Obstructive Sleep Apnea in Infants

• Published in: American journal of respiratory and critical care medicine 2012-04, Vol.185 (8), p.805-816
• Main Authors: KATZ, Eliot S, MITCHELL, Ron B, D'AMBROSIO, Carolyn M
• Format: Article
• Language: English
• Subjects: Adenoids - pathology; Adenoids - surgery; Adult; Age Factors; Airway management; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Babies; Biological and medical sciences; Chronic obstructive pulmonary disease, asthma; Combined Modality Therapy; Comorbidity; Concise Clinical Review; Craniofacial Abnormalities - complications; Craniofacial Abnormalities - diagnosis; Failure to thrive; Female; Follow-Up Studies; Gastroesophageal reflux; Humans; Hypertrophy - pathology; Hypertrophy - surgery; Incidence; Infant; Intensive care medicine; Laryngomalacia - complications; Laryngomalacia - congenital; Larynx; Larynx - abnormalities; Male; Medical sciences; Micrognathism - complications; Micrognathism - diagnosis; Mouth; Newborn babies; Nose; Ostomy; Palatine Tonsil - pathology; Palatine Tonsil - surgery; Physiology; Pneumology; Polysomnography - methods; Risk Assessment; Severity of Illness Index; Sleep apnea; Sleep Apnea, Obstructive - etiology; Sleep Apnea, Obstructive - physiopathology; Sleep Apnea, Obstructive - therapy; Sleep disorders; Treatment Outcome
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201108-1455CI

Obstructive sleep apnea in infants has a distinctive pathophysiology, natural history, and treatment compared with that of older children and adults. Infants have both anatomical and physiological predispositions toward airway obstruction and gas exchange abnormalities; including a superiorly placed larynx, increased chest wall compliance, ventilation-perfusion mismatching, and ventilatory control instability. Congenital abnormalities of the airway, such as laryngomalacia, hemangiomas, pyriform aperture stenosis, choanal atresia, and laryngeal webs, may also have adverse effects on airway patency. Additional exacerbating factors predisposing infants toward airway collapse include neck flexion, airway secretions, gastroesophageal reflux, and sleep deprivation. Obstructive sleep apnea in infants has been associated with failure to thrive, behavioral deficits, and sudden infant death. The proper interpretation of infant polysomnography requires an understanding of normative data related to gestation and postconceptual age for apnea, arousal, and oxygenation. Direct visualization of the upper airway is an important diagnostic modality in infants with obstructive apnea. Treatment options for infant obstructive sleep apnea are predicated on the underlying etiology, including supraglottoplasty for severe laryngomalacia, mandibular distraction for micrognathia, tonsillectomy and/or adenoidectomy, choanal atresia repair, and/or treatment of gastroesophageal reflux.