What is pediatric obstructive sleep apnea and how is it diagnosed?

• A. Snoring without sleep disturbance
• B. Daytime fatigue alone
• C. Recurrent partial or complete airway collapse during sleep; nocturnal polysomnography shows apneas/hypopneas and desaturation/arousal
• D. Central sleep apnea pattern on EEG

Answer: (C)

Pediatric obstructive sleep apnea is defined by recurrent partial or complete collapse of the upper airway during sleep, which leads to disrupted sleep and intermittent drops in oxygen saturation. Diagnosing it relies on objective evidence from overnight nocturnal polysomnography, which monitors brain activity, eye movements, muscle tone, airflow, respiratory effort, and oxygen levels. You look for apneas (airflow stopping for a period) or hypopneas (reduced airflow) that occur with ongoing respiratory effort, and you confirm obstruction by the presence of desaturation or arousal on the study.

Snoring by itself isn’t enough to diagnose OSA, and daytime fatigue alone is nonspecific. Central sleep apnea would show a different pattern on polysomnography, with pauses in breathing without respiratory effort, rather than the obstructive events described here. In kids, the PSG findings of recurrent obstructive events with desaturation or arousal are what establish the diagnosis.