Obstructive sleep apnea in developmental age. A narrative review
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.
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
KeywordsPediatric obstructive sleep apnea Children Sleep-disordered breathing Upper airway Diagnosis Treatment
American Academy of Sleep Medicine
Apnea hypopnea index
Continuous positive airway pressure
Excessive daytime sleepiness
Home cardiorespiratory polygraphy
International Classification of Sleep Disorders
Obstructive sleep apnea
Pediatric sleep questionnaire
Respiratory disturbance index
Rapid eye movement
Respiratory effort-related arousals
Sleep disordered breathing
Sleep-related breathing disorder
Total sleep time
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.
This work was supported by the National Research Council of Italy, order numbers DSB.AD008.060 and DSB.AD002.054. The funders had no role in the study design, data collection, and analysis, decision to publish or preparation of the manuscript.
Compliance with ethical standards
Consent for publication
All participants gave written informed consent for personal data processing.
The authors declare that they have no competing interests.
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