Abstract
The authors present a recent overview of the common clinical manifestations, management, diagnostic criteria and currently accepted treatment approaches of children with obstructive sleep apnoea syndrome (OSAS). Paediatric OSAS has become widely recognized as a frequent disorder and as a major public health problem. Diagnosis of this problem is usually based on physical examination, history and clinical evaluation confirmed by the polysomnography (PSG). PSG is considering as a gold-standard test for establishing the presence and severity of sleep disordered breathing (SDB) in children. According to current understanding, OSAS is a dynamic process in which increased upper airway collapsibility is present resulting from a combination of structural and neuromotor abnormalities, rather than from structural abnormalities alone. In children the OSAS has completely different clinical features and requires different management strategy. Snoring, difficult breathing and apnoea during sleep, restless sleep, frequent awakening and behavioural disturbances are the typical symptoms usually present in children with OSAS. Nowadays, the classic presentation of child with OSAS as underweight child with adenotonsillar hypertrophy is being replaced by younger overweight or obese patients usually without the hypertrophied adenoids and tonsils. Recently it has been reported that delayed diagnosis of OSAS can lead to neurobehavioural consequences and even serious cardiorespiratory morbidity, metabolic complications, as well as an increase in insulin resistance, high blood pressure and the development of OSAS in adulthood. OSAS must be diagnosed and managed aggressively with having these new repercussions. Evidence suggests that the surgical intervention with removal of the tonsils and/or adenoids will lead to significant improvements in the most incomplicated cases, as recently reported from a meta-analysis. SDB and especially OSAS should be taken into serious consideration by pediatricians to prevent comorbidities in adulthood.
Diverse Manifestations of Obstructive Sleep Apnoea in Pregnancy at a Chinese Hospital
