What is the prognosis of obstructive sleep apnea (OSA)?

Updated: Feb 13, 2019
  • Author: Mary E Cataletto, MD; Chief Editor: Denise Serebrisky, MD  more...
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Answer

Major morbidities associated with childhood obstructive sleep apnea include failure to thrive, difficulty concentrating and/or developmental delay, behavioral problems, hypertension, pulmonary hypertension, and, ultimately, cor pulmonale. Some pulmonologists theorize that chronic upper airway obstruction with labored breathing may result in the development of a pectus excavatum deformation in a compliant immature chest wall. Concomitant gastroesophageal reflux is likely to be exacerbated by obstructive sleep apnea.

Children with obstructive sleep apnea syndrome, as well as children with a history of loud habitual snoring, appear to be at risk for developing deficits of executive function. According to the model by Beebe and Gozal, sleep fragmentation, intermittent hypoxemia, and hypercapnia contribute to dysfunction in the prefrontal areas of the brain. [5] Executive functions include behavioral inhibition, regulation of affect and arousal, ability to analyze and synthesize, and memory. Executive dysfunction interferes with cognitive abilities and learning.

Obesity-related hypoventilation, commonly known as the pickwickian syndrome, occurs in some children who have obesity and obstructive sleep apnea. These individuals respond abnormally to both hypercapnic and hypoxemic stimuli to breathe; they have repetitive obstructive events with sleep and marked daytime sleepiness, daytime hypoventilation, and hypercapnia.

The incidence of cor pulmonale and death due to obstructive sleep apnea is unknown. Once pulmonary hypertension has developed, it is usually reversible if the underlying obstructive sleep apnea is effectively treated.

Children with severe obstructive sleep apnea may develop postobstructive pulmonary edema within a few hours of surgery undertaken to relieve upper airway obstruction. Furthermore, such patients are at risk for postoperative respiratory compromise, which is characterized by severe upper airway obstruction and may require endotracheal intubation or the use of noninvasive respiratory support such as continuous positive airway pressure via a nasal mask.


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