Attention disorders, slowness, but also cardiovascular complications, growth, metabolism and neuro-cognitive development. These are the possible consequences of sleep-disordered breathing, if not diagnosed early and adequately treated. Consequences that can persist even into adulthood, as demonstrated by recent scientific evidence. Yet, despite the important repercussions on the quality of life of the child and his family, sleep disorders are an underestimated and often unrecognized problem. Experts will discuss the topic at the National Congress of Simri, the Italian Society of Infantile Respiratory Diseases, which ends today in Rome, launching a campaign to raise awareness among paediatricians and parents, based on materials created in Italian and English (a brochure, a desk calendar and a ‘map’ for kids), with simple language and clear directions.
Sleep breathing disorders are a set of non-rare pathologies and are on the increase after Covid. We speak of habitual snoring, if present more than 3 nights a week for at least 2 months, of obstructive hypoventilation if snoring is associated with an increase in carbon dioxide (hypercapnia), while the syndrome of increased resistance of the upper airways, better known like Uars, it is associated with the presence of repeated pseudo-awakenings during sleep, linked to respiratory effort without apnea. The most serious form is obstructive sleep apnea syndrome or OSA characterized by respiratory effort, recurrent complete or partial obstruction of the upper airways, associated with an intermittent reduction in oxygenation during sleep.
Habitual snoring – the most widespread and underestimated disorder as it can give rise to attention problems – is present in 12% of preschool children. Osa has a prevalence in children ranging from 2 to 5.7%, with a maximum peak between the second and sixth year of life. But preliminary data presented at the Simri congress and collected by the Sleep Center of the University of Insubria of Varese, on 1,400 children with suspected sleep-related breathing disorders, document a significant increase in cases of Osa, passing in the sample studied by 48.7% pre-pandemic to 74.4% post-pandemic, with a significant increase in severe apnea from 8.6% pre-pandemic to 13.9% post-pandemic, an increase presumably linked to the peak of infections that followed the lockdown period , in pediatric age the main cause is adeno-tonsillar hypertrophy. This, in fact, can develop following an inadequate inflammatory response at the tonsil-adenoid level during some viral infections.
Nosetti, ‘consequences may persist into adulthood’
“The consequences of these disorders can persist even into adulthood”, explains Luana Nosetti, head of the Simri Sleep Study Group. “A recent follow-up demonstrated that adults with a history of severe childhood Osa, re-evaluated 20 years later, had a high risk of snoring, a high body mass index and lower academic performance. Children with severe Osa they may be at greater risk of chronic disease later in life.”
Difficult to diagnose because they are not seen during the day. Early diagnosis is essential, but this often does not happen. From the appearance of the first symptoms it takes approximately 16 to 19 months to make a diagnosis, according to data presented at the Simri congress carried out at the Sleep Center of the University of Insubria in Varese.
“The doctor often finds it difficult to identify in the child the symptoms of these pathologies typically associated with sleep, which during the day do not present themselves with the typical symptoms of the night hours. Parents therefore often feel misunderstood when they report that their child has noisy breathing in his sleep followed by prolonged pauses and they have the sensation that he is about to suffocate”, adds Nosetti.
Advice to parents, ‘it is useful to make a short video for your children to show to the pediatrician’
“A useful piece of advice for parents is to make a short video of their children, which, although it does not allow a diagnosis to be made, can give the doctor the suspicion that a child has this disorder”, continues Nosetti. There are also symptoms that mum and dad need to pay attention to, which can be divided into daytime and nighttime. Daytime symptoms are represented by mouth breathing, irritability, reduced school performance, difficulty waking up in the morning, drowsiness (typical of adolescence), morning headache, chronic nasal obstruction.
The nocturnal symptoms are: snoring, apnea, respiratory effort during sleep, profuse sweating, saliva dripping onto the pillow, abnormal positions assumed during sleep to overcome resistance in the upper airways, refusal to go to bed, fears and nocturnal agitation. In some cases they can also be associated with bruxism, nocturnal enuresis and sleepwalking.
The causes, in pediatric age, can be different, the most frequent is adeno-tonsillar hypertrophy, but there are also other risk factors such as obesity, the presence of conformational anomalies of the facial mass or genetics. Treatment can be pharmacological, surgical (the most common is adenotonsillectomy), dietary, and in the most severe forms non-invasive ventilation. The management of these patients, in addition to the fundamental role of the family pediatrician, often presupposes a multidisciplinary approach involving multiple specialists.