Sleep Disordered Breathing in Children

European Respiratory & Pulmonary Diseases, 2016;2(2):52–3 DOI: http://doi.org/10.17925/ERPD.2016.02.02.52

Abstract:

Although obstructive sleep apnoea (OSA) is a common problem in childhood, there are still unanswered questions regarding diagnosis and treatment. Polysomnography is the gold standard in diagnosing and assessing the severity of OSA. However, it is not always accessible and may not correlate with morbidity or predict treatment response. Home-based sleep studies and overnight oximetry are alternative diagnostic options. Adenotonsillectomy is the main treatment modality but residual disease is common. Continuous positive airway pressure is a treatment option in children who are not surgical candidates or have residual disease, but adherence is a significant issue. An individualised approach to diagnosis and treatment may improve both diagnosis and treatment in children with OSA, and prevent morbidity.

Keywords: Sleep disordered breathing, obstructive sleep apnea, childhood, diagnosis, treatment
Disclosure: Refika Ersu’ has nothing to disclose in relation to this article. This article is a short opinion piece and has not been submitted to external peer reviewers. No funding was received in the publication of this article.
Received: July 20, 2016 Published Online: August 12, 2016
Correspondence: Refika Ersu, Marmara University, Division of Pediatric Pulmonology, Fevzi Çakmak Mah., Mimar Sinan Cd., No: 41 Üst Kaynarca, Pendik, Istanbul, Turkey. E: rersu@yahoo.com
Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit.

Breathing problems during sleep commonly occur in children. Obstructive sleep apnoea (OSA) is the most common breathing-related problem that occurs during sleep and snoring is the main symptom. Habitual snoring, which is defined as snoring for more than three days a week, is seen in 7.45% of children.1 OSA is defined as recurrent events of partial or complete upper airway obstruction with disruption of normal oxygenation, ventilation and sleep pattern.2 Prevalence of OSA in children is 1–4%.1

OSA is associated with adverse health effects in children, such as cardiopulmonary consequences, neurocognitive impairment, growth failure and decreased quality of life.2 Therefore, it is recommended that children with snoring and symptoms of OSA undergo polysomnography (PSG) for diagnosis and assessment of severity of OSA.2 Although PSG is considered the gold standard for diagnosis of OSA in children, it also has some drawbacks:
• it is costly and not widely available;
• it requires an overnight hospital stay, which may not be well tolerated by children and may cause a first-night effect;
• there are no clear-cut values for treatment and treatment outcome cannot always be predicted by PSG.

Studies show that children living in poorer neighborhoods are more likely to have OSA.3 However, children with low socioeconomic status experience longer intervals from initial evaluation to PSG.4 The Childhood Adenotonsillectomy Study (CHAT) recently showed that 46% of children with PSG confirmed OSA improved without surgery and that the paediatric sleep questionnaire (PSQ) was better at predicting improvement in some of the outcomes after treatment, such as quality of life.5 Although healthy children rarely have respiratory events during sleep, it is still unclear what number of apnoeas or which level of oxygen desaturation are indications for treatment in children with OSA. A recent European Respiratory Society Task Force paper suggested the following indications for treatment:2
• An apnoea-hypopnoea index (AHI) >5 episodes/hour (irrespective of the presence of morbidity).
• AHI of one to five episodes/hour, in the presence of: morbidity from the cardiovascular system/ central nervous system; enuresis; somatic growth failure; decreased quality of life; or risk factors for persistence of sleep-disordered breathing (SDB).
• In the context of clinical suspicion of obstructive SDB and if PSG is not available, treatment is considered when an alternative diagnostic method indicates OSA or in the presence of morbidity.

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Keywords: Sleep disordered breathing, obstructive sleep apnea, childhood, diagnosis, treatment