SLEEP-DISORDERED BREATHING DIAGNOSIS AND TREATMENTkapak

DIAGNOSIS OF PEDIATRIC OBSTRUCTIVE SLEEP APNEA

Ağah Yeniçeri

Ankara Bilkent City Hospital, Department of Otorhinolaryngology, Ankara, Türkiye

Yeniçeri A. Diagnosis of Pediatric Obstructive Sleep Apnea. In: Özcan KM, editor. Sleep-Disordered Breathing: Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.195-203.

ABSTRACT

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder (SRBD) in children that significantly impacts their health, development, and quality of life. The American Academy of Pediatrics defines OSA in children as a condition characterized by prolonged partial or intermittent complete obstruction of the upper airway, leading to disrupted ventilation and sleep patterns. The prevalence of OSA in children ranges from 1.2% to 5.7%, and its consequences include cognitive and behavioral issues, cardiovascular complications, and increased healthcare utilization. Timely recognition and appropriate management are essential to prevent the progression to systemic complications; however, OSA diagnosis in the pediatric population is often delayed, contributing to significant morbidity.

The diagnostic process for pediatric OSA is complex, with varying symptoms and limitations of current diagnostic methods. Polysomnography (PSG) remains the reference standard in sleep diagnostics; however, its financial burden, time-intensive nature, and inconsistent availability pose significant limitations. As a result, clinicians increasingly rely on a combination of clinical evaluation, questionnaires, imaging techniques, and other diagnostic tools. A detailed sleep history and clinical evaluation, including physical examination, are essential for identifying children at risk for OSA and determining the need for further testing. When assessing pediatric patients with sleep-related breathing disorders (SRBDs), clinicians should take into account various risk factors, including neuromuscular conditions, craniofacial abnormalities, obesity, and adenotonsillar enlargement.

Questionnaires, such as the Pediatric Sleep Questionnaire, the OSA-18, and the Brouillette OSA score, offer practical and cost-effective alternatives to PSG in clinical settings, particularly in primary and secondary healthcare environments. Such instruments are useful in recognizing pediatric patients with a high likelihood of OSA and in streamlining referrals for comprehensive diagnostic workup. While PSG remains the definitive method for diagnosing OSA, these alternative diagnostic methods offer valuable support in managing OSA, especially when access to PSG is limited. In addition to traditional diagnostic tools, biomarkers are emerging as potential diagnostic aids. Studies have shown promising results with biomarkers such as IL-6, TNF-a, and CRP, although no single biomarker has been definitively established for OSA.

In conclusion, the diagnosis of pediatric OSA requires a multifaceted approach that includes clinical evaluation, questionnaires, imaging, and, when available, PSG. Ongoing research into alternative diagnostic tools and biomarkers will likely improve early detection and treatment, leading to better longterm outcomes for affected children.

Keywords: Pediatric; Obstructive sleep apnea; Diagnosis; Polysomnography; Leep-related breathing disorders

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