Growth and development in pediatric obstructive sleep apnea

Sleep-disordered breathing and other sleep disturbances have been associated with neurodevelopmental and growth delays in children. Physiological sequelae of obstructive sleep apnea (OSA) may include failure to thrive, hypertension, cardiac dysfunction, and systemic inflammation. The mechanisms involved may include intermittent or chronic hypoxia coupled with chronic sleep deprivation owing to frequent arousals and sleep fragmentation caused by respiratory events. The behavioral and developmental consequences of OSA were described as early as 1892 by Osler, who observed that children with “loud and snorting” respirations and “prolonged pauses” were often “stupid looking” and slow to respond to questions, further commenting that the “influence upon mental development is striking.” However, these observations took almost a century to be rigorously investigated. The current chapter aims to synthesize the evidence relating to growth and development in children with OSA, their response to treatment, and the potential underlying basis.