Childhood Obstructive Sleep Apnea: One or Two Distinct Disease Entities?

This article discusses sleep-disordered breathing (SDB) in children, spanning from habitual snoring to obstructive sleep apnea (OSA) and its various variants. The complexity of the disorder, which involves increased upper airway resistance and obstruction during sleep, has led to diverse clinical manifestations and treatment approaches. While SDB was initially recognized decades ago, recent increases in childhood obesity have altered its demographic characteristics and presentation. Habitual snoring is prevalent, with about 2-3% progressing to clinically-relevant OSA. Obesity plays a significant role, leading to airway obstruction due to increased adipose tissue in the upper airway and elsewhere. The paper proposes classifying pediatric OSA into two types based on the dominant contributing factors: type I, primarily characterized by lymphadenoid hypertrophy, and type II, primarily associated with obesity. This classification aims to better differentiate and treat these patients. The article also delves into the intricate mechanisms and manifestations of OSA in children, highlighting the evolving understanding of this complex condition.

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