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. 2005 Jun;60(6):511–516. doi: 10.1136/thx.2003.007203

Sleep · 8: Paediatric obstructive sleep apnoea

G Nixon 1, R Brouillette 1
PMCID: PMC1747440  PMID: 15923253

Abstract

In the past 25 years there has been increasing recognition of obstructive sleep apnoea (OSA) as a common condition of childhood. Morbidity includes impairment of growth, cardiovascular complications, learning impairment, and behavioural problems. Diagnosis and treatment of this condition in children differs in many respects from that in adults. We review here the key features of paediatric OSA, highlighting differences from adult OSA, and suggest future directions for research.

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Selected References

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  1. Adams J. A., Zabaleta I. A., Stroh D., Johnson P., Sackner M. A. Tidal volume measurements in newborns using respiratory inductive plethysmography. Am Rev Respir Dis. 1993 Sep;148(3):585–588. doi: 10.1164/ajrccm/148.3.585. [DOI] [PubMed] [Google Scholar]
  2. Adams J. A., Zabaleta I. A., Stroh D., Sackner M. A. Measurement of breath amplitudes: comparison of three noninvasive respiratory monitors to integrated pneumotachograph. Pediatr Pulmonol. 1993 Oct;16(4):254–258. doi: 10.1002/ppul.1950160408. [DOI] [PubMed] [Google Scholar]
  3. Ali N. J., Pitson D. J., Stradling J. R. Snoring, sleep disturbance, and behaviour in 4-5 year olds. Arch Dis Child. 1993 Mar;68(3):360–366. doi: 10.1136/adc.68.3.360. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Ali N. J., Pitson D., Stradling J. R. Natural history of snoring and related behaviour problems between the ages of 4 and 7 years. Arch Dis Child. 1994 Jul;71(1):74–76. doi: 10.1136/adc.71.1.74. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Ali N. J., Pitson D., Stradling J. R. Sleep disordered breathing: effects of adenotonsillectomy on behaviour and psychological functioning. Eur J Pediatr. 1996 Jan;155(1):56–62. doi: 10.1007/BF02115629. [DOI] [PubMed] [Google Scholar]
  6. Amin Raouf S., Kimball Thomas R., Bean Judy A., Jeffries Jenny L., Willging J. Paul, Cotton Robin T., Witt Sandra A., Glascock Betty J., Daniels Steven R. Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea. Am J Respir Crit Care Med. 2002 May 15;165(10):1395–1399. doi: 10.1164/rccm.2105118. [DOI] [PubMed] [Google Scholar]
  7. Anuntaseree W., Rookkapan K., Kuasirikul S., Thongsuksai P. Snoring and obstructive sleep apnea in Thai school-age children: prevalence and predisposing factors. Pediatr Pulmonol. 2001 Sep;32(3):222–227. doi: 10.1002/ppul.1112. [DOI] [PubMed] [Google Scholar]
  8. Arens R., McDonough J. M., Costarino A. T., Mahboubi S., Tayag-Kier C. E., Maislin G., Schwab R. J., Pack A. I. Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2001 Aug 15;164(4):698–703. doi: 10.1164/ajrccm.164.4.2101127. [DOI] [PubMed] [Google Scholar]
  9. Blunden S., Lushington K., Kennedy D., Martin J., Dawson D. Behavior and neurocognitive performance in children aged 5-10 years who snore compared to controls. J Clin Exp Neuropsychol. 2000 Oct;22(5):554–568. doi: 10.1076/1380-3395(200010)22:5;1-9;FT554. [DOI] [PubMed] [Google Scholar]
  10. Bonnet M. H. Performance and sleepiness following moderate sleep disruption and slow wave sleep deprivation. Physiol Behav. 1986;37(6):915–918. [PubMed] [Google Scholar]
  11. Bonnet M. H. The effect of sleep fragmentation on sleep and performance in younger and older subjects. Neurobiol Aging. 1989 Jan-Feb;10(1):21–25. doi: 10.1016/s0197-4580(89)80006-5. [DOI] [PubMed] [Google Scholar]
  12. Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am. 1989 Dec;36(6):1551–1569. doi: 10.1016/s0031-3955(16)36806-7. [DOI] [PubMed] [Google Scholar]
  13. Brooks L. J., Stephens B. M., Bacevice A. M. Adenoid size is related to severity but not the number of episodes of obstructive apnea in children. J Pediatr. 1998 Apr;132(4):682–686. doi: 10.1016/s0022-3476(98)70360-9. [DOI] [PubMed] [Google Scholar]
  14. Brouillette R. T., Fernbach S. K., Hunt C. E. Obstructive sleep apnea in infants and children. J Pediatr. 1982 Jan;100(1):31–40. doi: 10.1016/s0022-3476(82)80231-x. [DOI] [PubMed] [Google Scholar]
  15. Brouillette R. T., Manoukian J. J., Ducharme F. M., Oudjhane K., Earle L. G., Ladan S., Morielli A. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr. 2001 Jun;138(6):838–844. doi: 10.1067/mpd.2001.114474. [DOI] [PubMed] [Google Scholar]
  16. Brouillette R. T., Morielli A., Leimanis A., Waters K. A., Luciano R., Ducharme F. M. Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Pediatrics. 2000 Feb;105(2):405–412. doi: 10.1542/peds.105.2.405. [DOI] [PubMed] [Google Scholar]
  17. Brunetti L., Rana S., Lospalluti M. L., Pietrafesa A., Francavilla R., Fanelli M., Armenio L. Prevalence of obstructive sleep apnea syndrome in a cohort of 1,207 children of southern Italy. Chest. 2001 Dec;120(6):1930–1935. doi: 10.1378/chest.120.6.1930. [DOI] [PubMed] [Google Scholar]
  18. Bédard M. A., Montplaisir J., Richer F., Rouleau I., Malo J. Obstructive sleep apnea syndrome: pathogenesis of neuropsychological deficits. J Clin Exp Neuropsychol. 1991 Nov;13(6):950–964. doi: 10.1080/01688639108405110. [DOI] [PubMed] [Google Scholar]
  19. Carroll J. L., McColley S. A., Marcus C. L., Curtis S., Loughlin G. M. Inability of clinical history to distinguish primary snoring from obstructive sleep apnea syndrome in children. Chest. 1995 Sep;108(3):610–618. doi: 10.1378/chest.108.3.610. [DOI] [PubMed] [Google Scholar]
  20. Chervin R. D., Dillon J. E., Bassetti C., Ganoczy D. A., Pituch K. J. Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep. 1997 Dec;20(12):1185–1192. doi: 10.1093/sleep/20.12.1185. [DOI] [PubMed] [Google Scholar]
  21. Chervin Ronald D., Archbold Kristen Hedger, Dillon James E., Panahi Parviz, Pituch Kenneth J., Dahl Ronald E., Guilleminault Christian. Inattention, hyperactivity, and symptoms of sleep-disordered breathing. Pediatrics. 2002 Mar;109(3):449–456. doi: 10.1542/peds.109.3.449. [DOI] [PubMed] [Google Scholar]
  22. Cohen S. R., Ross D. A., Burstein F. D., Lefaivre J. F., Riski J. E., Simms C. Skeletal expansion combined with soft-tissue reduction in the treatment of obstructive sleep apnea in children: physiologic results. Otolaryngol Head Neck Surg. 1998 Nov;119(5):476–485. doi: 10.1016/S0194-5998(98)70105-6. [DOI] [PubMed] [Google Scholar]
  23. Collard P., Dury M., Delguste P., Aubert G., Rodenstein D. O. Movement arousals and sleep-related disordered breathing in adults. Am J Respir Crit Care Med. 1996 Aug;154(2 Pt 1):454–459. doi: 10.1164/ajrccm.154.2.8756822. [DOI] [PubMed] [Google Scholar]
  24. Corbo G. M., Forastiere F., Agabiti N., Pistelli R., Dell'Orco V., Perucci C. A., Valente S. Snoring in 9- to 15-year-old children: risk factors and clinical relevance. Pediatrics. 2001 Nov;108(5):1149–1154. doi: 10.1542/peds.108.5.1149. [DOI] [PubMed] [Google Scholar]
  25. Demain J. G., Goetz D. W. Pediatric adenoidal hypertrophy and nasal airway obstruction: reduction with aqueous nasal beclomethasone. Pediatrics. 1995 Mar;95(3):355–364. [PubMed] [Google Scholar]
  26. Douglas N. J., Luke M., Mathur R. Is the sleep apnoea/hypopnoea syndrome inherited? Thorax. 1993 Jul;48(7):719–721. doi: 10.1136/thx.48.7.719. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Fernbach S. K., Brouillette R. T., Riggs T. W., Hunt C. E. Radiologic evaluation of adenoids and tonsils in children with obstructive sleep apnea: plain films and fluoroscopy. Pediatr Radiol. 1983;13(5):258–265. doi: 10.1007/BF00973342. [DOI] [PubMed] [Google Scholar]
  28. Freezer N. J., Bucens I. K., Robertson C. F. Obstructive sleep apnoea presenting as failure to thrive in infancy. J Paediatr Child Health. 1995 Jun;31(3):172–175. doi: 10.1111/j.1440-1754.1995.tb00779.x. [DOI] [PubMed] [Google Scholar]
  29. Fujioka M., Young L. W., Girdany B. R. Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio. AJR Am J Roentgenol. 1979 Sep;133(3):401–404. doi: 10.2214/ajr.133.3.401. [DOI] [PubMed] [Google Scholar]
  30. Gislason T., Benediktsdóttir B. Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. An epidemiologic study of lower limit of prevalence. Chest. 1995 Apr;107(4):963–966. doi: 10.1378/chest.107.4.963. [DOI] [PubMed] [Google Scholar]
  31. Goh D. Y., Galster P., Marcus C. L. Sleep architecture and respiratory disturbances in children with obstructive sleep apnea. Am J Respir Crit Care Med. 2000 Aug;162(2 Pt 1):682–686. doi: 10.1164/ajrccm.162.2.9908058. [DOI] [PubMed] [Google Scholar]
  32. Goldstein Nira A., Fatima Mahnur, Campbell Thomas F., Rosenfeld Richard M. Child behavior and quality of life before and after tonsillectomy and adenoidectomy. Arch Otolaryngol Head Neck Surg. 2002 Jul;128(7):770–775. doi: 10.1001/archotol.128.7.770. [DOI] [PubMed] [Google Scholar]
  33. Gozal D., Pope D. W., Jr Snoring during early childhood and academic performance at ages thirteen to fourteen years. Pediatrics. 2001 Jun;107(6):1394–1399. doi: 10.1542/peds.107.6.1394. [DOI] [PubMed] [Google Scholar]
  34. Gozal D. Sleep-disordered breathing and school performance in children. Pediatrics. 1998 Sep;102(3 Pt 1):616–620. doi: 10.1542/peds.102.3.616. [DOI] [PubMed] [Google Scholar]
  35. Gozal D., Wang M., Pope D. W., Jr Objective sleepiness measures in pediatric obstructive sleep apnea. Pediatrics. 2001 Sep;108(3):693–697. doi: 10.1542/peds.108.3.693. [DOI] [PubMed] [Google Scholar]
  36. Guilleminault C., Eldridge F. L., Simmons F. B., Dement W. C. Sleep apnea in eight children. Pediatrics. 1976 Jul;58(1):23–30. [PubMed] [Google Scholar]
  37. Guilleminault C., Partinen M., Praud J. P., Quera-Salva M. A., Powell N., Riley R. Morphometric facial changes and obstructive sleep apnea in adolescents. J Pediatr. 1989 Jun;114(6):997–999. doi: 10.1016/s0022-3476(89)80447-0. [DOI] [PubMed] [Google Scholar]
  38. Guilleminault C., Pelayo R., Leger D., Clerk A., Bocian R. C. Recognition of sleep-disordered breathing in children. Pediatrics. 1996 Nov;98(5):871–882. [PubMed] [Google Scholar]
  39. Guilleminault C., Winkle R., Korobkin R., Simmons B. Children and nocturnal snoring: evaluation of the effects of sleep related respiratory resistive load and daytime functioning. Eur J Pediatr. 1982 Nov;139(3):165–171. doi: 10.1007/BF01377349. [DOI] [PubMed] [Google Scholar]
  40. Hudgel D. W., Martin R. J., Johnson B., Hill P. Mechanics of the respiratory system and breathing pattern during sleep in normal humans. J Appl Physiol Respir Environ Exerc Physiol. 1984 Jan;56(1):133–137. doi: 10.1152/jappl.1984.56.1.133. [DOI] [PubMed] [Google Scholar]
  41. Jacob S. V., Morielli A., Mograss M. A., Ducharme F. M., Schloss M. D., Brouillette R. T. Home testing for pediatric obstructive sleep apnea syndrome secondary to adenotonsillar hypertrophy. Pediatr Pulmonol. 1995 Oct;20(4):241–252. doi: 10.1002/ppul.1950200407. [DOI] [PubMed] [Google Scholar]
  42. Jeans W. D., Fernando D. C., Maw A. R., Leighton B. C. A longitudinal study of the growth of the nasopharynx and its contents in normal children. Br J Radiol. 1981 Feb;54(638):117–121. doi: 10.1259/0007-1285-54-638-117. [DOI] [PubMed] [Google Scholar]
  43. Laurikainen E., Erkinjuntti M., Alihanka J., Rikalainen H., Suonpä Radiological parameters of the bony nasopharynx and the adenotonsillar size compared with sleep apnea episodes in children. Int J Pediatr Otorhinolaryngol. 1987 Feb;12(3):303–310. doi: 10.1016/s0165-5876(87)80006-x. [DOI] [PubMed] [Google Scholar]
  44. Leighton S. E., Papsin B., Vellodi A., Dinwiddie R., Lane R. Disordered breathing during sleep in patients with mucopolysaccharidoses. Int J Pediatr Otorhinolaryngol. 2001 Apr 27;58(2):127–138. doi: 10.1016/s0165-5876(01)00417-7. [DOI] [PubMed] [Google Scholar]
  45. Lindberg E., Elmasry A., Gislason T., Janson C., Bengtsson H., Hetta J., Nettelbladt M., Boman G. Evolution of sleep apnea syndrome in sleepy snorers: a population-based prospective study. Am J Respir Crit Care Med. 1999 Jun;159(6):2024–2027. doi: 10.1164/ajrccm.159.6.9805070. [DOI] [PubMed] [Google Scholar]
  46. Marcotte A. C., Thacher P. V., Butters M., Bortz J., Acebo C., Carskadon M. A. Parental report of sleep problems in children with attentional and learning disorders. J Dev Behav Pediatr. 1998 Jun;19(3):178–186. doi: 10.1097/00004703-199806000-00005. [DOI] [PubMed] [Google Scholar]
  47. Marcus C. L., Carroll J. L., Koerner C. B., Hamer A., Lutz J., Loughlin G. M. Determinants of growth in children with the obstructive sleep apnea syndrome. J Pediatr. 1994 Oct;125(4):556–562. doi: 10.1016/s0022-3476(94)70007-9. [DOI] [PubMed] [Google Scholar]
  48. Marcus C. L., Greene M. G., Carroll J. L. Blood pressure in children with obstructive sleep apnea. Am J Respir Crit Care Med. 1998 Apr;157(4 Pt 1):1098–1103. doi: 10.1164/ajrccm.157.4.9704080. [DOI] [PubMed] [Google Scholar]
  49. Marcus C. L., Hamer A., Loughlin G. M. Natural history of primary snoring in children. Pediatr Pulmonol. 1998 Jul;26(1):6–11. doi: 10.1002/(sici)1099-0496(199807)26:1<6::aid-ppul3>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
  50. Marcus C. L., Keens T. G., Bautista D. B., von Pechmann W. S., Ward S. L. Obstructive sleep apnea in children with Down syndrome. Pediatrics. 1991 Jul;88(1):132–139. [PubMed] [Google Scholar]
  51. Marcus C. L., Keens T. G., Ward S. L. Comparison of nap and overnight polysomnography in children. Pediatr Pulmonol. 1992 May;13(1):16–21. doi: 10.1002/ppul.1950130106. [DOI] [PubMed] [Google Scholar]
  52. Marcus C. L., McColley S. A., Carroll J. L., Loughlin G. M., Smith P. L., Schwartz A. R. Upper airway collapsibility in children with obstructive sleep apnea syndrome. J Appl Physiol (1985) 1994 Aug;77(2):918–924. doi: 10.1152/jappl.1994.77.2.918. [DOI] [PubMed] [Google Scholar]
  53. Marcus C. L., Omlin K. J., Basinki D. J., Bailey S. L., Rachal A. B., Von Pechmann W. S., Keens T. G., Ward S. L. Normal polysomnographic values for children and adolescents. Am Rev Respir Dis. 1992 Nov;146(5 Pt 1):1235–1239. doi: 10.1164/ajrccm/146.5_Pt_1.1235. [DOI] [PubMed] [Google Scholar]
  54. Marcus C. L. Pathophysiology of childhood obstructive sleep apnea: current concepts. Respir Physiol. 2000 Feb;119(2-3):143–154. doi: 10.1016/s0034-5687(99)00109-7. [DOI] [PubMed] [Google Scholar]
  55. Marcus C. L. Sleep-disordered breathing in children. Am J Respir Crit Care Med. 2001 Jul 1;164(1):16–30. doi: 10.1164/ajrccm.164.1.2008171. [DOI] [PubMed] [Google Scholar]
  56. Marcus C. L., Ward S. L., Mallory G. B., Rosen C. L., Beckerman R. C., Weese-Mayer D. E., Brouillette R. T., Trang H. T., Brooks L. J. Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea. J Pediatr. 1995 Jul;127(1):88–94. doi: 10.1016/s0022-3476(95)70262-8. [DOI] [PubMed] [Google Scholar]
  57. McColley S. A., April M. M., Carroll J. L., Naclerio R. M., Loughlin G. M. Respiratory compromise after adenotonsillectomy in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 1992 Sep;118(9):940–943. doi: 10.1001/archotol.1992.01880090056017. [DOI] [PubMed] [Google Scholar]
  58. McNamara F., Issa F. G., Sullivan C. E. Arousal pattern following central and obstructive breathing abnormalities in infants and children. J Appl Physiol (1985) 1996 Dec;81(6):2651–2657. doi: 10.1152/jappl.1996.81.6.2651. [DOI] [PubMed] [Google Scholar]
  59. McNamara F., Sullivan C. E. Obstructive sleep apnea in infants and its management with nasal continuous positive airway pressure. Chest. 1999 Jul;116(1):10–16. doi: 10.1378/chest.116.1.10. [DOI] [PubMed] [Google Scholar]
  60. Mitchell E. A., Tuohy P. G., Brunt J. M., Thompson J. M., Clements M. S., Stewart A. W., Ford R. P., Taylor B. J. Risk factors for sudden infant death syndrome following the prevention campaign in New Zealand: a prospective study. Pediatrics. 1997 Nov;100(5):835–840. doi: 10.1542/peds.100.5.835. [DOI] [PubMed] [Google Scholar]
  61. Mograss M. A., Ducharme F. M., Brouillette R. T. Movement/arousals. Description, classification, and relationship to sleep apnea in children. Am J Respir Crit Care Med. 1994 Dec;150(6 Pt 1):1690–1696. doi: 10.1164/ajrccm.150.6.7952634. [DOI] [PubMed] [Google Scholar]
  62. Morielli A., Desjardins D., Brouillette R. T. Transcutaneous and end-tidal carbon dioxide pressures should be measured during pediatric polysomnography. Am Rev Respir Dis. 1993 Dec;148(6 Pt 1):1599–1604. doi: 10.1164/ajrccm/148.6_Pt_1.1599. [DOI] [PubMed] [Google Scholar]
  63. Morielli A., Ladan S., Ducharme F. M., Brouillette R. T. Can sleep and wakefulness be distinguished in children by cardiorespiratory and videotape recordings? Chest. 1996 Mar;109(3):680–687. doi: 10.1378/chest.109.3.680. [DOI] [PubMed] [Google Scholar]
  64. Morovic C. G., Monasterio L. Distraction osteogenesis for obstructive apneas in patients with congenital craniofacial malformations. Plast Reconstr Surg. 2000 Jun;105(7):2324–2330. doi: 10.1097/00006534-200006000-00003. [DOI] [PubMed] [Google Scholar]
  65. Nieminen P., Tolonen U., Löppönen H. Snoring and obstructive sleep apnea in children: a 6-month follow-up study. Arch Otolaryngol Head Neck Surg. 2000 Apr;126(4):481–486. doi: 10.1001/archotol.126.4.481. [DOI] [PubMed] [Google Scholar]
  66. Owens Judith, Spirito Anthony, Marcotte Ann, McGuinn Melissa, Berkelhammer Leslie. Neuropsychological and Behavioral Correlates of Obstructive Sleep Apnea Syndrome in Children: A Preliminary Study. Sleep Breath. 2000;4(2):67–78. doi: 10.1007/BF03045026. [DOI] [PubMed] [Google Scholar]
  67. Pendlebury S. T., Pépin J. L., Veale D., Lévy P. Natural evolution of moderate sleep apnoea syndrome: significant progression over a mean of 17 months. Thorax. 1997 Oct;52(10):872–878. doi: 10.1136/thx.52.10.872. [DOI] [PMC free article] [PubMed] [Google Scholar]
  68. Peppard P. E., Young T., Palta M., Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000 May 11;342(19):1378–1384. doi: 10.1056/NEJM200005113421901. [DOI] [PubMed] [Google Scholar]
  69. Pitson D. J., Sandell A., van den Hout R., Stradling J. R. Use of pulse transit time as a measure of inspiratory effort in patients with obstructive sleep apnoea. Eur Respir J. 1995 Oct;8(10):1669–1674. doi: 10.1183/09031936.95.08101669. [DOI] [PubMed] [Google Scholar]
  70. Redline S., Tishler P. V., Schluchter M., Aylor J., Clark K., Graham G. Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med. 1999 May;159(5 Pt 1):1527–1532. doi: 10.1164/ajrccm.159.5.9809079. [DOI] [PubMed] [Google Scholar]
  71. Redline S., Tishler P. V., Tosteson T. D., Williamson J., Kump K., Browner I., Ferrette V., Krejci P. The familial aggregation of obstructive sleep apnea. Am J Respir Crit Care Med. 1995 Mar;151(3 Pt 1):682–687. doi: 10.1164/ajrccm/151.3_Pt_1.682. [DOI] [PubMed] [Google Scholar]
  72. Remmers J. E., deGroot W. J., Sauerland E. K., Anch A. M. Pathogenesis of upper airway occlusion during sleep. J Appl Physiol Respir Environ Exerc Physiol. 1978 Jun;44(6):931–938. doi: 10.1152/jappl.1978.44.6.931. [DOI] [PubMed] [Google Scholar]
  73. Reuveni Haim, Simon Tzahit, Tal Asher, Elhayany Asher, Tarasiuk Ariel. Health care services utilization in children with obstructive sleep apnea syndrome. Pediatrics. 2002 Jul;110(1 Pt 1):68–72. doi: 10.1542/peds.110.1.68. [DOI] [PubMed] [Google Scholar]
  74. Rhodes S. K., Shimoda K. C., Waid L. R., O'Neil P. M., Oexmann M. J., Collop N. A., Willi S. M. Neurocognitive deficits in morbidly obese children with obstructive sleep apnea. J Pediatr. 1995 Nov;127(5):741–744. doi: 10.1016/s0022-3476(95)70164-8. [DOI] [PubMed] [Google Scholar]
  75. Richmond K. H., Wetmore R. F., Baranak C. C. Postoperative complications following tonsillectomy and adenoidectomy--who is at risk? Int J Pediatr Otorhinolaryngol. 1987 Aug;13(2):117–124. doi: 10.1016/0165-5876(87)90088-7. [DOI] [PubMed] [Google Scholar]
  76. Rosen C. L. Clinical features of obstructive sleep apnea hypoventilation syndrome in otherwise healthy children. Pediatr Pulmonol. 1999 Jun;27(6):403–409. doi: 10.1002/(sici)1099-0496(199906)27:6<403::aid-ppul7>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  77. Rosen C. L., D'Andrea L., Haddad G. G. Adult criteria for obstructive sleep apnea do not identify children with serious obstruction. Am Rev Respir Dis. 1992 Nov;146(5 Pt 1):1231–1234. doi: 10.1164/ajrccm/146.5_Pt_1.1231. [DOI] [PubMed] [Google Scholar]
  78. Rosen G. M., Muckle R. P., Mahowald M. W., Goding G. S., Ullevig C. Postoperative respiratory compromise in children with obstructive sleep apnea syndrome: can it be anticipated? Pediatrics. 1994 May;93(5):784–788. [PubMed] [Google Scholar]
  79. Scadding G. K. Corticosteroids in the treatment of pediatric allergic rhinitis. J Allergy Clin Immunol. 2001 Jul;108(1 Suppl):S59–S64. doi: 10.1067/mai.2001.115568. [DOI] [PubMed] [Google Scholar]
  80. Scholle S., Zwacka G. Arousals and obstructive sleep apnea syndrome in children. Clin Neurophysiol. 2001 Jun;112(6):984–991. doi: 10.1016/s1388-2457(01)00508-9. [DOI] [PubMed] [Google Scholar]
  81. Stradling J. R., Thomas G., Warley A. R., Williams P., Freeland A. Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children. Lancet. 1990 Feb 3;335(8684):249–253. doi: 10.1016/0140-6736(90)90068-g. [DOI] [PubMed] [Google Scholar]
  82. Suen J. S., Arnold J. E., Brooks L. J. Adenotonsillectomy for treatment of obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg. 1995 May;121(5):525–530. doi: 10.1001/archotol.1995.01890050023005. [DOI] [PubMed] [Google Scholar]
  83. Svanborg E., Larsson H. Development of nocturnal respiratory disturbance in untreated patients with obstructive sleep apnea syndrome. Chest. 1993 Aug;104(2):340–343. doi: 10.1378/chest.104.2.340. [DOI] [PubMed] [Google Scholar]
  84. Tal A., Leiberman A., Margulis G., Sofer S. Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment. Pediatr Pulmonol. 1988;4(3):139–143. doi: 10.1002/ppul.1950040304. [DOI] [PubMed] [Google Scholar]
  85. Tangel D. J., Mezzanotte W. S., White D. P. Influence of sleep on tensor palatini EMG and upper airway resistance in normal men. J Appl Physiol (1985) 1991 Jun;70(6):2574–2581. doi: 10.1152/jappl.1991.70.6.2574. [DOI] [PubMed] [Google Scholar]
  86. Tasker R. C., Dundas I., Laverty A., Fletcher M., Lane R., Stocks J. Distinct patterns of respiratory difficulty in young children with achondroplasia: a clinical, sleep, and lung function study. Arch Dis Child. 1998 Aug;79(2):99–108. doi: 10.1136/adc.79.2.99. [DOI] [PMC free article] [PubMed] [Google Scholar]
  87. Trang Ha, Leske Vivian, Gaultier Claude. Use of nasal cannula for detecting sleep apneas and hypopneas in infants and children. Am J Respir Crit Care Med. 2002 Aug 15;166(4):464–468. doi: 10.1164/rccm.2110114. [DOI] [PubMed] [Google Scholar]
  88. Uliel Shimrit, Tauman Riva, Greenfeld Michal, Sivan Yakov. Normal polysomnographic respiratory values in children and adolescents. Chest. 2004 Mar;125(3):872–878. doi: 10.1378/chest.125.3.872. [DOI] [PubMed] [Google Scholar]
  89. Vogler R. C., Ii F. J., Pilgram T. K. Age-specific size of the normal adenoid pad on magnetic resonance imaging. Clin Otolaryngol Allied Sci. 2000 Oct;25(5):392–395. doi: 10.1046/j.1365-2273.2000.00381.x. [DOI] [PubMed] [Google Scholar]
  90. Waters K. A., Forbes P., Morielli A., Hum C., O'Gorman A. M., Vernet O., Davis G. M., Tewfik T. L., Ducharme F. M., Brouillette R. T. Sleep-disordered breathing in children with myelomeningocele. J Pediatr. 1998 Apr;132(4):672–681. doi: 10.1016/s0022-3476(98)70359-2. [DOI] [PubMed] [Google Scholar]
  91. Wheeler A. J., van Someren V. Fluticasone for obstructive sleep apnea. J Pediatr. 2002 Apr;140(4):489–490. doi: 10.1067/mpd.2002.122090. [DOI] [PubMed] [Google Scholar]
  92. Wiegand D. A., Latz B., Zwillich C. W., Wiegand L. Geniohyoid muscle activity in normal men during wakefulness and sleep. J Appl Physiol (1985) 1990 Oct;69(4):1262–1269. doi: 10.1152/jappl.1990.69.4.1262. [DOI] [PubMed] [Google Scholar]
  93. Wiegand D. A., Latz B., Zwillich C. W., Wiegand L. Upper airway resistance and geniohyoid muscle activity in normal men during wakefulness and sleep. J Appl Physiol (1985) 1990 Oct;69(4):1252–1261. doi: 10.1152/jappl.1990.69.4.1252. [DOI] [PubMed] [Google Scholar]
  94. Wiegand L., Zwillich C. W., White D. P. Collapsibility of the human upper airway during normal sleep. J Appl Physiol (1985) 1989 Apr;66(4):1800–1808. doi: 10.1152/jappl.1989.66.4.1800. [DOI] [PubMed] [Google Scholar]
  95. Williams E. F., 3rd, Woo P., Miller R., Kellman R. M. The effects of adenotonsillectomy on growth in young children. Otolaryngol Head Neck Surg. 1991 Apr;104(4):509–516. doi: 10.1177/019459989110400415. [DOI] [PubMed] [Google Scholar]
  96. Wilson Kerryn, Lakheeram Indrani, Morielli Angie, Brouillette Robert, Brown Karen. Can assessment for obstructive sleep apnea help predict postadenotonsillectomy respiratory complications? Anesthesiology. 2002 Feb;96(2):313–322. doi: 10.1097/00000542-200202000-00015. [DOI] [PubMed] [Google Scholar]
  97. Yamadera W., Chiba S., Itoh H., Ozone M., Takahashi T., Sasaki M., Ushijima S., Moriyama H. Sleep architectures of obstructive sleep apnea syndrome in the young child. Psychiatry Clin Neurosci. 2000 Jun;54(3):330–331. doi: 10.1046/j.1440-1819.2000.00700.x. [DOI] [PubMed] [Google Scholar]
  98. Young T., Palta M., Dempsey J., Skatrud J., Weber S., Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993 Apr 29;328(17):1230–1235. doi: 10.1056/NEJM199304293281704. [DOI] [PubMed] [Google Scholar]
  99. Young Terry, Peppard Paul E., Gottlieb Daniel J. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002 May 1;165(9):1217–1239. doi: 10.1164/rccm.2109080. [DOI] [PubMed] [Google Scholar]

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