Obstructive sleep apnea (OSA) in children is an increasingly common medical problem, and is associated with many complications, including metabolic, cardiovascular, and neurocognitive changes.
The prevalence of obstructive sleep apnea in children has not been precisely determined since the diagnostic criteria have not been firmly established, but may be increasing in association with the rise in childhood obesity.
Estimates of the prevalence of OSA in children range from one to four percent. Strict numerical criteria for the diagnosis are unsatisfactory, however, and the International Classification of Sleep Disorders – Second Edition (ICSD-2) proposes using a combination of signs and symptoms: the AHI and supporting polysomnogram abnormalities such as respiratory effort related arousals, oxygen desaturation, increased end tidal carbon dioxide, or swings in esophageal pressure.
Despite these nosological challenges, studies of OSA in children reveal special features of the disease. For example, snoring is a very common sign, particularly in children ages 2-8. Nasal obstruction, tonsillar hypertrophy, obesity, craniofacial abnormalities, bedwetting, daytime mouth breathing, daytime somnolence or hyperactivity are all common features. The dental exam may reveal malocclusion, retrognathia, macroglossia, or a long or high arched palate.
A laboratory-based polysomnogram (PSG) is the gold standard diagnostic test and is generally recommended, but often skipped, before consideration of tonsillectomy and adenoidectomy. The PSG rules for scoring apneas and hypopneas in children are unique, so the scoring technologist must be made aware that the patient is a child.
Based on American Academy of Sleep Medicine task force guidelines, the number of apneas and hypopneas per hour (apnea hypopnea index, or AHI) considered abnormal for adults is greater than five. However, studies in children have concluded that one or more apnea per hour is abnormal. Esophageal pressure monitoring may be added to detect swings in intrathoracic pressure, thus improving the sensitivity of the test for detecting respiratory efforts.
Health risks associated with OSA in children are similar to that in adults: