1. Pathophysiology of OSA in Children
- OSA occurs due to partial or complete upper airway obstruction during sleep, leading to intermittent hypoxia and sleep fragmentation.
- The obstruction results from a combination of anatomical factors (such as enlarged tonsils/adenoids) and functional factors (like neuromuscular control issues).
- Recurrent episodes of apnea and hypoxia lead to systemic inflammation, oxidative stress, and cardiovascular complications.
2. Anatomical and Functional Factors Contributing to OSA
Anatomical Factors:
- Adenotonsillar hypertrophy – Most common cause in children.
- Craniofacial abnormalities – Retrognathia, micrognathia, midface hypoplasia.
- Obesity – Fat deposition around the neck and airway.
- Nasal obstruction – Deviated nasal septum, allergic rhinitis.
Functional Factors:
- Neuromuscular control issues – Reduced airway muscle tone during sleep.
- Airway collapsibility – Poor coordination of upper airway muscles.
3. Clinical Features of OSA in Children
- Nocturnal symptoms:
- Snoring, witnessed apneas, gasping or choking episodes.
- Restless sleep, frequent awakenings, nocturnal enuresis.
- Daytime symptoms:
- Morning headaches, excessive daytime sleepiness, difficulty concentrating.
- Hyperactivity, poor academic performance, behavioral problems.
4. Diagnosis of OSA
- Clinical history & examination – Snoring, apnea episodes, daytime fatigue.
- Polysomnography (PSG) – Gold standard test for diagnosis. It evaluates:
- Apnea-Hypopnea Index (AHI) >1 event/hour is diagnostic in children.
- Oxygen desaturation, sleep fragmentation, and arousals.
- Other investigations:
- Overnight pulse oximetry – Alternative screening tool.
- Drug-induced sleep endoscopy (DISE) – Evaluates site of obstruction.
- Lateral neck X-ray or MRI – Assess adenoid/tonsil size.
5. Management of OSA in Children
Non-Surgical Treatment:
- Weight management in obese children.
- Nasal corticosteroids & leukotriene receptor antagonists (for mild cases with allergic rhinitis).
- Continuous Positive Airway Pressure (CPAP) – For moderate-severe cases, especially if surgery is not an option.
Surgical Treatment:
- Adenotonsillectomy – First-line treatment for most children with OSA.
- Orthodontic interventions – Rapid maxillary expansion for craniofacial abnormalities.
- Tracheostomy – Reserved for severe cases with airway anomalies.
6. Role of Sleep Hygiene in OSA Prevention
- Maintain consistent sleep schedule.
- Avoid screen time before bed.
- Create a dark, quiet, and comfortable sleep environment.
- Encourage regular physical activity but avoid vigorous exercise before sleep.
- Manage nasal congestion and allergies effectively.
Conclusion
Early recognition and treatment of OSA in children are crucial to prevent long-term complications, including neurocognitive impairment and cardiovascular consequences. A multidisciplinary approach involving pediatricians, ENT specialists, and sleep medicine experts is essential for optimal management.
