Skip to main content

Pathophysiology of Pediatric Obstructive Sleep Apnea: Putting It All Together

  • Chapter
  • First Online:
Sleep Disordered Breathing in Children

Part of the book series: Respiratory Medicine ((RM))

Abstract

This chapter aims to amalgamate the various intermediate phenotypes involved in pediatric obstructive sleep apnea (OSA) to explain the clinical expression of the disease: habitual snoring, obstructive hypoventilation, upper airway resistance syndrome (UARS), and OSA. Understanding the individual determinants of the pathophysiology of the pediatric OSA may lead to a more personalized approach to therapy and improved outcomes in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Montgomery-Downs HE, O’Brien LM, et al. Polysomnographic characteristics in normal preschool and early school-aged children. Pediatrics. 2006;117: 741–53.

    Article  PubMed  Google Scholar 

  2. Uliel S, Tauman R, Greenfeld M, Sivan Y. Normal polysomnographic respiratory values in children and adolescents. Chest. 2004;125:872–8.

    Article  PubMed  Google Scholar 

  3. Traeger N, Schultz B, Pollock AN, et al. Polysomnographic values in children 2–9 years old: additional data and review of the literature. Pediatr Pulmonol. 2005;40:22–30.

    Article  PubMed  Google Scholar 

  4. Tabachnik E, Muller NL, Bryan AC, Levison H. Changes in ventilation and chest wall mechanics during sleep in normal adolescents. J Appl Phys. 1981;51:557–64.

    CAS  Google Scholar 

  5. Verhulst SL, Schrauwen N, Haentjens D, et al. Reference values for sleep-related respiratory variables in asymptomatic European children and adolescents. Pediatr Pulmonol. 2007;42:159–67.

    Article  PubMed  CAS  Google Scholar 

  6. Lopes MC, Guilleminault C. Chronic snoring and sleep in children: a demonstration of sleep disruption. Pediatrics. 2006;118:e741–6.

    Article  PubMed  Google Scholar 

  7. Guilleminault C, Li KK, Khramstov A, et al. Breathing patterns in prepubertal children with sleep-related breathing disorders. Arch Pediatr Adolesc Med. 2004;158:153–61.

    Article  PubMed  Google Scholar 

  8. Katz ES, Lutz J, Black C, Marcus CL. Pulse transit time as a measure of arousal and respiratory effort in children with sleep-disordered breathing. Pediatr Res. 2003;53:580–8.

    Article  PubMed  Google Scholar 

  9. O’Brien LM, Mervis CB, Holbrook CR, et al. Neurobehavioral implications of habitual snoring in children. Pediatrics. 2004;114:44–9.

    Article  PubMed  Google Scholar 

  10. Rosen C, D’Andrea L, Haddad G. Adult criteria for obstructive sleep apnea do not identify children with serious obstruction. Am Rev Respir Dis. 1992;146: 1231–4.

    PubMed  CAS  Google Scholar 

  11. Guilleminault C, Stoohs R, Clerk A, et al. A cause of excessive daytime sleepiness. The upper airway resistance syndrome. Chest. 1993;104:781–7.

    Article  PubMed  CAS  Google Scholar 

  12. Guilleminault C, Pelayo R, Leger D, et al. Recognition of sleep-disordered breathing in children. Pediatrics. 1996;98:871–82.

    PubMed  CAS  Google Scholar 

  13. Iber C, Ancoli-Israel S, Chesson AL et al. for the American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specifications. 1st ed. American Academy of Sleep Medicine: Westchester; 2007.

    Google Scholar 

  14. Tauman R, O’Brien LM, Holbrook CR, Gozal D. Sleep pressure score: a new index of sleep disruption in snoring children. Sleep. 2004;27:274–8.

    PubMed  Google Scholar 

  15. Chervin RD, Burns JW, Subotic NS, et al. Correlates of respiratory cycle-related EEG changes in children with sleep-disordered breathing. Sleep. 2004;27: 116–21.

    PubMed  Google Scholar 

  16. Kheirandish-Gozal L, Miano S, Bruni O, et al. Reduced NREM sleep instability in children with sleep disordered breathing. Sleep. 2007;30:450–7.

    PubMed  Google Scholar 

  17. Goh DY, Galster P, Marcus CL. Sleep architecture and respiratory disturbances in children with obstructive sleep apnea. Am J Respir Crit Care Med. 2000;162: 682–6.

    PubMed  CAS  Google Scholar 

  18. Monahan KJ, Larkin EK, Rosen CL, et al. Utility of noninvasive pharyngometry in epidemiologic studies of childhood sleep-disordered breathing. Am J Respir Crit Care Med. 2002;165:1499–503.

    Article  PubMed  Google Scholar 

  19. Arens R, McDonough JM, Costarino AT, et al. Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2001;164:698–703.

    PubMed  CAS  Google Scholar 

  20. Isono S, Shimada A, Utsugi M, et al. Comparison of static mechanical properties of the passive pharynx between normal children and children with sleep-disordered breathing. Am J Respir Crit Care Med. 1998;157:1204–12.

    PubMed  CAS  Google Scholar 

  21. Rizzi M, Onorato J, Andreoli A, et al. Nasal resistances are useful in identifying children with severe obstructive sleep apnea before polysomnography. Int J Pediatr Otorhinolaryngol. 2002;65:7–13.

    Article  PubMed  Google Scholar 

  22. Guilleminault C, Huang Y, Glamann C, et al. Adenotonsillectomy and obstructive sleep apnea in children: a prospective survey. Otolaryngol Head Neck Surg. 2007;136:169–75.

    Article  PubMed  Google Scholar 

  23. Tauman R, Gulliver TE, Krishna J, et al. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr. 2006;149:803–8.

    Article  PubMed  Google Scholar 

  24. Guilleminault C, Li K, Quo S, Inouye RN. A prospective study on the surgical outcomes of children with sleep-disordered breathing. Sleep. 2004;27:95–100.

    PubMed  Google Scholar 

  25. Brouillette RT, Manoukian JJ, Ducharme FM, et al. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr. 2001;138:838–44.

    Article  PubMed  CAS  Google Scholar 

  26. Pirelli P, Saponara M, Guilleminault C. Rapid maxillary expansion in children with obstructive sleep apnea syndrome. Sleep. 2004;27:761–6.

    PubMed  Google Scholar 

  27. Lofstrand-Tidestrom B, Thilander B, Ahlqvist-Rastad J, et al. Breathing obstruction in relation to craniofacial and dental arch morphology in 4-year-old children. Eur J Orthod. 1999;21:323–32.

    Article  PubMed  CAS  Google Scholar 

  28. Kawashima S, Niikuni N, Chia-hung L, et al. Cephalometric comparisons of craniofacial and upper airway structures in young children with obstructive sleep apnea syndrome. Ear Nose Throat J. 2000;79: 499–506.

    PubMed  CAS  Google Scholar 

  29. Behlfelt K, Linder-Aronson S, McWilliam J, et al. Cranio-facial morphology in children with and without enlarged tonsils. Eur J Orthod. 1990;12:233–43.

    PubMed  CAS  Google Scholar 

  30. Arens R, McDonough JM, Corbin AM, et al. Upper airway size analysis by magnetic resonance imaging of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2003;167:65–70.

    Article  PubMed  Google Scholar 

  31. Fregosi RF, Quan SF, Kaemingk KL, et al. Sleep-disordered breathing, pharyngeal size and soft tissue anatomy in children. J Appl Phys. 2003;95:2030–8.

    CAS  Google Scholar 

  32. Marcus CL, Katz ES, Lutz J, et al. Upper airway dynamic responses in children with the obstructive sleep apnea syndrome. Pediatr Res. 2005;57:99–107.

    Article  PubMed  Google Scholar 

  33. Huang J, Marcus C, Melendres C, et al. Respiratory sensation during sleep in children with obstructive sleep apnea syndrome [abstract]. Sleep 2007;30 Abstract Suppl A67.

    Google Scholar 

  34. Goldbart AD, Goldman JL, Li RC, et al. Differential expression of cysteinyl leukotriene receptors 1 and 2 in tonsils of children with obstructive sleep apnea syndrome or recurrent infection. Chest. 2004;126:13–8.

    Article  PubMed  CAS  Google Scholar 

  35. Kheirandish L, Goldbart AD, Gozal D. Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics. 2006;117:e61–6.

    Article  PubMed  Google Scholar 

  36. Katz ES, Marcus CL, White DP. Influence of airway pressure on genioglossus activity during sleep in normal children. Am J Respir Crit Care Med. 2006;173: 902–9.

    Article  PubMed  Google Scholar 

  37. Marcus CL, Lutz J, Carroll JL, Bamford O. Arousal and ventilatory responses during sleep in children with obstructive sleep apnea. J Appl Phys. 1998;84:1926–36.

    CAS  Google Scholar 

  38. Marcus CL, Moreira GA, Bamford O, Lutz J. Response to inspiratory resistive loading during sleep in normal children and children with obstructive apnea. J Appl Phys. 1999;87:1448–54.

    CAS  Google Scholar 

  39. Moreira GA, Tufik S, Nery LE, et al. Acoustic arousal responses in children with obstructive sleep apnea. Pediatr Pulmonol. 2005;40:300–5.

    Article  PubMed  Google Scholar 

  40. McNamara F, Issa F, Sullivan C. Arousal pattern ­following central and obstructive breathing abnormalities in infants and children. J Appl Physiol. 1996;81:2651–7.

    PubMed  CAS  Google Scholar 

  41. Waggener TB, Frantz ID, Cohlan BA, Stark AR. Mixed and obstructive apneas are related to ventilatory oscillations in premature infants. J Appl Phys. 1989;66:2818–26.

    CAS  Google Scholar 

  42. Katz ES, White DP. Genioglossus activity during sleep in normal control subjects and children with obstructive sleep apnea. Am J Respir Crit Care Med. 2004;170:553–60.

    Article  PubMed  Google Scholar 

  43. Katz ES, White DP. Genioglossus activity in children with obstructive sleep apnea during wakefulness and sleep onset. Am J Respir Crit Care Med. 2003;168: 664–70.

    Article  PubMed  Google Scholar 

  44. Gozal D, Burnside MM. Increased upper airway collapsibility in children with obstructive sleep apnea during wakefulness. Am J Respir Crit Care Med. 2004;169:163–7.

    Article  PubMed  Google Scholar 

  45. Henderson-Smart DJ, Read DJC. Reduced lung volume during behavioral active sleep in the newborn. J Appl Phys. 1979;46:1081–5.

    CAS  Google Scholar 

  46. Van de Graaff WB. Thoracic influence on upper airway patency. J Appl Phys. 1988;65:2124–31.

    Google Scholar 

  47. Stanchina ML, Malhotra A, Fogel RB, et al. The influence of lung volume on pharyngeal mechanics, collapsibility, and genioglossus muscle activation during sleep. Sleep. 2003;26:851–6.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eliot S. Katz MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media New York

About this chapter

Cite this chapter

Katz, E.S. (2012). Pathophysiology of Pediatric Obstructive Sleep Apnea: Putting It All Together. In: Kheirandish-Gozal, L., Gozal, D. (eds) Sleep Disordered Breathing in Children. Respiratory Medicine. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-725-9_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-60761-725-9_11

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60761-724-2

  • Online ISBN: 978-1-60761-725-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics