Obstructive breathing
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Summary
10 papers analyzed
These studies suggest that obstructive breathing disorders vary by age and underlying causes, with treatments including adenotonsillectomy in children and CPAP or oral appliances in adults, and that accurate diagnosis and tailored management are crucial.
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Understanding Obstructive Breathing Disorders
Obstructive Sleep-Disordered Breathing in Children
Diagnosis and Symptoms of Obstructive Sleep-Disordered Breathing (SDB)
Obstructive sleep-disordered breathing (SDB) in children is a spectrum of disorders characterized by upper airway obstruction during sleep, leading to symptoms such as snoring and disrupted sleep patterns. The most severe form, obstructive sleep apnea (OSA), involves prolonged complete upper airway obstruction, which can significantly disrupt normal ventilation and sleep. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are identified, such as snoring, growth delay, and behavioral problems .
Morbidity and Coexisting Conditions
Children with SDB may experience various morbidities, including pulmonary hypertension, growth delay, and behavioral issues. Coexisting conditions such as feeding difficulties and recurrent otitis media are also common. Additionally, central nervous or cardiovascular system morbidity, growth failure, and enuresis are recognized as predictors of SDB persistence in the long term.
Objective Assessment and Severity Measurement
The severity of SDB is measured objectively, preferably using polysomnography, which is considered the gold standard. Alternative methods include polygraphy or nocturnal oximetry . Children with an apnea-hypopnea index (AHI) greater than 5 episodes per hour, or those with an AHI of 1-5 episodes per hour combined with morbidity or factors predicting SDB persistence, benefit from treatment.
Treatment Approaches
Treatment for SDB in children often involves a stepwise approach. Adenotonsillectomy is the most common surgical intervention and is considered curative in a large proportion of cases, significantly improving the quality of life . Continuous positive airway pressure (CPAP) is another frequently used treatment, especially for children with complex conditions such as Down syndrome or Prader-Willi syndrome . Other interventions may target specific conditions, such as supraglottoplasty for laryngomalacia or the use of a nasopharyngeal airway for mandibular hypoplasia.
Obstructive Sleep Apnea in Adults
Pathophysiology and Symptoms
Obstructive sleep apnea (OSA) in adults is characterized by repetitive obstruction of the upper airway during sleep, leading to periods of apnea or hypopnea. This obstruction is usually caused by the collapse of soft tissues in the back of the throat and tongue during sleep. The primary daytime symptom of OSA is excessive sleepiness, but other symptoms such as unrefreshing sleep, poor concentration, and fatigue are also common.
Cognitive Impairments
OSA is associated with cognitive impairments, primarily due to sleep disruption and blood gas abnormalities. These cognitive deficits include problems with attention, memory, executive function, psychomotor function, and language abilities. Hypoxia and hypercarbia are significant determinants of these deficits.
Treatment with Continuous Positive Airway Pressure (CPAP)
CPAP is the main treatment for OSA in adults. It involves using a flow generator and mask at night to prevent apnea, hypoxia, and sleep disturbance. CPAP has been shown to significantly improve symptoms of sleepiness, quality of life, and cognitive function. It also helps lower 24-hour systolic and diastolic blood pressures compared to control treatments.
Conclusion
Obstructive breathing disorders, including SDB in children and OSA in adults, are significant health issues that require careful diagnosis and management. In children, adenotonsillectomy and CPAP are effective treatments, while in adults, CPAP remains the gold standard. Understanding the symptoms, morbidities, and treatment options is crucial for managing these conditions effectively.
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