Obstructive sleep apnea syndrome in children as a multi-disciplinary problem (a review)

Authors

DOI:

https://doi.org/10.14739/2310-1210.2022.5.257059

Keywords:

obstructive sleep apnea syndrome, night polysomnography

Abstract

Aim. To analyze the data of modern scientific literature about the etiology, risk factors, pathogenesis, diagnosis and treatment of obstructive sleep apnea (OSA) in children.

Results. The prevalence of OSA in children is about 1–5 %, with a peak incidence between the ages of 2 and 6 years. The main risk factors for OSA include adenotonsillar hypertrophy, obesity, and craniofacial anomalies. Nocturnal and daytime symptoms are clinically distinguished. Nocturnal ones include snoring, mouth breathing, pauses in breathing, restless sleep, enuresis and sweating; daytime symptoms are nasal obstruction, mouth breathing, morning headache, drowsiness, violation in attention concentration and hyperactivity. Nocturnal polysomnography is the gold standard for the diagnosis of OSA, in the absence of which the use of screening systems is possible, in particular – cardiorespiratory monitoring. The apnea/hypopnea index ≥1 per hour is considered a diagnostic criterion for mild OSA in children and differs from that in adults ≥5. Among the most effective treatments for OSA are adenoidectomy, CPAP therapy, intranasal corticosteroids, leukotriene receptor antagonists, and lifestyle modification in obesity is obvious.

Conclusions. The problem of OSA syndrome is underestimated, and the vigilance of physicians as well as diagnostic opportunities of treatment and prevention facilities in Ukraine are quite low. Nocturnal polysomnography or screening diagnostic methods (cardiorespiratory monitoring) should be used in case of suspected OSA. Therapeutic measures for apnea are primarily aimed at eliminating etiological and risk factors. The presence of OSA in children with adenoids is an absolute indication for their removal.

 

Author Biographies

O. D. Kuznietsova, Zaporizhzhіa State Medical University, Ukraine

MD, PhD, Associate Professor of the Department of Faculty Pediatrics

S. M. Nedelska, Zaporizhzhia State Medical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Faculty Pediatrics

А. А. Kuznietsov, Zaporizhzhia State Medical University, Ukraine

MD, PhD, Associate Professor of the Department of Nervous Diseases

References

Dehlink, E., & Tan, H. L. (2016). Update on paediatric obstructive sleep apnoea. Journal of thoracic disease, 8(2), 224-235. https://doi.org/10.3978/j.issn.2072-1439.2015.12.04

Trucco, F., Carruthers, E., Davies, J. C., Simonds, A. K., Bush, A., & Tan, H. L. (2020). Inflammation in children with neuromuscular disorders and sleep disordered breathing. Sleep medicine, 72, 118-121. https://doi.org/10.1016/j.sleep.2020.03.032

Rueda, J. R., Mugueta-Aguinaga, I., Vilaró, J., & Rueda-Etxebarria, M. (2020). Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. The Cochrane database of systematic reviews, 11(11), CD013449. https://doi.org/10.1002/14651858.CD013449.pub2

Horne, R. S., Wijayaratne, P., Nixon, G. M., & Walter, L. M. (2019). Sleep and sleep disordered breathing in children with down syndrome: Effects on behaviour, neurocognition and the cardiovascular system. Sleep medicine reviews, 44, 1-11. https://doi.org/10.1016/j.smrv.2018.11.002

Gerdung, C., Rodriguez-Lopez, S., Palkowski, S., Keto-Lambert, D., Sebastianski, M., & Castro Codesal, M. L. (2020). Does non-invasive ventilation change metabolic markers in children with obstructive sleep apnoea? A systematic review and meta-analysis study protocol. BMJ open, 10(8), e039655. https://doi.org/10.1136/bmjopen-2020-039655

Marcus, C. L., Brooks, L. J., Draper, K. A., Gozal, D., Halbower, A. C., Jones, J., Schechter, M. S., Sheldon, S. H., Spruyt, K., Ward, S. D., Lehmann, C., Shiffman, R. N., & American Academy of Pediatrics (2012). Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics, 130(3), 576-584. https://doi.org/10.1542/peds.2012-1671

Gileles-Hillel, A., Kheirandish-Gozal, L., & Gozal, D. (2016). Biological plausibility linking sleep apnoea and metabolic dysfunction. Nature reviews. Endocrinology, 12(5), 290-298. https://doi.org/10.1038/nrendo.2016.22

Gulotta, G., Iannella, G., Vicini, C., Polimeni, A., Greco, A., de Vincentiis, M., Visconti, I. C., Meccariello, G., Cammaroto, G., De Vito, A., Gobbi, R., Bellini, C., Firinu, E., Pace, A., Colizza, A., Pelucchi, S., & Magliulo, G. (2019). Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art. International journal of environmental research and public health, 16(18), 3235. https://doi.org/10.3390/ijerph16183235

Kaditis, A. G., Alonso Alvarez, M. L., Boudewyns, A., Alexopoulos, E. I., Ersu, R., Joosten, K., Larramona, H., Miano, S., Narang, I., Trang, H., Tsaoussoglou, M., Vandenbussche, N., Villa, M. P., Van Waardenburg, D., Weber, S., & Verhulst, S. (2016). Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. The European respiratory journal, 47(1), 69-94. https://doi.org/10.1183/13993003.00385-2015

Savini, S., Ciorba, A., Bianchini, C., Stomeo, F., Corazzi, V., Vicini, C., & Pelucchi, S. (2019). Assessment of obstructive sleep apnoea (OSA) in children: an update. Acta otorhinolaryngologica Italica, 39(5), 289-297. https://doi.org/10.14639/0392-100X-N0262

Perez C. (2018). Obstructive sleep apnea syndrome in children. General dentistry, 66(6), 46-50.

Köktürk, O., Baha, A., & Kanbay, A. (2015). A new approach in the diagnosis of upper airway resistance syndrome (UARS): PAP method. Tuberkuloz ve toraks, 63(1), 31-36. https://doi.org/10.5578/tt.8799

Tan, Y. H., How, C. H., Chan, Y. H., & Teoh, O. H. (2020). Approach to the snoring child. Singapore medical journal, 61(4), 170-175. https://doi.org/10.11622/smedj.2020054

Gipson, K., Lu, M., & Kinane, T. B. (2019). Sleep-Disordered Breathing in Children. Pediatrics in review, 40(1), 3-13. https://doi.org/10.1542/pir.2018-0142

Kuhle, S., Hoffmann, D. U., Mitra, S., & Urschitz, M. S. (2020). Anti-inflammatory medications for obstructive sleep apnoea in children. The Cochrane database of systematic reviews, 1(1), CD007074. https://doi.org/10.1002/14651858.CD007074.pub3

García Castillo, S., Hoyos Vázquez, M., Coloma Navarro, R., Cruz Ruiz, J., Callejas González, F. J., Godoy Mayoral, R., Tárraga López, P. J., & Rodríguez Montes, J. A. (2018). Síndrome de apneas-hipopneas durante el sueño [Obstructive sleep apnoea syndrome]. Anales de pediatria, 88(5), 266-272. https://doi.org/10.1016/j.anpedi.2017.07.004

Katz, E. S., & D'Ambrosio, C. M. (2008). Pathophysiology of pediatric obstructive sleep apnea. Proceedings of the American Thoracic Society, 5(2), 253-262. https://doi.org/10.1513/pats.200707-111MG

Chang, S. J., & Chae, K. Y. (2010). Obstructive sleep apnea syndrome in children: Epidemiology, pathophysiology, diagnosis and sequelae. Korean journal of pediatrics, 53(10), 863-871. https://doi.org/10.3345/kjp.2010.53.10.863

Xu, Z., Wu, Y., Tai, J., Feng, G., Ge, W., Zheng, L., Zhou, Z., & Ni, X. (2020). Risk factors of obstructive sleep apnea syndrome in children. Journal of otolaryngology - head & neck surgery, 49(1), 11. https://doi.org/10.1186/s40463-020-0404-1

Kang, K. T., Chou, C. H., Weng, W. C., Lee, P. L., & Hsu, W. C. (2013). Associations between adenotonsillar hypertrophy, age, and obesity in children with obstructive sleep apnea. PloS one, 8(10), e78666. https://doi.org/10.1371/journal.pone.0078666

Rodriguez-Lopez, S., Palkowski, S., Gerdung, C., Keto-Lambert, D., Sebastianski, M., & Castro-Codesal, M. L. (2020). Does obstructive sleep apnoea contribute to obesity, hypertension and kidney dysfunction in children? A systematic review protocol. BMJ open, 10(8), e039342. https://doi.org/10.1136/bmjopen-2020-039342

Kassim, R., Harris, M. A., Leong, G. M., & Heussler, H. (2016). Obstructive sleep apnoea in children with obesity. Journal of paediatrics and child health, 52(3), 284-290. https://doi.org/10.1111/jpc.13009

Paglia L. (2019). Respiratory sleep disorders in children and role of the paediatric dentist. European journal of paediatric dentistry, 20(1), 5. https://doi.org/10.23804/ejpd.2019.20.01.01

Bozzini, M. F., & Di Francesco, R. C. (2016). Managing obstructive sleep apnoea in children: the role of craniofacial morphology. Clinics, 71(11), 664-666. https://doi.org/10.6061/clinics/2016(11)08

Patel S. R. (2019). Obstructive Sleep Apnea. Annals of internal medicine, 171(11), ITC81-ITC96. https://doi.org/10.7326/AITC201912030

Wang, J. J., Imamura, T., Lee, J., Wright, M., & Goldman, R. D. (2021). Continuous positive airway pressure for obstructive sleep apnea in children. Canadian family physician Medecin de famille canadien, 67(1), 21-23. https://doi.org/10.46747/cfp.670121

Wu, J., Gu, M., Chen, S., Chen, W., Ni, K., Xu, H., & Li, X. (2017). Factors related to pediatric obstructive sleep apnea-hypopnea syndrome in children with attention deficit hyperactivity disorder in different age groups. Medicine, 96(42), e8281. https://doi.org/10.1097/MD.0000000000008281

Hady, K. K., & Okorie, C. (2021). Positive Airway Pressure Therapy for Pediatric Obstructive Sleep Apnea. Children, 8(11), 979. https://doi.org/10.3390/children8110979

Berry, R. B., Brooks, R., Gamaldo, C. E., Harding, S. M., Marcus, C. L., Vaughn, B. V., & Tangredi, M. M. (2012). The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.0. www.aasmnet.org, Darien, Illinois: American Academy of Sleep Medicine.

Miano, S., Paolino, M. C., Peraita-Adrados, R., Montesano, M., Barberi, S., & Villa, M. P. (2009). Prevalence of EEG paroxysmal activity in a population of children with obstructive sleep apnea syndrome. Sleep, 32(4), 522-529. https://doi.org/10.1093/sleep/32.4.522

Pavlou, E., Gkampeta, A., Evangeliou, A., & Athanasiadou-Piperopoulou, F. (2012). Benign epilepsy with centro-temporal spikes (BECTS): relationship between unilateral or bilateral localization of interictal stereotyped focal spikes on EEG and the effectiveness of anti-epileptic medication. Hippokratia, 16(3), 221-224.

Miano, S., Bachiller, C., Gutiérrez, M., Salcedo, A., Villa, M. P., & Peraita-Adrados, R. (2010). Paroxysmal activity and seizures associated with sleep breathing disorder in children: a possible overlap between diurnal and nocturnal symptoms. Seizure, 19(9), 547-552. https://doi.org/10.1016/j.seizure.2010.07.015

Oliveira, A. J., Zamagni, M., Dolso, P., Bassetti, M. A., & Gigli, G. L. (2000). Respiratory disorders during sleep in patients with epilepsy: effect of ventilatory therapy on EEG interictal epileptiform discharges. Clinical neurophysiology, 111 Suppl 2, S141-S145. https://doi.org/10.1016/s1388-2457(00)00415-6

American Academy of Sleep Medicine. (2014). International Classification of Sleep Disorders (3rd ed., pp. 51-55). American Academy of Sleep Medicine.

Bilgin, C., Erkorkmaz, U., Ucar, M. K., Akin, N., Nalbant, A., & Annakkaya, A. N. (2016). Use of a portable monitoring device (Somnocheck Micro) for the investigation and diagnosis of obstructive sleep apnoea in comparison with polysomnography. Pakistan journal of medical sciences, 32(2), 471-475. https://doi.org/10.12669/pjms.322.9561

Bitners, A. C., & Arens, R. (2020). Evaluation and Management of Children with Obstructive Sleep Apnea Syndrome. Lung, 198(2), 257-270. https://doi.org/10.1007/s00408-020-00342-5

Lin, S. Y., Su, Y. X., Wu, Y. C., Chang, J. Z., & Tu, Y. K. (2020). Management of paediatric obstructive sleep apnoea: A systematic review and network meta-analysis. International journal of paediatric dentistry, 30(2), 156-170. https://doi.org/10.1111/ipd.12593

Ji, T., Lu, T., Qiu, Y., Li, X., Liu, Y., Tai, J., Guo, Y., Zhang, J., Wang, S., Zhao, J., Ni, X., & Xu, Z. (2021). The efficacy and safety of montelukast in children with obstructive sleep apnea: a systematic review and meta-analysis. Sleep medicine, 78, 193-201. https://doi.org/10.1016/j.sleep.2020.11.009

Kheirandish-Gozal, L., Bandla, H. P., & Gozal, D. (2016). Montelukast for Children with Obstructive Sleep Apnea: Results of a Double-Blind, Randomized, Placebo-Controlled Trial. Annals of the American Thoracic Society, 13(10), 1736-1741. https://doi.org/10.1513/AnnalsATS.201606-432OC

Sakarya, E. U., Bayar Muluk, N., Sakalar, E. G., Senturk, M., Aricigil, M., Bafaqeeh, S. A., & Cingi, C. (2017). Use of intranasal corticosteroids in adenotonsillar hypertrophy. The Journal of laryngology and otology, 131(5), 384-390. https://doi.org/10.1017/S0022215117000408

Kheirandish-Gozal, L., & Gozal, D. (2008). Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics, 122(1), e149-e155. https://doi.org/10.1542/peds.2007-3398

Lavigne, F., Petrof, B. J., Johnson, J. R., Lavigne, P., Binothman, N., Kassissia, G. O., Al Samri, M., Giordano, C., Dubé, N., Hercz, D., Benedetti, A., & Hamid, Q. (2013). Effect of topical corticosteroids on allergic airway inflammation and disease severity in obstructive sleep apnoea. Clinical and experimental allergy, 43(10), 1124-1133. https://doi.org/10.1111/cea.12158

Acar, M., Cingi, C., Sakallioglu, O., San, T., Yimenicioglu, M. F., & Bal, C. (2013). The effects of mometasone furoate and desloratadine in obstructive sleep apnea syndrome patients with allergic rhinitis. American Journal of Rhinology and Allergy, 27(4), e113-e116. https://doi.org/10.2500/ajra.2013.27.3921

Aubertin, G. (2015). Continuous positive airway pressure in childhood obstructive sleep apnea syndrome. Journal of Dentofacial Anomalies and Orthodontics, 18(3), 309. https://doi.org/10.1051/odfen/2018102

Watach, A. J., Xanthopoulos, M. S., Afolabi-Brown, O., Saconi, B., Fox, K. A., Qiu, M., & Sawyer, A. M. (2020). Positive airway pressure adherence in pediatric obstructive sleep apnea: A systematic scoping review. Sleep medicine reviews, 51, 101273. https://doi.org/10.1016/j.smrv.2020.101273

Mehrtash, M., Bakker, J. P., & Ayas, N. (2019). Predictors of Continuous Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Lung, 197(2), 115-121. https://doi.org/10.1007/s00408-018-00193-1

Toth, M., Faludi, B., & Kondakor, I. (2012). Effects of CPAP-therapy on brain electrical activity in obstructive sleep apneic patients: a combined EEG study using LORETA and Omega complexity: reversible alterations of brain activity in OSAS. Brain topography, 25(4), 450-460. https://doi.org/10.1007/s10548-012-0243-0

Cao, J., Huppert, T. J., Grover, P., & Kainerstorfer, J. M. (2021). Enhanced spatiotemporal resolution imaging of neuronal activity using joint electroencephalography and diffuse optical tomography. Neurophotonics, 8(1), 015002. https://doi.org/10.1117/1.NPh.8.1.015002

Kuznietsov, А. А. (2018). Predicion of the functional outcome of cerebral ischemic supratentorial stroke acute period on the basis of spectral analysis of the brain bioelectrical activity. Zaporozhye medical journal, 20(3), 324-329. https://doi.org/10.14739/2310-1210.2018.3.132127

Puskás, S., Kozák, N., Sulina, D., Csiba, L., & Magyar, M. T. (2017). Quantitative EEG in obstructive sleep apnea syndrome: a review of the literature. Reviews in the neurosciences, 28(3), 265-270. https://doi.org/10.1515/revneuro-2016-0064

Horne, R. S., Davey, M. J., & Nixon, G. M. (2012). Investing in the future: the benefits of continuous positive airway pressure for childhood obstructive sleep apnea. American journal of respiratory and critical care medicine, 185(9), 908-910. https://doi.org/10.1164/rccm.201202-0296ED

Published

2022-10-22

How to Cite

1.
Kuznietsova OD, Nedelska SM, Kuznietsov АА. Obstructive sleep apnea syndrome in children as a multi-disciplinary problem (a review). Zaporozhye Medical Journal [Internet]. 2022Oct.22 [cited 2024Nov.14];24(5):591-8. Available from: http://zmj.zsmu.edu.ua/article/view/257059

Issue

Section

Review