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Paediatric Pulmonology and Allergology
2006 April, Vol. IX, No. 1 (3127-3161)
SLEEP-DISORDERED BREATHING IN CHILDREN
Carole Marcus
Eudwood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, Maryland, USA
Children’s sleep and breathing during sleep differ from adults. Although some respiratory disorders, such as sleep apnea, occur only during sleep, virtually all respiratory disorders – including upper airway obstruction, central hypoventilation, and chronic lung disease — are worse during sleep, particularly during REM sleep. One of the principal form of sleep-disordered breathing in children is obstructive sleep apnea syndrome (OMAS). The cause of OMAS in children mostly is adenotonsillar hypertrophy with age dependent combination of structural and neuromuscular factors. Untreated OSAS in children can result various complications – from failure to thrive and mental retardation to cardiovascular lesions. Other forms of sleep-disordered breathing in children are central hypoventilation syndrome (primary and secondary, induced by congenital and acquired causes), breathing disorders during sleep caused by chronic (pulmonary, chest wall, muscles, spinal columne) conditions. The gold standard for diagnosing sleep-disordered breathing in children is polysomnography. Treatment and outcome depend on the cause – obstructive sleep apnea syndrome, caused by adenotonsillar hypertrophy is curable by adenotonsillectomy. For other forms of sleep-disordered breathing in children the main stay of treatment is supportive therapy – supplemental oxygen, CPAP or chronic noninvasive negative or positive pressure ventilation with CPAP in home environment (Am J Respir Crit Care Med 2001; 4: 16–30).