Sleep apnea in children.

Sleep apnea in children develops when airway obstruction at night is severe; however, lesser degrees of obstruction may also cause problems. The most common cause of nighttime obstruction with or without apnea is hyperplasia of the tonsils and adenoids. Other conditions such as craniofacial anomalies and neuromuscular disorders may predispose children to obstruction of the airway during sleep. Although cor pulmonale, heart failure, and cardiorespiratory arrest are the most dramatic results of obstructive apnea, before these occur many other problems may develop that are detrimental to the child's health, including failure to thrive. A careful history and physical examination are usually sufficient to determine if obstruction and apnea are present at night. Additional studies such as sleep sonography and polysomnography are helpful for documentation of the disorder. The treatment of obstructive apnea, unless associated with central apnea, is surgical. The vast majority of children with obstruction have dramatic resolution of their obstruction following a tonsillectomy and adenoidectomy. Occasionally additional procedures including uvulopalatopharyngoplasty and tracheotomy are needed.