Children

In this chapter, we highlight salient differences in both the aetiology and pathophysiology of OSA in children compared with adults, and will document their clinical management implications. The aetiology of paediatric OSA is usually the confluence of multifactorial elements including anatomical factors (e.g. enlarged adenoids and tonsils) that promote intrinsic UA narrowing and factors that contribute to UA collapsibility (e.g. UA inflammation and altered neurological reflexes). Adenotonsillectomy remains the mainstay of treatment but medical anti-inflammatory therapies such as nasal steroids and leukotriene antagonists are gaining wider acceptance in the treatment of mild OSA. OSA morbidities primarily involve the neurocognitive, cardiovascular and metabolic systems. However, the phenotypic variance of paediatric OSA is only partially explained by its severity, such that a combination of genetic and environmental factors is likely to be an important contributor, opening the door for implementation of genomic and proteomic approaches to enable future personalised diagnosis and management.