Pulmonology and sleep disordered breathing

Abstract

Children with intellectual and developmental disabilities (IDD) are predisposed to an array of pulmonary complications and insults to both the respiratory tract and the process of respiration. Neuromuscular weakness can cause hypoventilation, ineffective cough with poor airway hygiene and, therefore, a predisposition to infection and atelectasis. It can also cause uncoordinated swallowing with aspiration of oral intake, oral secretions or gastric refluxate in the setting of gastroesophageal reflux (GER). In addition, children with congenital syndromes, craniofacial abnormalities, airway abnormalities, cerebral palsy (CP) or neuromuscular weakness can suffer from airway obstruction, obstructive sleep apnea (OSA) or obstructive hypoventilation that can contribute to gas exchange abnormalities. Children with IDD may also have underlying lung disease such as bronchopulmonary dysplasia (BPD), pulmonary hypoplasia, and asthma. Progression of pulmonary complications from recurrent insults such as aspiration and infection, or from progression of scoliosis or neuromuscular weakness, is commonly seen later in life and respiratory failure is ultimately the cause of death from many children with IDD. Developmental delay and IDD encompass a wide range of impairments thus the associated respiratory impairments have varied impact and severity.