Very important in terms of breathing because your muscles become essentially paralyzed. When this happens, your diaphragm takes on the bulk of the work.
Because of this, REM sleep can accentuate any respiratory problems. The child may be appearing to sleep fine, but when they enter REM sleep it is very clear that it is not.
Duration of REM sleep increases during the night.
Why Does OSA Occur in Children?
Anatomic factors (adenotonsillar hypertrophy, pharyngeal tissue, mandible size/position, airway size, fatty infiltration)
Functional factors (reduced tone of muscles, ventilatory control variability)
OSA Prevalence in Children
Risk Factors for OSA
Airway structure (decreased chin)
Airway tone (musculature)
Trisomy 21 (decreased tone and structure)
Consequences of OSA in Kids
Systemic inflammatory condition
Somatic growth impairment
Clinical Presentation of OSA
At night - Snoring, mouth breathing, noising breathing, paradoxical breathing, laboured breathing, witnessed apneas, cyanosis, neck hyperextension, restlessness, diaphoresis.
During the day - difficulty waking, morning headaches, nasal obstruction, mouth breathing, daytime fatigue, daytime sleepiness, hyperactivity.
Gold Standard for OSA Diagnosis
Overnight polysomnogram (PSG)
What Counts as OSA?
Absent airflow lasting two breaths or longer with continued respiratory effort.
Apnea-Hypopnea Index (AHI) for Children
Normal <1.5 events / hour
Mild 1.5-5 events / hour
Moderate 5-10 events / hour
Severe >10 events / hour
Who Needs a PSG?
High-risk child to undergo adenotonsillectomy (less than 2-3 years old, medically complex, or pulmonary hypertension)
Diagnositic dilemma (small/absent tonsil tissue)
Recommended screening (achondroplasia, trisomy 21)
Who Gets Referred Where?
Suspicion for OSA high - pediatric ENT
Suspicion for OSA moderate - pediatrician
If unsure - sleep clinic
Obesity and OSA
Children who are obese can suffer from OSA as well.
First line treatment is still an adenotonsillectomy, however the cure rate is lower at about 50% rather than 90% for non-obese children.