CC BY 4.0 · Journal of Child Science 2019; 09(01): e59-e67
DOI: 10.1055/s-0039-1688956
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Children with Upper Airway Dysfunction: At Risk of Obstructive Sleep Apnea

Carlos Sisniega
1   Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
,
Umakanth Katwa
2   Division of Respiratory Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations
Further Information

Publication History

02 April 2019

03 April 2019

Publication Date:
02 July 2019 (online)

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Abstract

Obstructive sleep apnea is characterized by prolonged partial upper airway obstruction or intermittent complete obstruction that disrupts normal ventilation during sleep and alters normal sleep patterns. Patients with obstructive sleep apnea tend to develop neurocognitive, cardiovascular, behavioral, attention issues, and poor academic performance. Therefore, it is essential to diagnose and treat obstructive sleep apnea early and avoid significant and long-lasting adverse outcomes. Most commonly, upper airway obstruction is caused by enlarged lymphoid tissues within the upper airway, and therefore adenotonsillectomy is considered as the first-line treatment of obstructive sleep apnea in children. Fifty to 70% of patients who have obstructive sleep apnea and treated by surgery are not entirely cured on follow-up polysomnography. In light of this, it is recommended that patients with suspected obstructive sleep apnea undergo a thorough evaluation, and all potential risk factors are identified and treated. The purpose of this review is to familiarize pediatricians with developmental, anatomical, and physiological risk factors involved in the development of obstructive sleep apnea. Additionally, we will present an array of evaluation techniques that can offer adequate assessment of the patient's upper airway anatomy and physiology.

Keywords

upper airway - sleep apnea - sleep breathing - tongue base - snoring - pathophysiology
 

  • Reference

  • 1 American Thoracic Society. Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 1996; 153 (02) 866-878
    CrossrefPubMedGoogle Scholar
  • 2 Maris M, Verhulst S, Wojciechowski M, Van de Heyning P, Boudewyns A. Prevalence of obstructive sleep apnea in children with Down syndrome. Sleep (Basel) 2016; 39 (03) 699-704
    CrossrefPubMedGoogle Scholar
  • 3 Kaditis AG, Alonso Alvarez ML, Boudewyns A. , et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 2016; 47 (01) 69-94
    CrossrefPubMedGoogle Scholar
  • 4 Ingram DG, Singh AV, Ehsan Z, Birnbaum BF. Obstructive sleep apnea and pulmonary hypertension in children. Paediatr Respir Rev 2017; 23: 33-39
    PubMedGoogle Scholar
  • 5 Loughlin GM, Wynne JW, Victorica BE. Sleep apnea as a possible cause of pulmonary hypertension in Down syndrome. J Pediatr 1981; 98 (03) 435-437
    CrossrefPubMedGoogle Scholar
  • 6 Blunden S, Lushington K, Kennedy D, Martin J, Dawson D. Behavior and neurocognitive performance in children aged 5-10 years who snore compared to controls. J Clin Exp Neuropsychol 2000; 22 (05) 554-568
    CrossrefPubMedGoogle Scholar
  • 7 Marcus CL, Brooks LJ, Draper KA. , et al; American Academy of Pediatrics. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012; 130 (03) 576-584
    CrossrefPubMedGoogle Scholar
  • 8 Guilleminault C, Li K, Quo S, Inouye RN. A prospective study on the surgical outcomes of children with sleep-disordered breathing. Sleep 2004; 27 (01) 95-100
    PubMedGoogle Scholar
  • 9 Tauman R, Gulliver TE, Krishna J. , et al. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr 2006; 149 (06) 803-808
    CrossrefPubMedGoogle Scholar
  • 10 Bhattacharjee R, Kheirandish-Gozal L, Spruyt K. , et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med 2010; 182 (05) 676-683
    CrossrefPubMedGoogle Scholar
  • 11 Guilleminault C, Huang YS. From oral facial dysfunction to dysmorphism and the onset of pediatric OSA. Sleep Med Rev 2018; 40: 203-214
    CrossrefPubMedGoogle Scholar
  • 12 Montgomery-Downs HE, Young ME, Ross MA, Polak MJ, Ritchie SK, Lynch SK. Sleep-disordered breathing symptoms frequency and growth among prematurely born infants. Sleep Med 2010; 11 (03) 263-267
    CrossrefPubMedGoogle Scholar
  • 13 Rosen CL, Larkin EK, Kirchner HL. , et al. Prevalence and risk factors for sleep-disordered breathing in 8- to 11-year-old children: association with race and prematurity. J Pediatr 2003; 142 (04) 383-389
    CrossrefPubMedGoogle Scholar
  • 14 Huang YS, Guilleminault C. Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences. Front Neurol 2013; 3: 184
    PubMedGoogle Scholar
  • 15 Ling L, Olson Jr EB, Vidruk EH, Mitchell GS. Developmental plasticity of the hypoxic ventilatory response. Respir Physiol 1997; 110 (2-3): 261-268
    CrossrefPubMedGoogle Scholar
  • 16 Kheirandish-Gozal L, Gozal D. Sleep Disordered Breathing in Children: A Comprehensive Clinical Guide to Evaluation and Treatment. New York, NY: Humana Press; 2012
    Google Scholar
  • 17 Pendolino AL, Lund VJ, Nardello E, Ottaviano G. The nasal cycle: a comprehensive review. Rhinol Online 2018; 1: 10
    PubMedGoogle Scholar
  • 18 Mahdavinia M, Schleimer RP, Keshavarzian A. Sleep disruption in chronic rhinosinusitis. Expert Rev Anti Infect Ther 2017; 15 (05) 457-465
    CrossrefPubMedGoogle Scholar
  • 19 Kheirandish-Gozal L, Gozal D. Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics 2008; 122 (01) e149-e155
    CrossrefPubMedGoogle Scholar
  • 20 Brouillette RT, Manoukian JJ, Ducharme FM. , et al. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr 2001; 138 (06) 838-844
    CrossrefPubMedGoogle Scholar
  • 21 Peltomäki T. The effect of mode of breathing on craniofacial growth--revisited. Eur J Orthod 2007; 29 (05) 426-429
    CrossrefPubMedGoogle Scholar
  • 22 Kezirian EJ, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 2011; 268 (08) 1233-1236
    CrossrefPubMedGoogle Scholar
  • 23 Azarbarzin A, Sands SA, Marques M. , et al. Palatal prolapse as a signature of expiratory flow limitation and inspiratory palatal collapse in patients with obstructive sleep apnoea. Eur Respir J 2018; 51 (02) 1701419
    CrossrefPubMedGoogle Scholar
  • 24 Genta PR, Sands SA, Butler JP. , et al. Airflow shape is associated with the pharyngeal structure causing OSA. Chest 2017; 152 (03) 537-546
    CrossrefPubMedGoogle Scholar
  • 25 Isono S, Feroah TR, Hajduk EA, Brant R, Whitelaw WA, Remmers JE. Interaction of cross-sectional area, driving pressure, and airflow of passive velopharynx. J Appl Physiol (1985) 1997; 83 (03) 851-859
    CrossrefPubMedGoogle Scholar
  • 26 Isono S, Remmers JE, Tanaka A, Sho Y, Sato J, Nishino T. Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects. J Appl Physiol (1985) 1997; 82 (04) 1319-1326
    CrossrefPubMedGoogle Scholar
  • 27 Patil SP, Schneider H, Marx JJ, Gladmon E, Schwartz AR, Smith PL. Neuromechanical control of upper airway patency during sleep. J Appl Physiol (1985) 2007; 102 (02) 547-556
    CrossrefPubMedGoogle Scholar
  • 28 Fogel RB, Malhotra A, Shea SA, Edwards JK, White DP. Reduced genioglossal activity with upper airway anesthesia in awake patients with OSA. J Appl Physiol (1985) 2000; 88 (04) 1346-1354
    PubMedGoogle Scholar
  • 29 Hotwani K, Sharma K, Jaiswal A. Evaluation of tongue/mandible volume ratio in children with obstructive sleep apnea. Dental Press J Orthod 2018; 23 (04) 72-78
    CrossrefPubMedGoogle Scholar
  • 30 Lal C, White DR, Joseph JE, van Bakergem K, LaRosa A. Sleep-disordered breathing in Down syndrome. Chest 2015; 147 (02) 570-579
    CrossrefPubMedGoogle Scholar
  • 31 Donnelly LF, Shott SR, LaRose CR, Chini BA, Amin RS. Causes of persistent obstructive sleep apnea despite previous tonsillectomy and adenoidectomy in children with down syndrome as depicted on static and dynamic cine MRI. AJR Am J Roentgenol 2004; 183 (01) 175-181
    CrossrefPubMedGoogle Scholar
  • 32 Whittle AT, Marshall I, Mortimore IL, Wraith PK, Sellar RJ, Douglas NJ. Neck soft tissue and fat distribution: comparison between normal men and women by magnetic resonance imaging. Thorax 1999; 54 (04) 323-328
    CrossrefPubMedGoogle Scholar
  • 33 Schwab RJ. Upper airway imaging. Clin Chest Med 1998; 19 (01) 33-54
    CrossrefPubMedGoogle Scholar
  • 34 Torre C, Camacho M, Liu SY, Huon LK, Capasso R. Epiglottis collapse in adult obstructive sleep apnea: a systematic review. Laryngoscope 2016; 126 (02) 515-523
    CrossrefPubMedGoogle Scholar
  • 35 Luzzi V, Di Carlo G, Saccucci M. , et al. Craniofacial morphology and airflow in children with primary snoring. Eur Rev Med Pharmacol Sci 2016; 20 (19) 3965-3971
    PubMedGoogle Scholar
  • 36 Pacheco MC, Fiorott BS, Finck NS, Araújo MT. Craniofacial changes and symptoms of sleep-disordered breathing in healthy children. Dental Press J Orthod 2015; 20 (03) 80-87
    CrossrefPubMedGoogle Scholar
  • 37 Lee RW, Chan AS, Grunstein RR, Cistulli PA. Craniofacial phenotyping in obstructive sleep apnea--a novel quantitative photographic approach. Sleep 2009; 32 (01) 37-45
    PubMedGoogle Scholar
  • 38 Pirilä-Parkkinen K, Pirttiniemi P, Nieminen P, Tolonen U, Pelttari U, Löppönen H. Dental arch morphology in children with sleep-disordered breathing. Eur J Orthod 2009; 31 (02) 160-167
    CrossrefPubMedGoogle Scholar
  • 39 Berthon-Jones M, Sullivan CE. Ventilation and arousal responses to hypercapnia in normal sleeping humans. J Appl Physiol 1984; 57 (01) 59-67
    CrossrefPubMedGoogle Scholar
  • 40 Osman AM, Carter SG, Carberry JC, Eckert DJ. Obstructive sleep apnea: current perspectives. Nat Sci Sleep 2018; 10: 21-34
    CrossrefPubMedGoogle Scholar
  • 41 Smith CA, Chenuel BJ, Henderson KS, Dempsey JA. The apneic threshold during non-REM sleep in dogs: sensitivity of carotid body vs. central chemoreceptors. J Appl Physiol (1985) 2007; 103 (02) 578-586
    CrossrefPubMedGoogle Scholar
  • 42 Bandla P, Huang J, Karamessinis L. , et al. Puberty and upper airway dynamics during sleep. Sleep 2008; 31 (04) 534-541
    CrossrefPubMedGoogle Scholar
  • 43 Huang J, Karamessinis LR, Pepe ME. , et al. Upper airway collapsibility during REM sleep in children with the obstructive sleep apnea syndrome. Sleep 2009; 32 (09) 1173-1181
    CrossrefPubMedGoogle Scholar
  • 44 Wilhelm CP, deShazo RD, Tamanna S, Ullah MI, Skipworth LB. The nose, upper airway, and obstructive sleep apnea. Ann Allergy Asthma Immunol 2015; 115 (02) 96-102
    CrossrefPubMedGoogle Scholar
  • 45 Ahbab S, Ataoğlu HE, Tuna M. , et al. Neck circumference, metabolic syndrome and obstructive sleep apnea syndrome; evaluation of possible linkage. Med Sci Monit 2013; 19: 111-117
    CrossrefPubMedGoogle Scholar
  • 46 Isono S, Tanaka A, Tagaito Y, Ishikawa T, Nishino T. Influences of head positions and bite opening on collapsibility of the passive pharynx. J Appl Physiol (1985) 2004; 97 (01) 339-346
    CrossrefPubMedGoogle Scholar
  • 47 Deacon-Diaz N, Malhotra A. Inherent vs. induced loop gain abnormalities in obstructive sleep apnea. Front Neurol 2018; 9: 896
    CrossrefPubMedGoogle Scholar
  • 48 Loewen A, Ostrowski M, Laprairie J. , et al. Determinants of ventilatory instability in obstructive sleep apnea: inherent or acquired?. Sleep 2009; 32 (10) 1355-1365
    CrossrefPubMedGoogle Scholar
  • 49 Salloum A, Rowley JA, Mateika JH, Chowdhuri S, Omran Q, Badr MS. Increased propensity for central apnea in patients with obstructive sleep apnea: effect of nasal continuous positive airway pressure. Am J Respir Crit Care Med 2010; 181 (02) 189-193
    CrossrefPubMedGoogle Scholar
  • 50 Mateika JH, Mendello C, Obeid D, Badr MS. Peripheral chemoreflex responsiveness is increased at elevated levels of carbon dioxide after episodic hypoxia in awake humans. J Appl Physiol (1985) 2004; 96 (03) 1197-1205 , discussion 1196
    PubMedGoogle Scholar
  • 51 Sands SA, Terrill PI, Edwards BA. , et al. Quantifying the arousal threshold using polysomnography in obstructive sleep apnea. Sleep (Basel) 2018 41(01):
    PubMedGoogle Scholar
  • 52 Patini R, Arrica M, Di Stasio E, Gallenzi P, Cordaro M. The use of magnetic resonance imaging in the evaluation of upper airway structures in paediatric obstructive sleep apnoea syndrome: a systematic review and meta-analysis. Dentomaxillofac Radiol 2016; 45 (07) 20160136
    CrossrefPubMedGoogle Scholar
  • 53 Fleck RJ, Shott SR, Mahmoud M, Ishman SL, Amin RS, Donnelly LF. Magnetic resonance imaging of obstructive sleep apnea in children. Pediatr Radiol 2018; 48 (09) 1223-1233
    CrossrefPubMedGoogle Scholar
  • 54 Chen W, Gillett E, Khoo MCK, Davidson Ward SL, Nayak KS. Real-time multislice MRI during continuous positive airway pressure reveals upper airway response to pressure change. J Magn Reson Imaging 2017; 46 (05) 1400-1408
    CrossrefPubMedGoogle Scholar
  • 55 Blumen M, Bequignon E, Chabolle F. Drug-induced sleep endoscopy: a new gold standard for evaluating OSAS? Part I: technique. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134 (02) 101-107
    CrossrefPubMedGoogle Scholar