Guidelines for diagnosing and treating sleep related breathing disorders in adults and children (Part 3: obstructive sleep apnea in children, diagnosis and treatment).

Obstructive sleep apnea syndrome (OSAS) in child-hood is characterized by intermittent partial or complete collapse of the upper airway (obstructive hypopnea or apnea). Airflow reduction or even cessation may be as-sociated with lung hypoventilation and hypoxemia or compromise normal sleep architecture.Definitions in pediatricsThe term obstructive sleep related breathing disorders includes a variety of pathologic conditions ranging from primary snoring and upper airway resistance syndrome to obstructive sleep apnea- hypopnea syndrome.Apnea: It is defined as absence of oral and nasal air-flow for at least two respiratory cycles. Central apnea is characterized by absence of respiratory effort, whereas obstructive apnea is characterized by continuous respi-ratory effort without airflow. Mixed apneas have both central and obstructive features without intervention of normal respiration.Obstructive apnea is considered clinically significant regardless of presence of desaturation or arousals. Cen-tral apnea is clinically significant only if it is followed by hemoglobin desaturation by at least 3% or by an arousal. It is also evaluated as significant when it lasts more than 20 seconds, regardless of presence of arousal or desatura-tion.Hypopnea is defined as reduction in airflow wave-form width by at least 50% compared to width recorded at the longest period of normal sleep, for at least two re-spiratory cycles. Clinically significant hypopneas have duration greater than two respiratory cycles and are as-sociated with hemoglobin desaturation by at least 3% or with an arousal.Primary snoring describes presence of snoring with-out apnea or hypopnea, hypercapnia, hypoxemia, high arousal index, disruption of normal sleep architecture or daytime symptoms.