Dangerous Consequences of Pediatric Sleep Apnea: Diagnosing and treating sleep apnea is vital to lifetime quality of life.

Question from Sylvia: What are the most common symptoms in children with sleep apnea? Does it affect their brain if left untreated

Dr Shapira Response: Dear Sylvia,
Great Question! There are many short term and long term problems related to sleep apnea. 80% of all ADD and ADHD are related to apnea. There are studies that show both delayed development and permanent changes in brain devlopment.

There are also hormonal (endocrine) changes that affect growth and development.

It is vitally important to children of all ages to iagnose and treat sleep apnea ASAP. Children may never recover from damages that occur in their first few years of life. I have publishe just a few studies below. Recent studies have shown tonsilectomy and adenoid removal may be insufficient treatment and that palatal widening is usually indicated in these patients. Pediatric may be better treated by doing rapid maxillary expansion prior to T&A surgery to create a better post-op healing situation.

It is never to soon to treat sleep apnea. snoring and even minimal apnea AHI of 1 or more should never be ignored but rather taken as an ominus sign of future developmental problems that can be prevented.

I would like to offer my highest recommendation to Dr Alexander Golbin at Sleep and Behavioral Medicine for Chicago area patients. Dr Ira L Shapira

See Pub Med abstracts below:

Pediatr Pulmonol. 2009 May;44(5):417-22.
Neurocognitive and behavioral impact of sleep disordered breathing in children.
Owens JA.

Department of Ambulatory Pediatrics, Rhode Island Hospital, Providence, Rhode Island 02903, USA. owensleep@gmail.com
Abstract
The consequences of poor quality and/or inadequate sleep in children and adolescents have become a major public health concern, and one in which pediatric health care professionals have become increasingly involved. In particular, insufficient and/or fragmented sleep resulting from primary sleep disorders such as obstructive sleep apnea (OSA), often compounded by the presence of comorbid sleep disorders as well as by voluntary sleep curtailment related to lifestyle and environmental factors, has been implicated in a host of negative consequences. These range from metabolic dysfunction and increased cardiovascular morbidity to impairments in mood and academic performance. The following review will focus on what is currently known about the effects of sleep disordered breathing (SDB) specifically on neurobehavioral and neurocognitive function in children. Because of the scarcity of literature on the cognitive and behavioral impact of sleep disorders in infants and very young children, this review will target largely the preschool/school-aged child and adolescent populations. In addition, the focus will be on a review of the most recent literature, as a supplement to several excellent previous reviews on the topic.

Sleep Med. 2010 Aug;11(7):714-20.
Autonomic alterations and endothelial dysfunction in pediatric obstructive sleep apnea.
Kheirandish-Gozal L, Bhattacharjee R, Gozal D.

Department of Pediatrics and Comer Children's Hospital, Pritzker School of Medicine, The University of Chicago, IL 60637, USA. lgozal@peds.bsd.uchicago.edu
Abstract
The cardiovascular consequences of obstructive sleep apnea syndrome (OSAS) in children have started to emerge over the last decade. It is clear that the respiratory and sleep alterations that characterize this relatively prevalent condition induce substantial alterations in autonomic nervous system control, ultimately generating high sympathetic outflow and reactivity that reflect an imbalance between sympatho-excitatory and vagal inhibitory inputs. In addition to these important consequences, the constitutive elements of OSAS also elicit a rather extensive activation of systemic inflammatory pathways that in turn pose substantial risk to the integrity and functional homeostasis of the endothelial network. The complex interactions between the multiple injury-associated pathways recruited by OSAS are further compounded by the potential release of angiogenic factors and by the mobilization and homing of progenitor cells that have the potential to repair and restore the OSAS-disrupted vascular function. Improved characterization of the mechanisms involved in every one of these processes and identification of the determinants of susceptibility in pediatric populations along with the interactions with obesity will clearly modify our approaches to OSAS in the future.

PMID: 20620107 [PubMed - in process]

Clin Chest Med. 2010 Jun;31(2):221-34.
Pediatric obstructive sleep apnea syndrome.
Katz ES, D'Ambrosio CM.

Division of Respiratory Diseases, Department of Medicine, Children's Hospital, Mailstop 208, 300 Longwood Avenue, Boston, MA 02115, USA. eliot.katz@childrens.harvard.edu
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common and serious cause of metabolic, cardiovascular, and neurocognitive morbidity in children. Children with OSAS have increased upper airway resistance during sleep due to a combination of soft tissue hypertrophy, craniofacial dysmorphology, neuromuscular weakness, or obesity. Consequently, children with OSAS encounter a combination of oxidative stress, inflammation, autonomic activation, and disruption of sleep homeostasis. The threshold amount of OSAS associated with adverse consequences varies widely among children, depending on genetic and environmental factors. The choice of therapy is predicated on the etiology, severity, and natural history of the increased upper airway resistance.

PMID: 20488283 [PubMed - in process]

Pediatr Ann. 2008 Jul;37(7):465-70.
The snoring child.
Perez IA, Ward SL.

Keck School of Medicine, University of Southern California, Division of Pediatric Pulmonology, Childrens Hospital Los Angeles, 90027-6062, USA.
Abstract
Snoring is a common manifestation of obstructive sleep apnea and represents one end of the spectrum of sleep-related breathing disorders. Children with primary snoring initially may develop OSAS later, so inquiring about symptoms of OSAS should be part of each visit. Obstructive sleep apnea can result in serious cardiovascular and metabolic consequences and neurocognitive deficits. Adenotonsillar hypertrophy remains the most common cause of OSA although the rising prevalence of obesity is of increasing importance. Polysomnography remains the gold standard in the diagnoses of OSAS and in assessing the risks associated with surgery. Most children with OSAS can be treated with adenotonsillectomy in the ambulatory surgery center. However, there are children at risk for severe OSAS and for postoperative complications, who will need PICU care. In addition to adenotonsillectomy, OSAS can be treated successfully in referral centers with other surgical approaches and by the use of positive airway pressure. Children with obesity-related OSAS often require CPAP or BPAP for control of OSAS.

PMID: 18710136 [PubMed - indexed for MEDLINE]