Sleep and Breathing in Children: Developmental Changes in Breathing During Sleep PDF

Preface

Depending on age, infants and children spend one- to two-thirds of their life asleep. Despite this, very little attention was paid until recently to understanding both normal sleep and sleep-related abnormalities during development. However, the last few years have seen burgeoning research and publications in this area. Important developments have occurred in the field since the publication of the first edition of this book in 2000. Thus, the book has been totally revised. The basis of the book remains rigorously conducted scientific research. The chapters have been authored by an international group of outstanding scientists. As several clinical pediatric sleep books have been published since the first edition of this book, we have shifted the focus of the book away from some of the more clinically oriented chapters toward developmental physiology. In addition, we have divided the book into two volumes to accommodate the increased amount of literature that is now available. One volume concentrates on sleep alone, and the other on breathing during sleep. It should be noted, however, that not all chapters could be so neatly categorized, and thus the two volumes are synergistic.

This volume is devoted to breathing during sleep, its changes with development (from the fetus onward), and the pathophysiology of sleeprelated breathing disorders. The concluding chapter reviews the history of our young field and outlines future directions.

Breathing influences sleep, and sleep influences breathing. During sleep, there is a change in upper airway resistance, ventilatory drive, and respiratory muscle tone, all of which will affect breathing. Conversely, respiratory abnormalities such as upper airway occlusion and hypercapnia can result in arousal from sleep. Normal changes in breathing during sleep are magnified in patients with respiratory disease. Thus, in addition to sleepspecific respiratory disorders (such as obstructive sleep apnea and congenital central hypoventilation syndrome), breathing during sleep is worse than breathing during wakefulness in virtually any child with lung disease. There are profound changes in breathing, and sleep, during growth and maturation. An example of this interaction is seen in the young child with obstructive sleep apnea, compared with an adult. The child may have marked paradoxical inward rib cage motion due to the compliant rib cage, resulting in a low functional residual capacity and desaturation. In conjunction with this, the young child has a high arousal threshold, allowing the apnea to be prolonged.

The success of the book depends, of course, on the quality of the individual contributors. We therefore want to thank the many authors who have contributed to the book. They are all leaders in the field and, as such, have many demands on their time. Nevertheless, as the reader will appreciate, they have devoted time and energy into writing outstanding chapters.

We would like to dedicate this book to the children and families who have willingly participated in sleep research experiments. Without them, this book would not exist.

We thank Mary Anne Cornaglia for her invaluable assistance with the book preparation.