Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art

Abstract

The obstructive sleep apnea syndrome (OSAS) represents only part of a large group of pathologies of variable entity called respiratory sleep disorders (RSD) which include simple snoring and increased upper airway resistance syndrome (UARS). Although the etiopathogenesis of adult OSAS is well known, many aspects of this syndrome in children are still debated. Its prevalence is about 2% in children from 2 to 8 years of age, mostly related to the size of the upper airways adenoid tissue. Several risk factors linked to the development of OSAS are typical of the pediatric age. The object of this paper is to analyze the state of the art on this specific topic, discussing its implications in terms of diagnosis and management.

Efficacy of Rapid Maxillary Expansion with or without Previous Adenotonsillectomy for Pediatric Obstructive Sleep Apnea Syndrome Based on Polysomnographic Data: A Systematic Review and Meta-Analysis

“…Although the etiopathogenesis of this disorder in adults is known, many characteristics of this syndrome in children are debated. OSAS and is known to be highly connected to the size of the upper airways and adenoid tissue [5] OSAS can and have different levels of severity that could give rise to long term effects on children including alterations in behavior and neurocognitive deficits affecting attention, learning and memory as well as executive and motor functions [1,3]. According to the American Academy of Sleep Medicine (AASM) both apneas and hypopneas are observed in this syndrome.…”

“…It can be classified as a mild OSAS (AHI = 1 to 4.9), moderate OSAS (AHI = 5 to 9.9) or severe OSAS (AHI > 10) [6][7][8]. While obesity is considered to be a major cause of OSAS in adults, adenotonsillar hypertrophy (ATH) which may increase airways resistance, is thought to be the prime cause of childhood OSAS [4,8,9], as it contributes to the narrowing of the retro-palatal area that already has the smallest cross-sectional area and therefore is the prevalent site of obstruction [5,[9][10][11]. In literature it is seen that ATH leads not only to problems related to mouth breathing, snoring, chronic sinusitis, nasal congestion, hyponasal speech, but also to emotional disorders and poor neurological development [7].…”

“…In literature it is seen that ATH leads not only to problems related to mouth breathing, snoring, chronic sinusitis, nasal congestion, hyponasal speech, but also to emotional disorders and poor neurological development [7]. When fat is present in the area of the pharyngeal soft tissue it decreases the caliber of the lumen and it also increases the collapse of the structures [5,9,11]. Additionally, the increased occurrence of fat in the thoracic and abdominal walls importantly reduces the respiratory function in these patients [5].…”

“…When fat is present in the area of the pharyngeal soft tissue it decreases the caliber of the lumen and it also increases the collapse of the structures [5,9,11]. Additionally, the increased occurrence of fat in the thoracic and abdominal walls importantly reduces the respiratory function in these patients [5]. In fact, obese and overweight children compared to normal-weight children present a higher risk of developing OSAS [5,10,12].…”

“…Additionally, the increased occurrence of fat in the thoracic and abdominal walls importantly reduces the respiratory function in these patients [5]. In fact, obese and overweight children compared to normal-weight children present a higher risk of developing OSAS [5,10,12]. However, the primary structural abnormality present in obese children with OSAS is the lymphoid tissue, rather than other soft tissue components [9].…”