Sleep-Disordered Breathing in Children.

Abstract

1. Kevin Gipson, MD, MS* 2. Mengdi Lu, MD* 3. T. Bernard Kinane, MD* 1. *Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA * Abbreviations: AAP: : American Academy of Pediatrics AHI: : apnea-hypopnea index AT: : adenotonsillectomy Bi-level: : bilevel positive airway pressure CPAP: : continuous positive airway pressure CSA: : central sleep apnea FDA: : Food and Drug Administration OSA: : obstructive sleep apnea PAP: : positive airway pressure PSG: : polysomnography SDB: : sleep-disordered breathing An estimated 1% to 5% of children have sleep-disordered breathing related to obstructive sleep apnea, with a smaller proportion of children having central or mixed sleep apnea. Improved screening for sleep-disordered breathing in the general pediatrics clinic, coupled with effective management strategies, has the potential to have wide-ranging benefits on the patient’s long-term health and development. After completing this article, readers should be able to: 1. Recognize the signs and symptoms of obstructive sleep apnea in pediatric and adolescent patients. 2. Understand the role of in-laboratory sleep studies in the evaluation of pediatric patients with suspected sleep-disordered breathing. 3. Weigh the indications, benefits, and risks of various therapies for obstructive sleep apnea. 4. Have a general understanding of, and maintain an appropriate index of suspicion for, comorbid central sleep apnea when a patient presents with signs of sleep-disordered breathing. Sleep is central to a healthy childhood, and sleep-disordered breathing (SDB)—the disruption of normal respiratory patterns and ventilation during sleep—is implicated in several behavioral and physical health issues. Although we now have strong evidence that chronic, unchecked obstructive sleep apnea (OSA) can lead to hypertension, cardiovascular disease, metabolic disorders, obesity, and neuropsychiatric and developmental issues, the full scope of the effect of SDB on health remains underappreciated by many clinicians (Table 1). View this table: Table 1. Disease States Associated with or Complicated by Chronic Sleep-Disordered Breathing Sleep research has rapidly expanded and evolved in the past few decades. Of recent note, chronobiologists Hall, Rosbash, and Young received the 2017 Nobel prize in medicine for their work on the cell’s internal clock. While the biological role of sleep remains mysterious, as famed researcher Allan Rechtschaffen once remarked, “If sleep …