Obstructive sleep apnea (OSA) is characterized by prolonged partial and/or intermittent complete (apnea) or partial (hypopnea) upper airway obstructions. The disruption of normal ventilation can be associated with hypoxemia and abnormal sleep patterns. OSA occurs predominantly during REM-sleep. Most affected children present with snoring and breathing problems during sleep.
The prevalence of OSA in children is approximately 4%. OSA can be associated with daytime sleepiness and cognitive/behavioral complications like poor school performance and hyperactivity. Cardiovascular complications include pulmonary hypertension, cor pulmonale, and systemic hypertension. There is a significant association between apnea-/hypopnea-index (AHI) and oxygen desaturation index with raised daytime and nocturnal blood pressure.
There is an increasing prevalence of obesity in children. Obesity can interfere with sleep in different ways. A lack of sleep is associated with an increased risk for obesity. On the other hand, obesity can have a negative influence on sleep. An increased soft tissue mass and altered mechanics lead to an increased airflow resistance, causing upper airway obstruction. With the current epidemic of obesity the incidence of OSA due to obesity in younger children may become remarkable. The risk for systemic hypertension caused by obesity is independent from the risk for hypertension caused by obstructive sleep apnea.
Insofar, blood pressure and sleep-related breathing should be monitored beginning with an obstructive AHI of 3/hour sleep. Children with OSA should be treated early enough. Prevention and early treatment of obesity as a risk factor for OSA as well as for hypertension is becoming an important social challenge.
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