The obstructive sleep apnoea syndrome in infants and children

Abstract □ 171

This presentation will summarize data from recent studies on the prevalence, diagnosis and therapy of obstructive sleep apnea syndrome (OSAS) in infants and children. The prevalence of this disorder in 4-6 year old children is 0.7%. Leading clinical sign in 90% of patients is habitual snoring, but this is rather nonspecific, as 60% of patients investigated for habitual snoring do not have OSAS. Other signs such as daytime sleepiness, failure to thrive, profuse nocturnal sweating or mouth breathing are equally nonspecific. The diagnosis, therefore, has to be confirmed by polysomnography, where OSAS is suggested by the occurrence of >5 obstructive apneas/hypopneas per hour of sleep in conjuction with a CO₂ of >50 mmHg for >8% of sleep time and/or >2 desaturations to <90%/h. Regarding treatment, adenotomy (AT) or adenotonsillectomy (ATE) are the procedures most commonly recommended. Recent data, however, suggest that nasal steroids may also be effective in reducing adenoidal size and improving OSAS. If symptoms persist after AT/ATE, nasal mask CPAP should be considered. Due to problems with fitting the face mask, failure rates around 15% are reported even in the most experienced centers. Recently, nasal cannula O₂ administration has been reported as an alternative to CPAP therapy. As this may occasionally worsen hypercapnia, CO₂ must be measured during sleep when first applying this therapy. In children with severe OSAS due to mandibular hypoplasia, osteoplastic callous distraction was recently shown to be an effective option. Experience with this new procedure, however, is yet limited. In summary, OSAS in children continues to be an interdisciplinary challenge, with the pediatric sleep specialist playing a key role in the diagnostic and therapeutic workup of these patients.