUE n = 48; OSAS n = 34) and divided them into two age groups: < 1 year old (1–12 months; n = 59) and >1 year old (>12–24 months; n = 23). Assessment included nap polysomnography, multichannel intraluminal impedance-pH, and nasopharyngoscopy. Sleep disordered breathing was comparable between the two groups. Omega-shaped epiglottis, laryngomalacia, and nasal septum deviation were more frequent in the younger group, and nasal congestion in older group. Tonsillar and adenoidal hypertrophy was more frequent in the older group, while laryngomalacia and gastroesophageal reflux was more frequent in the younger group. Tonsil and adenoid size were associated with grade of apnea-hypopnea index severity in the older group, and laryngomalacia and gastroesophageal reflux in the younger group. The main causes of respiratory sleep disorders differ in children before or after age 1 year. Our findings have potential clinical utility for assessing the pathophysiology of obstructive sleep disordered breathing in patients less than 2 years old.

Highlights

Obstructive sleep apnea syndrome (OSAS) describes a spectrum of abnormal breathing patterns during sleep, characterized by snoring and respiratory effort secondary to increased upper airway resistance and pharyngeal collapsibility, with alterations of normal oxygenation, ventilation, and sleepInt
There are data suggesting that children younger than 1 year have different pathophysiology of OSA and brief unexplained event (BRUE) than those having more than 1 year of age, the aim of the study was to investigate characteristic and severity based on a multidisciplinary approach
19% were hospitalized for obstructive sleep apnea syndrome (OSAS) and 81% for a BRUE

Summary

Introduction

Obstructive sleep apnea syndrome (OSAS) describes a spectrum of abnormal breathing patterns during sleep, characterized by snoring and respiratory effort secondary to increased upper airway resistance and pharyngeal collapsibility, with alterations of normal oxygenation, ventilation, and sleepInt. Obstructive sleep apnea syndrome (OSAS) describes a spectrum of abnormal breathing patterns during sleep, characterized by snoring and respiratory effort secondary to increased upper airway resistance and pharyngeal collapsibility, with alterations of normal oxygenation, ventilation, and sleep. Res. Public Health 2020, 17, 3531; doi:10.3390/ijerph17103531 www.mdpi.com/journal/ijerph. Res. Public Health 2020, 17, 3531 architecture. Intermittent desaturation during sleep has multiorgan implications from childhood to adulthood [1,2]. The estimated frequency of OSAS is between 1% and 5% in preschool and school children [2]

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