Mechanisms and predisposing factors for sleep-related breathing disorders in children
- Gerald M Rosen, MD
Gerald M Rosen, MD
- Associate Professor of Pediatrics
- University of Minnesota Medical School
- Keith L Cavanaugh, MD, FAAP, FCCP
Keith L Cavanaugh, MD, FAAP, FCCP
- Adjunct Assistant Professor
- University of Minnesota
- Brianne Barnett Roby, MD
Brianne Barnett Roby, MD
- Assistant Professor
- University of Minnesota
The gold standard for good sleep quality is a child who functions well when awake. Children normally have a brief latency to sleep onset and then breathe quietly and comfortably during sleep. 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 play. During the day, children are normally very alert and do not display signs of sleepiness (which can include hyperactivity and poor impulse control). For younger children, a certain frequency of napping is normal and expected. Sleep-related breathing disorders in children occur along a spectrum of severity, ranging from primary 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".)
Starting at birth, a child's sleep can be divided into rapid eye movement (REM) and non-REM (NREM) sleep and scored polygraphically using the American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events . (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:
●Generalized muscle atonia
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- SLEEP STAGES
- CHANGES IN RESPIRATORY PHYSIOLOGY DURING SLEEP
- Increased upper airway resistance
- Decreased central respiratory drive
- Other factors
- BALANCE OF FORCES MODEL OF UPPER AIRWAY OBSTRUCTION
- OBSTRUCTIVE SLEEP APNEA AND OBSTRUCTIVE HYPOVENTILATION
- Airway collapse
- Patterns of OSA/OHV in children
- PREDISPOSING FACTORS
- Enlarged tonsils and adenoids
- Craniofacial anomalies
- Neuromuscular factors
- Combined anatomic and neuromuscular factors
- Environmental factors