Type I SBD

Type II SBD

Type III SBD

Adenotonsillar hypertrophy without obesity

Obesity with mild-to-moderate adenotonsillar hypertrophy

Neuromuscular diseases

Down syndrome

Arnold–Chiari malformation

Cerebral palsy

Craniofacial syndromes: Pierre Robin syndrome, Apert syndrome, Goldenhar syndrome, Crouzon syndrome, achondroplasia

The prevalence of snoring in the general pediatric population is 3–12%. Among individuals with obstructive sleep apnea (OSA) it is 0.7–2%, mainly associated with adenotonsillar hypertrophy.

The notable increase in the prevalence of child obesity has changed the demographic and anthropometric characteristics of children who are referred to sleep units. In the USA, fewer than 15% of children were obese in the 1990s, but in the last decade more than 50% were.

Several authors have argued that type I and II SBDs should be considered specific phenotypes with different characteristics and forms of presentation (Table 21.2).

Table 21.2

Differences between type I and type II sleep breathing disorders (SBDs)

Symptoms	Type I SBDs*	Type II SBDs*
Somnolence	+	++++
Weight gain	−	++
Hyperactivity	++++	−/+
Attention deficit disorder	++++	+++
Truncal/visceral obesity	−/+	+++
Increased cervical girth	−/+	+++
Increased adenotonsillar size	++++	++
Acute otitis media/tympanostomy	+++	+
Depression and low self-esteem	+	+++
Shyness and social isolation	+	+++
Left ventricular hypertrophy	++	++++
Hypertension	+	++++
Insulin resistance	−	++++
Dyslipidemia	+	++++
Elevated C-reactive protein	++	++++
Elevated liver enzymes	−	++

^*+ to ++++ infrequent to very frequent, − absent

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