Pediatric obstructive sleep apnea syndrome (OSAS) for the allergist: update on the assessment and management

Objective: The purpose of this article is to provide an understanding of the epidemiology, pathophysiology, risk factors, potentially serious complications, diagnostic modalities, and treatment options available for pediatric obstructive sleep apnea syndrome (OSAS).

Data sources: The Ovid, MEDLINE, and PubMed databases from 1950 to the present were searched for relevant articles regarding pediatric OSAS.

Study selection: Articles describing the prevalence, mechanisms, risk factors, complications, and most recent updates on assessment and management of pediatric sleep-disordered breathing (SDB) were used for this review.

Results: The data suggest that SDB may be considered a disease continuum. It ranges in severity from mild obstruction of the upper airway, producing primary snoring, to increased upper airway resistance syndrome (UARS), to continuous episodes of complete upper airway obstruction or OSAS. The degree of sleep disruption, hypoxemia, hypercapnia, and upper airway airflow reduction are main factors in determining the severity of SDB. Mounting evidence implicates OSAS as a risk factor for decreased growth, impaired neurocognitive function, and cardiovascular morbidity. The first treatment of choice for OSAS in children remains tonsillectomy and adenoidectomy.

Conclusions: Sleep-disordered breathing is common in children and can cause minor as well as major disruption of sleep and health problems requiring intervention. Despite apparent symptoms and potentially severe consequences, SDB may be underdiagnosed and unrecognized. Therefore, a high index of suspicion and detailed clinical history and physical examination should be part of any clinical assessment of a child presenting with breathing difficulty during sleep.