Pediatric Sleep Apnea

Snoring occurs in both the young and the old. Although all of us are more likely to snore as we get older because the muscles and tissues of the neck and throat start to lose their elasticity, snoring can occur in children as well. When children snore, it can be due to oversized tonsils and adenoids, or a condition called sleep apnea. Seasonal allergies and deviated septums may also cause children to snore.

Pediatric sleep apnea is known to affect 1 to 3 percent of children, but because there may be many unreported cases, it is likely to actually affect more. Sleep apnea can affect your children’s sleep and behavior, and if left untreated, can lead to more serious problems. Because sleep apnea can be difficult to diagnose, it is important to monitor your child for symptoms and schedule a doctor visit if you see any.

What is Sleep Apnea?
Sleep apnea occurs when breathing is temporarily obstructed and stops for brief episodes during sleep. When this happens, the brain is alerted and often results in sudden gasping or choking, disturbing sleep even if it may not fully awaken the child.

What Causes Sleep Apnea?
In children, sleep apnea can occur for several physical reasons, including enlarged tonsils and adenoids, and abnormalities of the jaw bone and tongue. These factors cause the airway to be blocked, resulting in vibration of the tonsils, or snoring. Overweight children are at increased risk for sleep apnea. Of the 37 percent of children who are considered overweight, 25 percent of them likely have sleeping difficulties that may include sleep apnea. This is because extra fat around the neck and throat block the airway, making it difficult for these children to sleep soundly. Studies have shown that after three months of exercise, the number of children at risk for sleep apnea drop by 50 percent.

What Are the Symptoms of Sleep Apnea?
The first sign that your child may have sleep apnea is loud snoring that occurs regularly. You may also notice behavioral changes. Due to a lack of sleep, he or she may be more cranky, have more or less energy, and have difficulty concentrating in school.

Left untreated, sleep apnea can lead to more serious problems such as:

  • Behavior problems
  • Increased bed wetting
  • Delayed physical and emotional growth
  • Attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD)
  • Breathing difficulty
  • Heart trouble

How is Sleep Apnea Diagnosed?
If you notice that your child has any of those symptoms, have him or her checked by an otolaryngologist, head and neck surgeon, who will conduct a sleep test to determine sleep apnea. For the test, electrodes are attached to the child’s head to monitor brain waves, muscle tension, eye movement, breathing, and the level of oxygen in the blood. The test is not painful and can be performed in a sleep laboratory or at home.

Results can vary, so it is important to have the otolaryngologist determine whether your child needs treatment. Often, in mild cases, treatment will be delayed while you are asked to monitor your child and let the doctor know if the symptoms worsen. In severe cases, the doctor will determine the appropriate treatment.

How is Sleep Apnea Treated?
Because enlarged tonsils and adenoids are a common cause of sleep apnea in children, routine treatment often involves an adenotonsillectomy, the operation to remove the tonsils and adenoids. This is a routine operation with a 90 percent success rate. Studies show that when children with sleep apnea were tested one to five months after removal of their tonsils and/or adenoids, they showed significant improvement in their sleep and behavior.

A child with suspected sleep apnea should be evaluated by an experienced otolaryngologist who works regularly with the pediatric population like those we have here at Atlanta Institute for ENT.

Other Pediatric Sleep Disorders
Apparent life-threatening episodes (ALTE) is another form of sleep disorders that affects breathing in children. Children with this condition warrant a thorough evaluation by a pediatric sleep specialist as soon as it is suspected. Children with craniofacial abnormalities, primarily abnormalities of the jaw bones, tongue and associated structures, often have sleep-disordered breathing. This must be managed and the deformities treated as the child grows.

The sleep test is the standard diagnostic test for sleep-disordered breathing. This test can be performed in a sleep laboratory or at home. Unfortunately, sleep tests are not always accurate can produce inaccurate results, especially in children. Borderline or normal sleep test results may still result in a diagnosis of sleep-disordered breathing based on parental observation and clinical evaluation.

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