The childhood form of Obstructive Sleep Apnea (OSA) has been estimated to occur in 1 to 3% of otherwise healthy children. Although it is observed most commonly in children from two to six years of age, OSA can occur in infants and adolescents as well and can result in significant morbidity and mortality.
OSAS may present only subtle or indirect symptoms:
- Daytime agitation
- Behavioral problems
- Attention deficit problems
- Impaired school performance
Children exhibiting any of the following symptoms should be considered prime candidates for evaluation:
- Snoring with a history of difficulty breathing during sleep
- Impaired growth
- Neurobehavioral indicators such as poor grades in school
- Agitation / attention deficit problems or hyperactivity
Although snoring is the major symptom of childhood OSA, most snoring children do not have OSA. Recent studies suggest that about 10% of children snore nightly, but only about 20% of these children actually have OSA. In other words, about 70 to 80% of children who snore nightly do not have OSA and don't need surgical treatment with adenotonsillectomy. It is, therefore, imperative that the diagnosis of childhood OSA be established before subjecting a child to potentially unnecessary surgical treatment.
Unlike adults, who exhibit obvious repetitive episodes of obstructive sleep apnea, the clinical manifestations of childhood OSA are more subtle. Children may exhibit continuous partial upper airway obstruction (obstructive hypoventilation) as their main pattern of abnormal breathing. Without objective testing, it is impossible for an observer to tell the difference between obstructive hypoventilation (with hypoxia and/or CO2 retention) and just snoring.
Furthermore, very unlike adults with OSA, who exhibit excessive daytime sleepiness (EDS), sleep fragmentation or poor sleep quality in children often leads to more subtle daytime symptoms such as agitation, attention deficits, difficult behavior and poor school performance.
PSG as an Essential Tool
Childhood OSA cannot be reliably diagnosed by clinical history and physical examination alone. However, a comprehensive program which includes the use of polysomnography (PSG) has been shown to result in definitive diagnoses and is considered the diagnostic tool of choice for evaluating the presence of OSA. PSG has also been shown to not only serve as a barometer of the severity of the patient's OSA condition, it has proven to be of significant benefit in predicting those children at high risk for post-operative respiratory compromise.