Sleep Disordered Breathing

Question 1

Definition of sleep disordered breathing

Answer 1

Occurs during REM sleep, when control of breathing becomes unstable and relaxation of voluntary muscles in the upper airway and chest make upper airway collapse likely.

Question 2

Causes of sleep disordered breathing

Answer 2

• Airway obstruction (in children this rends to be caused by adenotonsillar hypertrophy)
• Central hypoventilation
• May be a combination of both

Question 3

Diseases which predispose to SDB

Answer 3

Neuromuscular diseases (DMD), craniofacial abnormalities, dystonia of upper airway (cerebral palsy), DOWN’S (restriction and dystonia)

Question 4

Presentation of SDB

Answer 4

• Children will present with loud snoring, pauses in breathing (apnoea), restlessness and disturbed sleep.
• OSA can lead to Excessive daytime sleepiness or hyperactivity, learning and behaviour problems, faltering growth and pulmonary hypertension in very severe cases

Question 5

Investigations for SDB

Answer 5

• Overnight pulse oximetry (most basic assessment that can be performed at home). This allows quantification of the frequency and severity of periods of desaturation
• Polysomnography- A multi-parameter sleep study (saturation, EEG, HR, video recording etc) required in more complex cases

Question 6

Managment of SDB

Answer 6

• Children with adenotonsillar hypertrophy may need adenotonsillectomy which usually causes a dramatic improvement in symptoms
• Other children may benefit from CPAP or BiPAP to maintain their upper airway at night
• Can use montelukast +/- intranasal budesonide if surgery didn’t improve the obstruction