Aggiornamento
I disturbi respiratori ostruttivi del sonno
Obstructive sleep disordered breathing in paediatrics
Basilicata S, Traunero A, Borrelli M, Maschio M, Ghirardo S, Amaddeo A.
Giugno 2025 - pagg. 359 -365 | DOI: 10.53126/MEB44359
Abstract
Obstructive sleep disordered breathing encompasses different clinical entities, the most severe of which is obstructive sleep apnea syndrome (OSAS). Children with severe adenotonsillar hypertrophy, obesity, congenital malformations or specific syndromes are most likely to develop OSAS. Even though the diagnostic gold standard is polysomnography (PSG), alternative diagnostic tools are currently more used and seem to be more cost-effective and less time-consuming for families and sleep technicians. Therapeutic approach may be pharmaceutical, surgical or, in more severe cases, needs ventilation therapy.
Riassunto
I disturbi respiratori ostruttivi del sonno comprendono diverse entità cliniche, la più grave delle quali è la sindrome delle apnee ostruttive del sonno (OSAS). I bambini con grave ipertrofia adenotonsillare, obesità, malformazioni congenite o sindromi specifiche sono quelli con maggior probabilità di sviluppare l’OSAS. Sebbene il gold standard diagnostico sia rappresentato dalla polisonnografia (PSG), attualmente si utilizzano più frequentemente strumenti diagnostici alternativi, che sembrano essere più convenienti dal punto di vista economico e meno dispendiosi in termini di tempo per le famiglie e i tecnici del sonno. L’approccio terapeutico può essere farmacologico, chirurgico oppure, nei casi più gravi, può richiedere terapia ventilatoria.
Classificazione MeSH
Contenuto riservato
Per leggere l'articolo completo è necessario effettuare il login.
Non sei ancora registrato? Registrati
Bibliografia
1. Kaditis AG, Alonso Alvarez ML, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 2016;47(1):69-94. doi: 10.1183/13993003.00385-2015.
2. Brockmann PE, Urschitz MS, Schlaud M, Poets CF. Primary snoring in school children: prevalence and neurocognitive impairments. Sleep Breath 2012;16(1):23-9. doi: 10.1007/ s11325-011-0480-6.
3. Hunter SJ, Gozal D, Smith DL, Philby MF, Kaylegian J, Kheirandish-Gozal L. Effect of Sleep-disordered Breathing Severity on Cognitive Performance Measures in a Large Community Cohort of Young School-aged Children. Am J Respir Crit Care Med 2016; 194(6):739-47. doi: 10.1164/rccm.201510-2099OC.
4. Smith DL, Gozal D, Hunter SJ, Kheirandish-Gozal L. Frequency of snoring, rather than apnea-hypopnea index, predicts both cognitive and behavioral problems in young children. Sleep Med 2017;34:170-8. doi: 10.1016/j.sleep.2017.02.028.
5. Bixler EO, Vgontzas AN, Lin HM, et al. Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep 2009;32(6):731-6. doi: 10.1093/sleep/32.6.731.
6. Kaditis AG, Alonso Alvarez ML, Boudewyns A, et al. ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children. Eur Respir J 2017;50(6):1700985. doi: 10.1183/13993003.00985-2017.
7. Dayyat E, Kheirandish-Gozal L, Gozal D. Childhood Obstructive Sleep Apnea: One or Two Distinct Disease Entities? Sleep Med Clin 2007;2(3):433-44. doi: 10.1016/j.jsmc. 2007.05.004.
8. Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med 2010;182 (5):676-83. doi: 10.1164/rccm.200912-1930OC.
9. Bitners AC, Arens R. Evaluation and Management of Children with Obstructive Sleep Apnea Syndrome. Lung 2020;198(2):257-70. doi: 10.1007/s00408-020-00342-5.
10. Marcus CL. Pathophysiology of childhood obstructive sleep apnea: current concepts. Respir Physiol 2000;119(2-3):143-54. doi: 10.1016/s0034-5687(99)00109-7.
11. Pavone M, Caldarelli V, Khirani S, et al. Sleep disordered breathing in patients with Prader-Willi syndrome: A multicenter study. Pediatr Pulmonol 2015;50(12):1354-9. doi: 10.1002/ppul.23177.
12. Anderson IC, Sedaghat AR, McGinley BM, Redett RJ, Boss EF, Ishman SL. Prevalence and severity of obstructive sleep apnea and snoring in infants with Pierre Robin sequence. Cleft Palate Craniofac J 2011;48(5): 614-8. doi: 10.1597/10-100.
13. Bourke RS, Anderson V, Yang JS,et al. Neurobehavioral function is impaired in children with all severities of sleep disordered breathing. Sleep Med 2011;12(3):222-9. doi: 10.1016/j.sleep.2010.08.011.
14. Chervin RD, Archbold KH, Dillon JE, et al. Inattention, hyperactivity, and symptoms of sleep-disordered breathing. Pediatrics 2002;109(3):449-56. doi: 10.1542/peds.109.3. 449.
15. Chervin RD, Dillon JE, Bassetti C, Ganoczy DA, Pituch KJ. Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep 1997;20(12):1185-92. doi: 10.1093/ sleep/20.12.1185.
16. Piteo AM, Kennedy JD, Roberts RM, et al. Snoring and cognitive development in infancy. Sleep Med 2011;12(10):981-7. doi: 10.1016/j.sleep.2011.03.023.
17. Nieminen P, Löppönen T, Tolonen U, Lanning P, Knip M, Löppönen H. Growth and biochemical markers of growth in children with snoring and obstructive sleep apnea. Pediatrics 2002;109(4):e55. doi: 10.1542/peds.109.4.e55.
18. de la Eva RC, Baur LA, Donaghue KC, Waters KA. Metabolic correlates with obstructive sleep apnea in obese subjects. J Pediatr 2002;140(6):654-9. doi: 10.1067/mpd. 2002.123765.
19. Chuang HH, Hsu JF, Wang CY, et al. Hypertension in Children with Obstructive Sleep Apnea Syndrome-Age, Weight Status, and Disease Severity. Int J Environ Res Public Health 2021;18(18):9602. doi: 10.3390/ ijerph18189602.
20. Bitners AC, Arens R, Mahgerefteh J, et al. Prevalence of elevated right ventricular pressure in children with obstructive sleep apnea syndrome undergoing pulmonary hypertension screening. J Clin Sleep Med 2021;17(11):2225-32. doi: 10.5664/jcsm.9412.
21. American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed. text revision. American Academy of Sleep Medicine, 2023.
22. Tsai CM, Kang CH, Su MC, et al. Usefulness of desaturation index for the assessment of obstructive sleep apnea syndrome in children. Int J Pediatr Otorhinolaryngol 2013;77(8):1286-90. doi: 10.1016/j.ijporl.2013.05.011.
23. Pavone M, Cutrera R, Verrillo E, Salerno T, Soldini S, Brouillette RT. Night-to-night consistency of at-home nocturnal pulse oximetry testing for obstructive sleep apnea in children. Pediatr Pulmonol 2013;48(8):754-60. doi: 10.1002/ppul.22685.
24. Coverstone AM, Bird M, Sicard M, et al. Overnight pulse oximetry for evaluation of sleep apnea among children with trisomy 21. J Clin Sleep Med 2014;10(12):1309-15. doi: 10.5664/jcsm.4286.
25. Leong KW, Griffiths A, Adams AM, Massie J. How to interpret polysomnography. Arch Dis Child Educ Pract Ed 2020;105(3):130-5. doi: 10.1136/archdischild-2018-316031.
26. Tan HL, Gozal D, Ramirez HM, Bandla HP, Kheirandish-Gozal L. Overnight polysomnography versus respiratory polygraphy in the diagnosis of pediatric obstructive sleep apnea. Sleep 2014;37(2):255-60. doi: 10.5665/sleep.3392.
27. Chervin RD, Hedger K, Dillon JE, Pituch KJ. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med 2000;1(1):21-32. doi: 10.1016/s1389-9457(99)00009-x.
28. Borrelli M, Corcione A, Cimbalo C, et al. Diagnosis of Paediatric Obstructive Sleep-Disordered Breathing beyond Polysomnography. Children (Basel) 2023;10(8):1331. doi: 10.3390/children10081331.
29. Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med 2010;182(5):676-83. doi: 10.1164/rccm.200912-1930OC.
30. Chadha NK, Zhang L, Mendoza-Sassi RA, César JA. Using nasal steroids to treat nasal obstruction caused by adenoid hypertrophy: does it work? Otolaryngol Head Neck Surg 2009;140(2):139-47. doi: 10.1016/j.otohns. 2008.11.008.
31. Kuhle S, Hoffmann DU, Mitra S, Urschitz MS. Anti-inflammatory medications for obstructive sleep apnoea in children. Cochrane Database Syst Rev 2020;1(1):CD007074. doi: 10.1002/14651858.CD007074.pub3.
32. Kheirandish L, Goldbart AD, Gozal D. Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics 2006;117(1):e61-6. doi: 10.1542/peds.2005-0795.
33. Hull J, Aniapravan R, Chan E, et al. British Thoracic Society guideline for respiratory management of children with neuromuscular weakness. Thorax 2012;67 Suppl 1:i1-40. doi: 10.1136/thoraxjnl-2012-201964.
Corrispondenza: simonabasilicata@gmail.com