Obstructive sleep apnea in developmental age. A narrative review

Sleep is a physiological function that undergoes, at different stages of life, to considerable variations in neurophysiologicaland behavioral functions. The developmental age is a period characterized by a continuous process ofphysical and neuropsychological changes and synaptic remodeling processes that are the neurophysiological basisof brain plasticity, typical of this developmental phase, occurring mainly during sleep. In the description of obstructivesleep apnea (OSA) in children, two main points should be highlighted: its variability in different age groups,and its specificity compared with OSA in adults. The definition and criteria used for the diagnosis of OSA in adultsare not applicable to OSA in developmental age. Although the adenotonsillar hypertrophy is the most common riskfactor for pediatric OSA, obesity is becoming an increasingly prevalent risk factor, mostly in early childhood (6-9 years) and adolescence. OSA has been shown to affect cognitive function in children and adults. However, OSAimpact on cognitive function in children is more severe since acting on the plastic brain structures can change theneuro-psychic development, learning skills, and social interactions. There is a clear difference in the definition ofpathology between developmental age and adulthood according to the instrumental parameters: an AHI >= 5, whichrepresents, in the pediatric age, the cut-off for a therapeutic pathway necessary to avoid a long-term effect on thechild, instead, it represents in adulthood, the lower limit value for the definition of disease. This is a narrativereview concerning obstructive sleep apnea in developmental age.Conclusions: OSA is a common disorder in children and those at riskmust be identified, studied, and treated promptly becauseuntreated OSA can be responsible for cardiovascular, metabolic, and neurocognitive morbidities and may induce, sometimes,non-reversible deficits given his insistence on a period of physical and neuro-psychic development.