Obstructive Sleep Apnea Syndrome in Children

Obstructive sleep apnea syndrome is a clinical condition within the spectrum of sleep-disordered breathing. Altered neuromuscular control of the airway and its anatomy can explain its appearance, which can cause increase of respiratory work, intermittent hypoxemia, sleep fragmentation, and alveolar hypoventilation. Important risk factors are adenotonsillar growth, obesity, family predisposition, race, and prematurity. Its clinical presentation can encompass nighttime symptoms, growth failure, behavioral problems, and cardiovascular manifestations. There is a strong association between sleep-disordered breathing and attention deficit with hyperactivity, although it has not been possible to attribute causality in this association. Genetic syndromes, obesity, asthma, and inflammation have also been associated with obstructive sleep apnea syndrome. Diagnosis should be suspected according to clinical history, and complemented with night polysomnography if necessary. Medical treatment includes use of intranasal steroids and leukotriene receptor antagonists. Adenotonsillectomy is proposed as the first choice for adenotonsillar hypertrophy, being the most important and frequent cause. Continuous positive airway pressure and oxygen supplements are recommended in selected cases only.