The contribution of intermittent hypoxia, sleep debt and sleep disruption to daytime performance deficits in children: Consideration of respiratory and non-respiratory sleep disorders

In children, the most abundant available information regarding the effects of paediatric steep disturbance on daytime function has been obtained by studying children with steep disordered breathing (SDB). The purported underlying pathophysiological mechanisms responsible for these deficits include hypoxia secondary to obstructive apneas/hypopneas and/or disrupted steep architecture from frequent arousals during steep. This review will present evidence that, while hypoxia is likely to play a role for many children with SDB, steep disruption is an important and often overlooked factor that can contribute to daytime deficits in children with SDB. Indeed, steep deprivation and disruption appear to have a potent impact on the daytime functioning of the much larger number of children with non-respiratory steep disorders. It is concluded that steep deprivation, steep disruption, and intermittent hypoxia independently may be sufficient to cause daytime effects in vulnerable children, and the combination of two or more of these factors can result in particularly impaired daytime functioning. These conclusions have significant implications for research and clinical practice. (C) 2005 Elsevier Ltd. All rights reserved.