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Obstructive sleep apnea in developmental age. A narrative review

Abstract

Sleep is a physiological function that undergoes, at different stages of life, to considerable variations in neurophysiological and behavioral functions. The developmental age is a period characterized by a continuous process of physical and neuropsychological changes and synaptic remodeling processes that are the neurophysiological basis of brain plasticity, typical of this developmental phase, occurring mainly during sleep. In the description of obstructive sleep apnea (OSA) in children, two main points should be highlighted: its variability in different age groups, and its specificity compared with OSA in adults. The definition and criteria used for the diagnosis of OSA in adults are not applicable to OSA in developmental age. Although the adenotonsillar hypertrophy is the most common risk factor for pediatric OSA, obesity is becoming an increasingly prevalent risk factor, mostly in early childhood (6–9 years) and adolescence. OSA has been shown to affect cognitive function in children and adults. However, OSA impact on cognitive function in children is more severe since acting on the plastic brain structures can change the neuro-psychic development, learning skills, and social interactions. There is a clear difference in the definition of pathology between developmental age and adulthood according to the instrumental parameters: an AHI ≥ 5, which represents, in the pediatric age, the cut-off for a therapeutic pathway necessary to avoid a long-term effect on the child, instead, it represents in adulthood, the lower limit value for the definition of disease. This is a narrative review concerning obstructive sleep apnea in developmental age.

Conclusions: OSA is a common disorder in children and those at risk must be identified, studied, and treated promptly because untreated OSA can be responsible for cardiovascular, metabolic, and neurocognitive morbidities and may induce, sometimes, non-reversible deficits given his insistence on a period of physical and neuro-psychic development.

What is Known:
This is a review concerning Obstructive Sleep Apnea in developmental age
•Clinical manifestation, diagnostic and therapeutic criteria of sleep apnea in developmental age
What is New:
This is a “narrative” review
•This narrative review describes sleep apnea comparing and analyzing the different ages of life

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Fig. 1

Abbreviations

AASM:

American Academy of Sleep Medicine

AHI:

Apnea hypopnea index

AT:

Adenotonsillectomy

CPAP:

Continuous positive airway pressure

EDS:

Excessive daytime sleepiness

HRP:

Home cardiorespiratory polygraphy

ICSD:

International Classification of Sleep Disorders

OSA:

Obstructive sleep apnea

PSQ:

Pediatric sleep questionnaire

PSG:

Polysomnography

RDI:

Respiratory disturbance index

REM:

Rapid eye movement

RERA:

Respiratory effort-related arousals

SDB:

Sleep disordered breathing

SRBD:

Sleep-related breathing disorder

TST:

Total sleep time

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Author information

LBA conceived the study, was responsible for the collection of data and their organization, and drafted the manuscript. SA contributed to the design of the study and drafted the manuscript. IG conceived the study, contributed to the interpretation of the data, and performed a critical revision of the article. All authors actively discussed the subject, revised the paper, and provided final approval.

Correspondence to Anna Lo Bue.

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The authors declare that they have no competing interests.

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Communicated by Peter de Winter

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Lo Bue, A., Salvaggio, A. & Insalaco, G. Obstructive sleep apnea in developmental age. A narrative review. Eur J Pediatr (2020) doi:10.1007/s00431-019-03557-8

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Keywords

  • Pediatric obstructive sleep apnea
  • Children
  • Sleep-disordered breathing
  • Upper airway
  • Diagnosis
  • Treatment