The genesis of adult sleep apnoea in childhood
- David Read Laboratory, Department of Medicine, University of Sydney, NSW 2006, Australia
- Professor C E Sullivan
Obstructive sleep apnoea (OSA) and central sleep apnoea have been identified and described in adults, children, and infants.1-3 It is not certain, however, if the adult sleep apnoea syndromes, particularly OSA, originate from childhood or whether paediatric and adult sleep apnoea are separate syndromes. Some investigators have suggested that the pathophysiology, criteria for diagnosis, and the management of paediatric patients with OSA are different from that for adults.4-7 Other investigators have found that risk factors, clinical symptoms, and the consequences of OSA share common features between adults, children and infants.8-11 We propose that the adult sleep apnoea syndrome is related to sleep apnoea in children, and that adult patients with sleep apnoea have been predisposed to developing apnoea since early infancy. The differences in OSA in patient populations of different age groups may represent different stages in the development of the adult form of OSA. This review will discuss the similarities and differences between adult, childhood and infant sleep apnoea, particularly OSA. The risk factors, potential mechanisms, and familial factors of OSA will be presented to ascertain the possible genesis of adult sleep apnoea during childhood.
The sleep apnoea syndromes
The OSA syndrome in adults was identified more than 30 years ago,12 has been described extensively in adults, and is believed to be caused by collapse of the oropharyngeal airway.1 It is not certain whether adult patients had OSA as infants or children; however, the diagnosis of OSA in adults often occurs several years after the onset of symptoms, sometimes starting during adolescence. Obstructive apnoea is associated with repetitive episodes of hypoxaemia, sleep fragmentation, and cardiovascular and neurobehavioural sequelae (fig 1).13-15 Several risk factors have been identified that predispose an individual to developing OSA including obesity, age, sex, upper airway structural abnormalities, and a family history of …