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Advances in Sleep Respiratory Disorders in Children and Adolescents
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Advances in Sleep Respiratory Disorders in Children and Adolescents

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Pulmonary and Sleep Medicine".

Deadline for manuscript submissions: closed (10 November 2023) | Viewed by 15247

Special Issue Editors

Prof. Dr. Refika Ersu

E-Mail Website
Guest Editor
Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
Interests: sleep respiratory disorders; pediatric long term ventilation; non invasive ventilation; pediatric pulmonology
Dr. Luana Nosetti

E-Mail Website
Guest Editor
Centro di Sperimentazione Regionale per la SIDS, Università degli Studi dell'Insubria, Varese, Italy
Interests: sleep respiratory disorders; ALTE BRUE; pediatric respiratory diseases
Prof. Dr. Renato Cutrera

E-Mail Website
Guest Editor
IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
Interests: sleep respiratory disorders; pediatric long term ventilation; non invasive ventilation; rare respiratory diseases; pediatric pulmonology

Special Issue Information

Dear Colleagues,

This Special Issue will focus on sleep disordered breathing (SDB), a spectrum of pathologies of varying degrees of severity which includes habitual snoring, obstructive hypoventilation, upper airway resistance syndrome (UARS) and obstructive sleep apnea (OSA). The latter is common in children, affecting 2–5% of the pediatric population. Untreated OSA is linked to adverse cardiovascular and neurobehavioral outcomes and poor quality of life in children. Additionally, central congenital hypoventilation syndrome (CCHS), apparent life-threatening events (ALTE) and brief resolved unexplained event (BRUE) are part of sleep disorders. The awareness of SDB in children has steadfastly increased over the last several decades.

For this Special Issue, we are seeking original research and review articles focusing on advancements in the epidemiology, complications, diagnostic approaches and management of SDB, with particular attention to multidisciplinary approaches, new therapies and technologies. These papers will stimulate the continuing efforts to improve our understanding in this very interesting field.

The goal of this Special Issue is to serve as a source for pediatric clinical practitioners in the field of SDB for their daily practice, as well as for researchers and their future studies.

Prof. Dr. Refika Ersu
Dr. Luana Nosetti
Prof. Dr. Renato Cutrera
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • obstructive sleep apnea
  • sleep disordered breathing
  • snoring
  • central congenital hypoventilation syndrome (CCHS)
  • apparent life-threatening events (ALTE)
  • brief resolved unexplained event (BRUE)
  • craniofacial malformations
  • neuromuscular disease
  • obesity
  • SDB complications
  • SDB co-morbidities

Published Papers (7 papers)

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Research

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12 pages, 2233 KiB  
Article
Insights into Pediatric Sleep Disordered Breathing: Exploring Risk Factors, Surgical Interventions, and Physical and Scholastic Performance at Follow-Up
by Marco Zaffanello, Angelo Pietrobelli, Leonardo Zoccante, Luca Sacchetto, Luana Nosetti, Michele Piazza and Giorgio Piacentini
Children 2024, 11(4), 388; https://doi.org/10.3390/children11040388 - 24 Mar 2024
Viewed by 711
Abstract
(1) Background: Sleep-disordered breathing represents a growing public health concern, especially among children and adolescents. The main risk factors for pediatric sleep-disordered breathing in school-age children are tonsillar and adenoid hypertrophy. Adenoidectomy, often in combination with tonsillectomy, is the primary treatment modality for [...] Read more.
(1) Background: Sleep-disordered breathing represents a growing public health concern, especially among children and adolescents. The main risk factors for pediatric sleep-disordered breathing in school-age children are tonsillar and adenoid hypertrophy. Adenoidectomy, often in combination with tonsillectomy, is the primary treatment modality for pediatric sleep-disordered breathing. This study aims to comprehensively investigate various risk and protective factors in children with sleep-disordered breathing undergoing adenotonsillar or adenoidal surgeries. We also aim to explore the differences in neuropsychological profiles. (2) Methods: This is an observational, retrospective cohort study. We collected information on adenoidectomy or adenotonsillectomy in children referred to our center. We reviewed the clinical history and preoperative visits and collected data through a telephone questionnaire. The Pediatric Sleep Questionnaire (PSQ) and the Pediatric Quality of Life Inventory (PedsQL) screen sleep-disordered breathing and quality of life, respectively. The data were statistically analyzed using SPSS version 22.0 for Windows (SPSS Inc., Chicago, IL, USA). (3) Results: The study involved 138 patients, but only 100 children participated. A higher percentage of patients with sleep-disordered breathing were observed to have mothers who smoked during pregnancy. A smaller proportion of patients with sleep-disordered breathing habitually used a pacifier. A rise in physical score was associated with a reduced PSQ at follow-up (p = 0.051). An increase in the overall academic score was related to a decrease in the PSQ at follow-up (p < 0.001). A more significant proportion of patients undergoing adenotonsillectomy were observed to have a history of prematurity and cesarean birth. (4) This comprehensive study delves into the intricate interplay of risk and protective factors impacting children with sleep-disordered breathing undergoing adenotonsillectomy and adenoidectomy. Full article
(This article belongs to the Special Issue Advances in Sleep Respiratory Disorders in Children and Adolescents)
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10 pages, 615 KiB  
Article
Vitamin D Deficit as Inducer of Adenotonsillar Hypertrophy in Children with Obstructive Sleep Apnea—A Prospective Case-Control Study
by Pietro De Luca, Arianna Di Stadio, Pasquale Marra, Francesca Atturo, Alfonso Scarpa, Claudia Cassandro, Ignazio La Mantia, Antonio Della Volpe, Luca de Campora, Domenico Tassone, Angelo Camaioni and Ettore Cassandro
Children 2023, 10(2), 274; https://doi.org/10.3390/children10020274 - 31 Jan 2023
Cited by 1 | Viewed by 1547
Abstract
(1) Objective: This prospective case-control study aimed to assess the level of serum vitamin D comparing pediatric non-allergic patients with obstructive sleep apnea (OSA) and healthy controls. (2) Methods: The period of the enrollment was from November 2021 to February 2022. Children with [...] Read more.
(1) Objective: This prospective case-control study aimed to assess the level of serum vitamin D comparing pediatric non-allergic patients with obstructive sleep apnea (OSA) and healthy controls. (2) Methods: The period of the enrollment was from November 2021 to February 2022. Children with uncomplicated OSA caused by adenotonsillar hypertrophy (ATH) were recruited. Allergy was excluded by skin prick test (SPT), and the determination of serum IgE level using ELISA test. Plasma concentration of 25-hydroxy vitamin D (25-OHD) was quantitatively determined; then, the vitamin D concentration in patients was compared with healthy controls matched for sex, age, ethnicity, and characteristics. (3) Results: Plasma 25-OHD levels were significantly lower in patients than in healthy subjects (mean 17 ng/mL, 6.27 DS, range 6–30.7 ng/mL, vs. mean 22 ng/mL, 9.45 DS, range 7–41.2 ng/ ml; p < 0.0005). The prevalence of children with vitamin D deficiency was significantly higher in the ATH group than controls. The plasma 25-OHD level did not change following the ATH clinical presentation (III or IV grade according to the Brodsky scale), while the different categories of 25-OHD status (insufficiency, deficiency, and adequacy) in the ATH group were statistically significantly different (p < 0.001) from healthy controls. (4) Conclusions: This study identified statistically significant differences between the ATH group and control regarding the plasma concentration of vitamin D; this data, despite not being directly linkable to the lymphoid tissue hypertrophy (p-value not significant), might suggest a negative effect of vitamin D deficit on the immune system. Full article
(This article belongs to the Special Issue Advances in Sleep Respiratory Disorders in Children and Adolescents)
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11 pages, 2126 KiB  
Article
Effects of Rapid Palatal Expansion on the Upper Airway Space in Children with Obstructive Sleep Apnea (OSA): A Case-Control Study
by Angela Galeotti, Roberto Gatto, Silvia Caruso, Simone Piga, Wanda Maldonato, Emanuela Sitzia, Valeria Viarani, Gaia Bompiani, Francesco Aristei, Giuseppe Marzo and Paola Festa
Children 2023, 10(2), 244; https://doi.org/10.3390/children10020244 - 30 Jan 2023
Cited by 1 | Viewed by 3934
Abstract
Obstructive Sleep Apnea (OSA) in children needs a multidisciplinary approach. Even if the first-line treatment of pediatric OSA is adenotonsillectomy, nowadays rapid palatal expansion (RPE) is considered a valid additional treatment. The aim of this study is to evaluate cephalometric changes in upper [...] Read more.
Obstructive Sleep Apnea (OSA) in children needs a multidisciplinary approach. Even if the first-line treatment of pediatric OSA is adenotonsillectomy, nowadays rapid palatal expansion (RPE) is considered a valid additional treatment. The aim of this study is to evaluate cephalometric changes in upper airways dimensions after rapid palatal expansion (RPE) in children suffering from Obstructive Sleep Apnea (OSA). A total of 37 children (range age 4–10 years) with diagnosis of OSA referred to Dentistry Unit of Bambino Gesù Children’s Research Hospital IRCCS (Rome, Italy) were included in this pre-post study and underwent lateral radiographs at the start (T0) and at the end (T1) of a RPE treatment. Inclusion criteria were: diagnosis of OSA confirmed by cardiorespiratory polygraphy (AHI > 1) or pulse oximetry (McGill = >2), skeletal maxillary contraction evaluated by presence of posterior crossbite. A control group of 39 untreated patients (range age 4–11 years), in good general health, was set up. A paired T-test was used to investigate the statistical differences between T0 and T1 values in both groups. The results showed a statistically significant increase of nasopharyngeal width in the treated group after RPE treatment. Moreover, the angle that identifies mandibular divergence compared to palatal plane (PP-MP°) was significantly reduced. In the control group, no statistically significant differences were observed. The present study showed that RPE treatment determines a significant sagittal space increase in the upper airways space and a counterclockwise mandibular growth in children with OSA compared to a control group. These results suggest that a widening of the nasal cavities induced by RPE may support a return to physiological nasal breathing and promote a counterclockwise mandibular growth in children. This evidence confirms the crucial role of the orthodontist in the management of OSA in pediatric patients. Full article
(This article belongs to the Special Issue Advances in Sleep Respiratory Disorders in Children and Adolescents)
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Review

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10 pages, 586 KiB  
Review
Sleep Respiratory Disorders in Children and Adolescents with Cystic Fibrosis and Primary Ciliary Dyskinesia
by Maria Papale, Sara Manti, Santiago Presti, Federico Mollica, Giuseppe F. Parisi and Salvatore Leonardi
Children 2023, 10(10), 1707; https://doi.org/10.3390/children10101707 - 20 Oct 2023
Viewed by 1258
Abstract
Cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) are genetic respiratory diseases featured by chronic upper and lower airway inflammation and infection, mainly due to impaired mucociliary clearance due to genetic mutations. Sleep is crucial to healthy children’s normal physical and psychological development [...] Read more.
Cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) are genetic respiratory diseases featured by chronic upper and lower airway inflammation and infection, mainly due to impaired mucociliary clearance due to genetic mutations. Sleep is crucial to healthy children’s normal physical and psychological development and has an important value in chronic respiratory diseases. Impaired sleep quality, such as sleep deprivation or insufficient sleep during the night, and sleep respiratory disorders (SRDs) are common in 5% to 30% of the general population. Sleep disruption leads to attention deficits, daytime sleepiness, fatigue and mood disorders and correlates to a worsened quality of life. Furthermore, sleep respiratory disorders (SRSs) are under-recognized comorbidities in CF and PCD patients. SRSs include a spectrum of symptoms ranging from primary snoring through upper airway resistance to obstructive sleep apnea (OSA), nocturnal hypoventilation and hypoxemia occurring in people with moderate to severe lung disease and damaging the disease-related outcomes and quality of life. Effective screening during sleep with polysomnography is very important for the timely initiation of efficacious treatments and to prevent worsened respiratory, metabolic and cardiovascular outcomes. However, the impact of SRDs on health and quality of life is still underinvestigated. Full article
(This article belongs to the Special Issue Advances in Sleep Respiratory Disorders in Children and Adolescents)
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13 pages, 1578 KiB  
Review
Exploring the Intricate Links between Adenotonsillar Hypertrophy, Mouth Breathing, and Craniofacial Development in Children with Sleep-Disordered Breathing: Unraveling the Vicious Cycle
by Luana Nosetti, Marco Zaffanello, Francesca De Bernardi di Valserra, Daniela Simoncini, Giulio Beretta, Pietro Guacci, Giorgio Piacentini and Massimo Agosti
Children 2023, 10(8), 1426; https://doi.org/10.3390/children10081426 - 21 Aug 2023
Cited by 2 | Viewed by 2051
Abstract
Adenotonsillar hypertrophy has been well-acknowledged as the primary instigator of sleep-disordered breathing in the pediatric population. This condition spans a spectrum, from typical age-related growth that the immune system influences to persistent pathological hypertrophy. Reduction in air spaces, metabolic changes, neurobehavioral alterations, and [...] Read more.
Adenotonsillar hypertrophy has been well-acknowledged as the primary instigator of sleep-disordered breathing in the pediatric population. This condition spans a spectrum, from typical age-related growth that the immune system influences to persistent pathological hypertrophy. Reduction in air spaces, metabolic changes, neurobehavioral alterations, and chronic inflammation characterizes the latter form. As the go-to treatment, adenotonsillectomy has proven effective. However, it is not a guarantee for all patients, leaving us without reliable predictors of treatment success. Evidence suggests a connection between adenotonsillar hypertrophy and specific oral breathing patterns resulting from craniofacial development. This finding implies an intricate interdependence between the two, hinting at a self-sustaining vicious cycle that persists without proper intervention. The theories regarding the relationship between craniofacial conformation and sleep-disordered breathing have given rise to intriguing perspectives. In particular, the “gracilization theory” and the “gravitational hypothesis” have provided fascinating insights into the complex interaction between craniofacial conformation and SDB. Further investigation is crucial to unraveling the underlying pathophysiological mechanisms behind this relationship. It is also vital to explore the risk factors linked to adenotonsillectomy failure, study the long-term effects of adenotonsillar hypertrophy on craniofacial growth, and devise innovative diagnostic techniques to detect upper airway compromise early. Moreover, to assess their efficacy, we must delve into novel therapeutic approaches for cases that do not respond to traditional treatment, including positional therapy and orofacial myofunctional therapy. Though complex and unpredictable, these challenges promise to enhance our understanding and treatment of adenotonsillar hypertrophy and its related complications in children. By taking on this task, we can pave the way for more effective and targeted interventions, ultimately improving affected individuals’ well-being and quality of life. Full article
(This article belongs to the Special Issue Advances in Sleep Respiratory Disorders in Children and Adolescents)
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19 pages, 3055 KiB  
Review
Diagnosis of Paediatric Obstructive Sleep-Disordered Breathing beyond Polysomnography
by Melissa Borrelli, Adele Corcione, Chiara Cimbalo, Anna Annunziata, Simona Basilicata, Giuseppe Fiorentino and Francesca Santamaria
Children 2023, 10(8), 1331; https://doi.org/10.3390/children10081331 - 1 Aug 2023
Cited by 1 | Viewed by 1956
Abstract
Obstructive sleep-disordered breathing (SDB) has significant impacts on health, and therefore, a timely and accurate diagnosis is crucial for effective management and intervention. This narrative review provides an overview of the current approaches utilised in the diagnosis of SDB in children. Diagnostic methods [...] Read more.
Obstructive sleep-disordered breathing (SDB) has significant impacts on health, and therefore, a timely and accurate diagnosis is crucial for effective management and intervention. This narrative review provides an overview of the current approaches utilised in the diagnosis of SDB in children. Diagnostic methods for SDB in children involve a combination of clinical assessment, medical history evaluation, questionnaires, and objective measurements. Polysomnography (PSG) is the diagnostic gold standard. It records activity of brain and tibial and submental muscles, heart rhythm, eye movements, oximetry, oronasal airflow, abdominal and chest movements, body position. Despite its accuracy, it is a time-consuming and expensive tool. Respiratory polygraphy instead monitors cardiorespiratory function without simultaneously assessing sleep and wakefulness; it is more affordable than PSG, but few paediatric studies compare these techniques and there is optional recommendation in children. Nocturnal oximetry is a simple and accessible exam that has high predictive value only for children at high risk. The daytime nap PSG, despite the advantage of shorter duration and lower costs, is not accurate for predicting SDB. Few paediatric data support the use of home testing during sleep. Finally, laboratory biomarkers and radiological findings are potentially useful hallmarks of SDB, but further investigations are needed to standardise their use in clinical practice. Full article
(This article belongs to the Special Issue Advances in Sleep Respiratory Disorders in Children and Adolescents)
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16 pages, 653 KiB  
Review
Pediatric Sleep Respiratory Disorders: A Narrative Review of Epidemiology and Risk Factors
by Marta Piotto, Antonella Gambadauro, Alessia Rocchi, Mara Lelii, Barbara Madini, Lucia Cerrato, Federica Chironi, Youssra Belhaj and Maria Francesca Patria
Children 2023, 10(6), 955; https://doi.org/10.3390/children10060955 - 27 May 2023
Cited by 2 | Viewed by 2899
Abstract
Sleep is a fundamental biological necessity, the lack of which has severe repercussions on the mental and physical well-being in individuals of all ages. The phrase “sleep-disordered breathing (SDB)” indicates a wide array of conditions characterized by snoring and/or respiratory distress due to [...] Read more.
Sleep is a fundamental biological necessity, the lack of which has severe repercussions on the mental and physical well-being in individuals of all ages. The phrase “sleep-disordered breathing (SDB)” indicates a wide array of conditions characterized by snoring and/or respiratory distress due to increased upper airway resistance and pharyngeal collapsibility; these range from primary snoring to obstructive sleep apnea (OSA) and occur in all age groups. In the general pediatric population, the prevalence of OSA varies between 2% and 5%, but in some particular clinical conditions, it can be much higher. While adenotonsillar hypertrophy (“classic phenotype”) is the main cause of OSA in preschool age (3–5 years), obesity (“adult phenotype”) is the most common cause in adolescence. There is also a “congenital–structural” phenotype that is characterized by a high prevalence of OSA, appearing from the earliest ages of life, supported by morpho-structural abnormalities or craniofacial changes and associated with genetic syndromes such as Pierre Robin syndrome, Prader-Willi, achondroplasia, and Down syndrome. Neuromuscular disorders and lysosomal storage disorders are also frequently accompanied by a high prevalence of OSA in all life ages. Early recognition and proper treatment are crucial to avoid major neuro-cognitive, cardiovascular, and metabolic morbidities. Full article
(This article belongs to the Special Issue Advances in Sleep Respiratory Disorders in Children and Adolescents)
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