Obstructive Sleep Apnea Syndrome(OSAS) is a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea). This disrupts normal ventilation during sleep & normal sleep pattern. Prevalence of OSAS is 1% to 5%. Its is different from a habitual snoring, which also has a prevalence of 3% to 12%.
On a clinical history and examination alone, it is difficult to confirm or rule out a diagnosis of OSA in children. Signs and symptoms not only have a poor sensitivity & specificity but they poorly predict disease severity. If a child or adolescent snores on a regular basis and has any of the complaints or findings should undergo sleep study or Polysomnography.
| History | Physical Examination |
|---|---|
| Frequent snoring (≥3 nights / week) | Underweight or overweight |
| Labored breathing during sleep | Tonsillar hypertrophy |
| Gasps or snorting noises /observed episodes of apnea | Adenoidal facies |
| Sleep enuresis (especially secondary enuresis) | Micrognathia /Retrognathia |
| Sleeping in a seated position or with the neck hyperextended | High-arched palate |
| Cyanosis | Failure to thrive |
| Headaches on awakening | Hypertension |
| Daytime sleepiness | Underweight |
| Attention-deficit/ hyperactivity disorder | Overweight |
Other Respiratory indications of sleep study
- Suspected sleep Apnea
- Adenotonsillar hypertrophy and/or
- Obesity
- Complicated Sleep Apnea
- Neuromusular Disorders
- Suspected Noctural Hypoventialtion
- Oxygen Titration Studies
- Infants: CCHS, ALTE, GERD, central sleep apnea
- Syndromes associated with OSA
- Craniofacial syndromes: Apert, Crouzon, Down’s syndrome, Obesity syndromes, Prader Willi, Pierre Robin sequence
- Other high risk situations like CLD, Sickle cell disease, MPS, Cleft palate, Choanal stenosis, Tracheo-bronchomalacia
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