MED INSIDER–DR RIA MASLOG
Obstructive Sleep Apnea/Hypoventilation
By Dr. Ria Maslog
This OSA/H or obstructive sleep apnea/hypoventilation is a common disorder that has become increasingly recognized in children.
This disorder is a combination of prolonged partial upper airway obstruction and intermittent complete obstruction that disrupts normal ventilation and sleep patterns and the most common symptom is habitual snoring. The peak of age is 2-5 years.
At onset of sleep, there will be decreased upper airway muscle activity that may lead to upper airway narrowing. This narrowing could be more enhanced because of obesity, small airway and enlarged tonsils and adenoids. Because of this narrowing, it may result to obstructive hypoventilation and apnea then to hypoxemia and hypercapnia. With this happening, there will be increased ventilatory effort and then the patients awakens.
Once the patient is awake, there will be an increase in upper airway muscle activity that will afford relief of obstruction and restoration of airflow. This will then increase the oxygenation and decrease the carbon dioxide.
Clinically, OSA/H will manifest snoring and severe cardio-respiratory sequelae. There will be daytime hypersomnolence , which is more common in adults than in children. Children will also have: chronic mouth breathing, snoring, restlessness during sleep with or without frequent awakening, sleeping in unusual position with the neck hyper-extended or with the bottom up in the air to help maintain a patent upper airway.
Generally, children who will present loud snoring associated with nocturnal breathing difficulties and witnessed respiratory pauses then think highly of OSA/H.
So, it is very important to refer children with loud snoring to experts for further work up. A sleep history should be part of every well child exam.