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Obstructive sleep apnea in developmental age. A narrative review

  • Anna Lo BueEmail author
  • Adriana Salvaggio
  • Giuseppe Insalaco
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

Keywords

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

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

Notes

Authors’ Contributions

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.

Funding information

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.

Competing interests

The authors declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  • Anna Lo Bue
    • 1
    Email author
  • Adriana Salvaggio
    • 1
  • Giuseppe Insalaco
    • 1
  1. 1.National Research Council of ItalyInstitute for Biomedical Research and InnovationPalermoItaly

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