SLEEP APNOEA

In recent years there has been a dramatic increase in the recognition of sleep related breathing disorders in children, and a consequent but less dramatic increase in the availability of specialist provision for the diagnosis and treatment of such problems. However, the clinical awareness of these problems and their possible consequences remains patchy. The purpose of this article is to review the causes and consequences of sleep apnoea in children, to guide clinicians in the recognition of those children who need assessment, and to outline the management options.

Sleep apnoea in children may include obstructive sleep apnoea or hypopnoea and sleep apnoea or hypoventilation due to central causes. By far the most common of these pathologies is obstructive sleep apnoea. Obstructive sleep apnoea has been defined as a “disorder of breathing during sleep characterised by prolonged partial upper airway obstruction and/or intermittent complete obstruction that disrupts normal ventilation during sleep and normal sleep patterns”.1 In this article we will concentrate on obstructive airway problems leading to sleep apnoea, although high risk groups with mixed pathology will be discussed. We will not deal with purely central causes of sleep apnoea or hypoventilation, such as congenital central hypoventilation syndrome, nor with apnoea or apparently life threatening events of infancy.

AETIOLOGY

Apnoea or pathological hypoventilation during sleep may result from a decrease in central drive, a reduction in muscle power, or most commonly from upper airway obstruction.

The newborn infant spends 16–18 hours of the day asleep, and the majority of this is rapid eye movement (REM) sleep. The pharyngeal airway is maintained by mental and submental muscles such as genioglossus, and these relax during sleep, facilitating upper airway collapse. During REM sleep these effects are most pronounced, and intercostal muscles are also relaxed, leading to a reliance on diaphragmatic breathing and paradoxical …