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Mechanisms and predisposing factors for sleep related breathing disorders in children

Author
Gerald M Rosen, MD
Section Editor
Ronald D Chervin, MD, MS
Deputy Editor
Alison G Hoppin, MD

INTRODUCTION

A normal child is the gold standard for sleep quality. Children have a brief latency to sleep onset and then breathe quietly and comfortably during sleep, without evidence of increased work of breathing. Sleep efficiency (time asleep/time in bed) is high (greater than 90 percent). There are few behavioral arousals during the night, and the child awakens in the morning refreshed and ready to learn and explore. During the day, children are normally very alert and do not appear tired or sleepy except during discrete nap times.

A sleep related breathing disorder (also known as sleep-disordered breathing) is an abnormal respiratory pattern (including apneas, hypopneas, respiratory effort-related arousals) or an abnormal reduction in gas exchange (hypoventilation) that manifests with repetitive episodes of complete or partial obstruction of the upper airway during sleep. Sleep related breathing disorders in children occur along a spectrum of severity, ranging from habitual snoring on the mild end of the spectrum to obstructive sleep apnea (OSA) on the serious end of the spectrum.

This topic review will discuss the normal physiology of sleep in children and the factors that disturb respiration during sleep and contribute to the development of a sleep related breathing disorder, including OSA. The evaluation of the child with snoring or suspected OSA and the management of the child with OSA are discussed separately. (See "Evaluation of suspected obstructive sleep apnea in children" and "Management of obstructive sleep apnea in children" and "Adenotonsillectomy for obstructive sleep apnea in children".)

SLEEP STAGES

After two months of age a child's sleep can be divided into rapid eye movement (REM) and non-REM (NREM) sleep and scored polygraphically using the AASM Manual for the Scoring of Sleep and Associated Events [1]. (See "Stages and architecture of normal sleep" and "Sleep physiology in children", section on 'Sleep states'.)

REM sleep is a physiologically activated sleep state characterized by:

                     

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Literature review current through: Nov 2016. | This topic last updated: Mon May 02 00:00:00 GMT+00:00 2016.
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