Sleep-Disordered Breathing in High-Risk Children

High-risk children are those affected by obesity, neuromuscular or craniofacial disorders, Down syndrome, and mucopolysaccharidoses as well as a number of other disorders such as cerebral palsy, Prader-Willi syndrome, achondroplasia, Arnold-Chiari malformations, and sickle cell disease. Adenotonsillar hypertrophy is the most common cause of sleep-disordered breathing (SDB) in children, and adenotonsillectomy has been shown to be an effective treatment in the majority of these children. However, the surgical management of SDB is more complex in children considered to be at high risk. The prevalence of childhood obesity in the United States has risen from 6% to 14% over the last quarter century. There is also increasing evidence that childhood obesity is a worldwide problem. Obese children with SDB have been shown to have neurocognitive abnormalities including reduced learning, memory, and language skills. It has been postulated that decreased activity and hypersomnolence, both known to be consequences of SDB in children, may lead to obesity.