Obstructive Sleep Apnea Syndrome in children
Authors: Surya Prakash Bhatt, Ph.D; Randeep Guleria, DM; Sushil Kumar Kabra, MD
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Childhood obstructive sleep apnea (OSA) syndrome is an increasingly recognized morbidity affecting 2-5% of children specifically Asian Indian children due to growing urbanization and nutrition transition, obesity and metabolic syndrome. It is associated with metabolic (resistance to insulin-mediated glucose uptake; insulin resistance), cardiovascular (hypertension and cardiac arrhythmias) and neuropsychological disorders. Polysomnography is the gold standard technique for diagnosis of OSA in children. Severity of OSA is assessed by calculating apnea/hypopnea index. Apnea in children is defined as absence of airflow with continued chest wall and abdominal wall movement for duration longer than two breaths. In children, the most common cause of OSA is enlarged tonsils and adenoids. During sleep there is a considerable decrease in muscle tone, which affects the airway and breathing. Some other causes of OSA in children include obesity, tumor, Down syndrome, pierre-robin syndrome, cleft palate repairs, receding chin, allergies and anatomical abnormalities. Wide variety of intermediate phenotype and genes are involved in sleep apnea which makes this syndrome genetically complex. Various adipokines and cytokines have a key role in OSA. Some studies have suggested that oxidative stress may also contribute to the development of OSA. Treatment of patients with OSA has typically been focused on the management of associated conditions such as obesity, adenotonsillectomy, hyperlipemia and cardiovascular disease. Different modalities of treatment include weight loss, lifestyle modifications and, continuous positive airway pressure therapy and surgical treatment.
Key words: Asian Indian, Body mass index, inflammation, Insulin resistance; Obstructive sleep apnea syndrome.