Medical Insider – Dr. Ria P. Maslog
- Obstructive Sleep Apnea/Hypoventilation Syndrome
This syndrome is increasingly recognized in children and this is characterized by a combination of prolonged partial upper airway obstruction and intermittent complete obstruction that disrupts normal ventilation and sleep patterns.
What really happens in OSA/H is that there is decreased upper airway muscle activity that may be due to sedation or anesthesia and muscle weakness. Because of this, it may result to upper airway narrowing that may be aggravated by obesity, small airway and enlarged tonsils and adenoids. This may lead to obstructive hypoventilation and apnea and that triggers hypoxemia and hypercapnia.
The presence of hypoxemia and hypercapnia will result to increased in ventilatory effort and then the child may be awaken from sleep. As the child awakes, there is increased in upper airway muscle activity that may relieve obstruction and restoration of airflow thus oxygenation increases and carbon dioxide decreases.
Clinically, OSA/H syndrome presents a range of symptoms from snoring to severe cardio- respiratory sequelae. Habitual snoring is the most common symptom. The peak age of incidence is 2-5 year which coincides with both normal lymphoid hyperplasia and frequent upper respiratory infections.
Other symptoms may include the following:
chronic mouth breathing; restlessness during sleep with or without frequent awakening;
unusual positions while sleeping like the neck is hyperextended or with the bottom up in the air to help maintain a patent upper airway; parents will describe the breathing as cyclical, the loud snoring followed by silence, a snort, an arousal and resumption of snoring.
The triad symptom of OSA/H is: Snoring; Nocturnal breathing difficulties; and witnessed respiratory pauses
It is very important for parents and care givers to be able to observe this early on so that proper diagnosis and management can be done since OSA/H can have serious cardiorespiratory and neurobehavioral consequences. This syndrome could lead to: polycythemia; growth failure; increased pulmonary artery pressure and pulmonary hypertension; right heart failure; arrhythmias and even death.
Lack of sleep could also cause behavioral problems, impaired school performance and accidents.