Sleep Apnea in Children
Sleep apnea is a type of sleep disorder in which normal breathing patterns are repeatedly interrupted, reducing or even stopping the flow of air into the lungs while a person is asleep. This is a potentially serious condition that should be identified and treated as soon as possible. It is under diagnosed in children, meaning that it goes unrecognized in many children who have it.
What causes it?
In children most sleep apnea is caused by obstruction, or blockage, of the airway. This makes it difficult for air to enter the lungs in a normal way, causing sleep disturbances and other symptoms. During sleep, tissues around the face and throat are more relaxed, which can lead to partial collapsing of the breathing space. In addition, some children have blockages from enlarged adenoids and tonsils in the upper airway.
What are the symptoms?
While sleep apnea occurs in both children and adults, the symptoms of it can be very different. Many times sleep apnea is not even a concern at first, until a more detailed history of the problem is obtained from parents. The most common symptoms in children include the following:
- Snoring. Many children snore when they are sick or congested, but if you find your child is snoring noisily on a nightly basis, talk to your Pediatrician.
- Pauses in breathing while sleeping. Different from snoring, pauses are actually exactly what they sound like – a definite pause in the breathing pattern while asleep, usually followed by a gasping or choking sound and then regulation of normal breathing (or snoring).
- Daytime sleepiness. Much like adults, children who have interrupted nights due to sleep apnea can be very sleepy during the day. They may take naps long past the age at which it is normal to do so, or may take longer naps than expected.
- Behavior problems and attention issues. Some children will not demonstrate daytime sleepiness but instead will have issues with behavior and attention. They may lash out unexpectedly, not be able to focus on school work, forget responsibilities, or be defiant. If related to underlying sleep apnea, this is unusual behavior for these children.
Who is at risk?
In adults the risk of sleep apnea increases with obesity, and this is also true in children though it is not the most common cause. In children it is more often due to underlying structural or anatomical abnormalities. Children with enlarged tonsils (tissue in the back of the throat) or adenoids (tissue in the back of the nose) can have sleep apnea when this tissue become large enough to obstruct airflow.
In addition, children with underlying medical conditions such as Down syndrome, genetic abnormalities of the skull and face, and cerebral palsy, are also at a higher risk due to changes in the anatomic structure of the upper airway.
How is it diagnosed and treated?
The first step in diagnosis is recognizing that there may be a problem. If you notice any potential symptoms of sleep apnea in your child it is important to bring them up to the Pediatrician so evaluation can be done if needed. Your child may need an overnight sleep study, called a polysomnogram. This study is done at a hospital or sleep center, and allows trained medical personnel to monitor several factors while your child sleeps, including restlessness, breathing patterns, oxygenation, and brain wave patterns.
Your child may be referred to a specialist, such as a Pediatric Otolaryngologist (ENT), Pediatric Pulmonlogist, or Pediatric Sleep Specialist. These physicians help to evaluate and manage children with sleep disorders and sleep apnea. If a polysomnogram shows that obstructive sleep apnea is present, surgery to remove tonsils and/or adenoids may be recommended.
Children with other forms of sleep apnea, including those with structural abnormalities of the face and airway, may be given a CPAP machine to wear while sleeping. This machine provides continuous positive pressure into the airways to keep them open while the child is sleeping.
Final thoughts
Obtaining good quality sleep is such an important part of keeping bodies of all ages healthy. Sleep apnea disrupts the natural course of sleep, causing frequent awakenings, poor quality of sleep, and even drops in blood oxygen levels overnight. If you are concerned that sleep apnea could be affecting your child, don’t hesitate to talk to your Pediatrician.
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