Upper airway obstruction and disordered nocturnal breathing in children.

Fourteen children with disordered breathing during sleep (obstructive apnea, obstructive hypopnea, or snoring) and anatomic obstruction of the upper airway were studied. Twelve children had hypertrophied tonsils and adenoids, and two had a deviated nasal septum. No child had sequelae of severe sleep apnea--that is, cor pulmonale, pulmonary hypertension, or alveolar hypoventilation. Results of polysomnographic studies were abnormal in all and revealed that obstructive hypopnea (increased respiratory effort with decreased airflow) was more common than obstructive apnea (increased respiratory effort without airflow). Surgical removal or correction of the upper airway obstructive lesion in 12 children resulted in normal nocturnal respiration. Surgical intervention was declined in two patients, and their symptoms persist. We conclude that surgical removal of upper airway obstructive lesions in children with disturbed nocturnal sleep should not be reserved only for those with serious sequelae of obstructive sleep apnea; considerable benefit is gained in selected patients with mild obstructive sleep apnea or hypopnea.