Pathophysiology of pediatric obstructive sleep apnea
Open accessAbstract
Sleep-disordered breathing is a common and serious cause of metabolic, cardiovascular, and neurocognitive morbidity in children. The spectrum of obstructive sleep-disordered breathing ranges from habitual snoring to partial or complete airway obstruction, termed obstructive sleep apnea (OSA). Breathing patterns due to airway narrowing are highly variable, including obstructive cycling, increased respiratory effort, flow limitation, tachypnea, and/or gas exchange abnormalities. As a consequence, sleep homeostasis may be disturbed. Increased upper airway resistance is an essential component of OSA, including any combination of narrowing/retropositioning of the maxilla/mandible and/or adenotonsillar hypertrophy. However, in addition to anatomic factors, the stability of the upper airway is predicated on neuromuscular activation, ventilatory control, and arousal threshold. During sleep, most children with OSA intermittently attain a stable breathing pattern, indicating successful neuromuscular activation. At sleep onset, airway muscle activity is reduced, ventilatory variability increases, and an apneic threshold slightly below eupneic levels is observed in non-REM sleep. Airway collapse is offset by pharyngeal dilator activity in response to hypercapnia and negative lumenal pressure. Ventilatory overshoot results in sudden reduction in airway muscle activation, contributing to obstruction during non-REM sleep. Arousal from sleep exacerbates ventilatory instability and, thus, obstructive cycling. Paroxysmal reductions in pharyngeal dilator activity related to central REM sleep processes likely account for the disproportionate severity of OSA observed during REM sleep. Understanding the pathophysiology of pediatric OSA may permit more precise clinical phenotyping, and therefore improve or target therapies related to anatomy, neuromuscular compensation, ventilatory control, and/or arousal threshold.
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In OSA patients, after overcoming the critical closing pressure (Pcrit), a partial or total airway collapse occurs.
“in OSA patients, after overcoming the critical closing pressure (Pcrit), a partial or total airway collapse will happen.”
From Role of Nasal Surgery in Adult Obstructive Sleep Apnea: A Systematic Review (2024) · cites this paper as [41]
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King, Z., Josee-Leclerc, M., Wales, P., Masters, I. B., & Kapur, N. (2019) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.8022 · Cited by 17 · see citing works
Liu, C.-N., Kang, K., Yao, C. J., Chen, Y., Lee, P., Weng, W., & Hsu, W. (2022) · JAMA Otolaryngology–Head & Neck Surgery · doi:10.1001/jamaoto.2022.0925 · Cited by 17 · see citing works
- Authors
- Katz, E. S., & D'Ambrosio, C. M.
- Affiliations
- Boston Children's Hospital (US)
- Division of Pulmonary Diseases, Department of Medicine, Tufts-New England Medical Center, and Tufts Medical School, Boston, Massachusetts
- ORCID
- Katz, Eliot S.
- Venue
- Proceedings of the American Thoracic Society
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-02
- Volume
- 5
- Issue
- 2
- Pages
- 253-262
- ISSN
- 1546-3222 (ISSN-L)
- 1943-5665
- PMC
- PMC2645256
- OpenAlex
- W2054680308
- Cited by
- 326
- References
- 87
- Citations by year
- 2026: 14 · 2025: 23 · 2024: 23 · 2023: 26 · 2022: 21 · 2021: 29 · 2020: 28 · 2019: 19 · 2018: 10 · 2017: 17 · 2016: 12 · 2015: 17 · 2014: 15 · 2013: 13 · 2012: 18
- FWCI
- 1.40
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Proceedings of the American Thoracic Society (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (HL073238, K23HL073238)
- National Center for Research Resources (M01-RR02172, M01RR002172, RR02172)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- pediatric obstructive sleep apnea, sleep-disordered breathing, upper airway resistance, airway collapse, ventilation control, arousal threshold, REM sleep, NREM sleep, adenotonsillar hypertrophy, neuromuscular activation, sleep homeostasis, snoring
- MeSH terms
- Child, Electromyography, Humans, Obesity, Pharynx, Risk Factors, Snoring, Craniofacial Abnormalities, Sleep Apnea, Obstructive
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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