Sleep-Related Breathing Disorder: Upper Respiratory Tract-Related Etiologies

Childhood obstructive sleep apnea (OSA) syndrome is defined as recurring upper airway obstructions during sleep with serious long-term effects on neurocognition and the cardiovascular system. Adenotonsillar hypertrophy is a prevalent secondary cause of mechanical airway obstruction in pediatric OSA. Craniofacial abnormalities including enlarged tongue, retrognathia, high-arched palate, and midface hypoplasia also play a role in the development of OSA. The presence of anatomical characteristics associated with OSA has also been observed in pediatric patients diagnosed with achondroplasia, mucopolysaccharidoses, Beckwith–Wiedemann syndrome, trisomy 21, and Chiari malformation. In addition to these anatomic factors, obesity is an independent risk factor for OSA in the pediatric population. However, neuromotor anomalies and unstable central ventilatory regulation are also implicated. There are a variety of surgical and nonsurgical therapy modalities for pediatric OSA. Several procedures are available to address the condition, including adenotonsillectomy, lingual tonsillectomy, and supraglottoplasty. Additionally, treatment options such as continuous positive airway pressure, oral appliance therapy, rapid maxillary expansion, supplemental oxygen, and antiinflammatory therapies might be considered.