ABSTRACT
The present chapter will review the early history of sleep apnea in children, detail
several of the seminal papers (Table 1) in this field, and propose challenges for the
future.
In 1975-1976, Christian Guilleminault et al. published the first case series
that clearly described sleep apnea, its clinical manifestations, consequences,
diagnosis, and treatment in children aged 5 to 14 years (1,2). Loud, frequent
snoring was present in all the children. Associated problems included daytime
hypersomnolence, decreased school performance, mood and behavioral dis-
turbances, hypertension, marked respiratory sinus arrhythmia, and weight abnor-
malities, including both underweight and obesity. Polysomnography was used as a
diagnostic technique and demonstrated drops in oxygen saturation consequent to
obstructive sleep apneas, dramatic fluctuations in esophageal pressure, and
arousals terminating the obstructive events. They reported that apnea and hypo-
pnea were most frequent in stages 1 and 2 of non-rapid eye movement (NREM)
sleep. Upper airway examination revealed adenotonsillar hypertrophy in six of
Table 1 Seminal Papers in the Investigation of Pediatric OSAS
1951-1953 Aserinsky and Kleitman discover REM sleep
1965-1967 Cox, Menash, Noonan, Luke, Levy and their groups report cor pulmonale
secondary to enlarged tonsils and adenoids
1965 Gastaut et al. and Jung and Kuhlo describe OSAS in adults
1976 Guilleminault et al. study a case series of 8 children with sleep apnea
1978 Remmers et al. show that in adult OSAS the upper airway obstructs when
collapsing negative pressure is not balanced by dilating muscular force
1979,1980 Brouillette and Thach develop a model for airway collapse in OSAS
1983 Haponik et al. show that adultswithOSAShave smaller pharynxeswhen awake
1984 Brouillette et al. prepare a questionnaire to distinguish children with OSAS
from normals
1989 Mallory et al. report sleep-associated breathing disorders in morbidly
obese children and adolescents
1991 Gleadhill et al. show that adults with OSAS have smaller, more collapsible
pharynx when asleep
1992 Marcus et al. find normal values for polysomnography
1992,1994 McColley et al. and Rosen et al. delineate risk factors for respiratory
compromise after adenotonsillectomy
1994 Marcus et al. apply Starling resistor model to airway collapse in
sleeping children
1995 Carroll et al. study inability of clinical history to distinguish primary
snoring from OSAS
1996 American Thoracic Society reports standards and indications
for cardiopulmonary sleep studies
1997 Isono and Remmers show that adults with OSAS have smaller,
more collapsible pharynx under anesthesia
1997 Chervin et al. report that habitual snoring was more frequent in children with
ADHD than in children from psychiatry or general pediatric clinics.
