Abstract
Sleep apnea in neurologically compromised children is common but underrecognized. It can be secondary to diseases at all locations on the neuroaxis and may independently alter their presentation, severity, and course. As a primary and secondary illness, it is associated with significant neurological morbidities. In its severe manifestation, it can cause life-threatening short- and long-term systemic morbidities. The authors review the most recent and relevant literature and provide the pediatric neurologist with a framework with which to identify children at risk.
Similar content being viewed by others
References and Recommended Reading
Benarroch EE: Brainstem respiratory chemosensitivity: new insights and clinical implications. Neurology 2007, 68:2140–2143.
Lopes MC, Marcus CL: The significance of ASDA arousals in children. Sleep Med 2007, 9:3–8.
Beebe DW: Neurobehavioral morbidity associated with disordered breathing during sleep in children: a comprehensive review. Sleep 2006, 29:1115–1134.
Kaleyias J, Grant M, Darbari F, et al.: Detection of cortical arousals in children using frontal EEG leads in addition to conventional central leads. J Clin Sleep Med 2006, 2:305–308.
Katz ES, Greene MG, Carson KA, et al.: Night-to-night variability of polysomnography in children with suspected obstructive sleep apnea. J Pediatr 2002, 140:589–594.
Iber C: American Academy of Sleep Medicine Manual for Scoring Sleep and Associated Events: Rules, Terminology and Technical Specifications. Westchester, IL: American Academy of Sleep Medicine; 2007.
Dayyat E, Kheirandish-Gozal L, Gozal D: Childhood obstructive sleep apnea: one or two distinct disease entities? Sleep Med Clin 2007, 2:433–444.
Chng SY, Goh DY, Wang XS, et al.: Snoring and atopic disease: a strong association. Pediatr Pulmonol 2004, 38:210–216.
Hazebroek EJ, Hazebroek FW, Leibman S, Smith GS: Total esophagogastric dissociation in adult neurologically impaired patients with severe gastroesophageal reflux: an alternative approach. Dis Esophagus 2008, 21:742–745.
Seddon PC, Khan Y: Respiratory problems in children with neurological impairment. Arch Dis Child 2003, 88:75–78.
Kotagal S, Gibbons VP, Stith JA: Sleep abnormalities in patients with severe cerebral palsy. Dev Med Child Neurol 1994, 36:304–311.
Mikkelsson M, El-Metwally A, Kautiainen H, et al.: Onset, prognosis and risk factors for widespread pain in schoolchildren: a prospective 4-year follow-up study. Pain 2008, 138:681–687.
Malow BA, Weatherwax KJ, Chervin RD, et al.: Identification and treatment of obstructive sleep apnea in adults and children with epilepsy: a prospective pilot study. Sleep Med 2003, 4:509–515.
Mol Debes NM, Hjalgrim H, Skov L: Validation of the presence of comorbidities in a Danish clinical cohort of children with Tourette syndrome. J Child Neurol 2008, 23:1017–1027.
Ivanenko A: Sleep and Psychiatric Disorders in Children and Adolescents. New York, NY: Taylor and Francis; 2008.
Lavigne GJ, Khoury S, Abe S, et al.: Bruxism physiology and pathology: an overview for clinicians. J Oral Rehabil 2008, 35:476–494.
Xu Z, Cheuk DK, Lee SL: Clinical evaluation in predicting childhood obstructive sleep apnea. Chest 2006, 130:1765–1771.
Chan EY, Ng DK, Chan CH, et al.: Modified Epworth Sleepiness Scale in Chinese children with obstructive sleep apnea: a retrospective study. Sleep Breath 2009, 13:59–63.
Spilsbury JC, Drotar D, Rosen CL, Redline S: The Cleveland adolescent sleepiness questionnaire: a new measure to assess excessive daytime sleepiness in adolescents. J Clin Sleep Med 2007, 3:603–612.
Chervin RD, Weatherly RA, Garetz SL, et al.: Pediatric sleep questionnaire: prediction of sleep apnea and outcomes. Arch Otolaryngol Head Neck Surg 2007, 133:216–222.
Capdevila OS, Kheirandish-Gozal L, Dayyat E, Gozal D: Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc 2008, 5:274–282.
Row BW: Intermittent hypoxia and cognitive function: implications from chronic animal models. Adv Exp Med Biol 2007, 618:51–67.
Vgontzas AN, Zoumakis E, Bixler EO, et al.: Adverse effects of modest sleep restriction on sleepiness, performance and inflammatory cytokines. J Clin Endocrinol Metab 2004, 89:2119–2126.
Kim EY, Mahmoud GS, Grover LM: REM sleep deprivation inhibits LTP in vivo in area CA1 of rat hippocampus. Neurosci Lett 2005, 388:163–167.
Mayer PM, Dematteis M, Pépin JL, et al.: Peripheral neuropathy in sleep apnea. A tissue marker of the severity of nocturnal desaturation. Am J Respir Crit Care Med 1999, 159:213–219.
O’Donnell CP: Metabolic consequences of intermittent hypoxia. Adv Exp Med Biol 2007, 618:41–49.
Veale D, Pépin JL, Wuyam B, Lévy PA: Abnormal autonomic stress responses in obstructive sleep apnoea are reversed by nasal continuous positive airway pressure. Eur Respir J 1996, 9:2122–2126.
Gozal D, Kheirandish-Gozal L: Cardiovascular morbidity in obstructive sleep apnea: oxidative stress, inflammation, and much more. Am J Respir Crit Care Med 2008, 177:369–375.
Bonuck K, Parikh S, Bassila M: Growth failure and sleep disordered breathing: a review of the literature. Int J Pediatr Otorhinolaryngol 2006, 70:769–778.
Zettergren-Wijk L, Forsberg CM, Linder-Aronson S: Changes in dentofacial morphology after adeno-/tonsillectomy in young children with obstructive sleep apnoea—a 5-year follow-up study. Eur J Orthod 2006, 28:319–326.
Nakra N, Bhargava S, Dzuira J, et al.: Sleep-disordered breathing in children with metabolic syndrome: the role of leptin and sympathetic nervous system activity and the effect of continuous positive airway pressure. Pediatrics 2008, 122:e634–e642.
Gozal D, Capdevila OS, Kheirandish-Gozal L, Crabtree VM: APOE epsilon 4 allele, cognitive dysfunction, and obstructive sleep apnea in children. Neurology 2007, 69:243–249.
Shott SR, Donnelly LF: Cine magnetic resonance imaging: evaluation of persistent airway obstruction after tonsil and adenoidectomy in children with Down syndrome. Laryngoscope 2004, 114:1724–1729.
Resta O, Barbaro MP, Giliberti T, et al.: Sleep related breathing disorders in adults with Down syndrome. Downs Syndr Res Pract 2003, 8:115–119.
American Academy of Pediatrics Committee on Genetics: Health supervision for children with Down syndrome. Pediatrics 2001, 107:442–449.
Zigman WB, Jenkins EC, Tycko B, et al.: Mortality is associated with apolipoprotein E epsilon4 in nondemented adults with Down syndrome. Neurosci Lett 2005, 390:93–97.
Sengupta S, Grizenko N, Schmitz N, et al.: COMT Val(108/158)Met polymorphism and the modulation of task-oriented behavior in children with ADHD. Neuropsychopharmacology 2008, 33:3069–3077.
Sangal RB, Owens JA, Sangal J: Patients with attentiondeficit/hyperactivity disorder without observed apneic episodes in sleep or daytime sleepiness have normal sleep on polysomnography. Sleep 2005, 28:1143–1148.
Mayes SD, Calhoun SL, Bixler EO, et al.: ADHD subtypes and comorbid anxiety, depression, and oppositional-defiant disorder: differences in sleep problems. J Pediatr Psychol 2008 Aug 1 (Epub ahead of print).
Luc ME, Gupta A, Birnberg JM, et al.: Characterization of symptoms of sleep disorders in children with headache. Pediatr Neurol 2006, 34:7–12.
Pakalnis A, Gibson J, Colvin A: Comorbidity of psychiatric and behavioral disorders in pediatric migraine. Headache 2005, 45:590–596.
Vendrame M, Kaleyias J, Valencia I, et al.: Polysomnographic findings in children with headaches. Pediatr Neurol 2008, 39:6–11.
Lee AG, Golnik K, Kardon R, et al.: Sleep apnea and intracranial hypertension in men. Ophthalmology 2002, 109:482–485.
Kapp-Simon KA, Speltz ML, Cunningham ML, et al.: Neurodevelopment of children with single suture craniosynostosis: a review. Childs Nerv Syst 2007, 23:269–281.
Fang PC, Chen YJ, Lee IC: Seizure precipitants in children with intractable epilepsy. Brain Dev 2008, 30:527–532.
Kaleyias J, Cruz M, Goraya JS, et al.: Spectrum of polysomnographic abnormalities in children with epilepsy. Pediatr Neurol 2008, 39:170–176.
Devinsky O, Ehrenberg B, Barthlen GM, et al.: Epilepsy and sleep apnea syndrome. Neurology 1994, 44:2060–2064.
Newman CJ, O’Regan M, Hensey O: Sleep disorders in children with cerebral palsy. Dev Med Child Neurol 2006, 48:564–568.
Hsiao KH, Nixon GM: The effect of treatment of obstructive sleep apnea on quality of life in children with cerebral palsy. Res Dev Disabil 2008, 29:133–140.
Rosen GM, Bendel AE, Neglia JP, et al.: Sleep in children with neoplasms of the central nervous system: case review of 14 children. Pediatrics 2003, 112:e46–e54.
Francois J, Manaligod JM: Upper airway abnormalities in Canavan disease. Int J Pediatr Otorhinolaryngol 2002, 66:303–307.
Golomb MR, Walsh LE, Carvalho KS, et al.: Clinical findings in Pelizaeus-Merzbacher disease. J Child Neurol 2004, 19:328–331.
Pareyson D, Fancellu R, Mariotti C, et al.: Adult-onset Alexander disease: a series of eleven unrelated cases with review of the literature. Brain 2008, 131:2321–2331.
Yasaki E, Saito Y, Nakano K, et al.: Characteristics of breathing abnormality in Leigh and its overlap syndromes. Neuropediatrics 2001, 32:299–306.
Ferini-Strambi L, Filippi M, Martinelli V, et al.: Nocturnal sleep study in multiple sclerosis: correlations with clinical and brain magnetic resonance imaging findings. J Neurol Sci 1994, 125:194–197.
Kirk VG, Morielli A, Gozal D, et al.: Treatment of sleepdisordered breathing in children with myelomeningocele. Pediatr Pulmonol 2000, 30:445–452.
Dauvilliers Y, Stal V, Abril B, et al.: Chiari malformation and sleep related breathing disorders. J Neurol Neurosurg Psychiatry 2007, 78:1344–1348.
Danielpour M, Wilcox WR, Alanay Y, et al.: Dynamic cervicomedullary cord compression and alterations in cerebrospinal fluid dynamics in children with achondroplasia. Report of four cases. J Neurosurg 2007, 107(6 Suppl):504–507.
Wraith JE: The first 5 years of clinical experience with laronidase enzyme replacement therapy for mucopolysaccharidosis I. Expert Opin Pharmacother 2005, 6:489–506.
Bach JR: The use of mechanical ventilation is appropriate in children with genetically proven spinal muscular atrophy type 1: the motion for. Paediatr Respir Rev 2008, 9:45–50; quiz 50; discussion 55–56.
Ryan MM: The use of invasive ventilation is appropriate in children with genetically proven spinal muscular atrophy type 1: the motion against. Paediatr Respir Rev 2008, 9:51–54; discussion 55–56.
Sevilla T, Jaijo T, Nauffal D, et al.: Vocal cord paresis and diaphragmatic dysfunction are severe and frequent symptoms of GDAP1-associated neuropathy. Brain 2008, 131:3051–3061.
Kraner S, Laufenberg I, Strassburg HM, et al.: Congenital myasthenic syndrome with episodic apnea in patients homozygous for a CHAT missense mutation. Arch Neurol 2003, 60:761–763.
Prudlo J, Koenig J, Ermert S, Juhász J: Sleep disordered breathing in medically stable patients with myasthenia gravis. Eur J Neurol 2007, 14:321–326.
Quera Salva MA, Blumen M, Jacquette A, et al.: Sleep disorders in childhood-onset myotonic dystrophy type 1. Neuromuscul Disord 2006, 16:564–570.
Suresh S, Wales P, Dakin C, et al.: Sleep-related breathing disorder in Duchenne muscular dystrophy: disease spectrum in the paediatric population. J Paediatr Child Health 2005, 41:500–503.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Szuhay, G., Rotenberg, J. Sleep apnea in pediatric neurological conditions. Curr Neurol Neurosci Rep 9, 145–152 (2009). https://doi.org/10.1007/s11910-009-0023-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11910-009-0023-8