Pediatric Sleep Apnea
Sleep apnea is known to affect 1 to 3 percent of children, but because there may be many unreported cases, could 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?
Obstructive sleep apnea occurs when breathing is disrupted during sleep. This happens when the airway is blocked, resulting in choking that causes a slower heart rate and increased blood pressure, alerting the child’s brain and causing him or her to wake up.
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.
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.
What are the dangers if sleep apnea is left untreated?
Because sleep apnea can lead to more serious problems, it is important that it be properly treated. When left untreated, sleep apnea can cause:
- Sleep deprivation
- Increased bed wetting
- Slowed growth
- Attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD)
- Breathing difficulty
- Heart trouble
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.
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 (an operation to remove the tonsils and adenoids). This is a routine operation with a 90 percent success rate. Studies published in the October 2005 issue of Otolaryngology—Head and Neck Surgery , which werepresented at the American Academy of Otolaryngology’s 2006 annual meeting in Toronto, showed that when children with sleep apnea were tested one to five months after their surgery, they showed extreme improvement in their sleep and behavior. These improvements remained nearly a year and a half later.
Pediatric Obstructive Sleep Apnea
Sleep disordered breathing (SDB) is a common problem for adults leading to hypertension, heart attack, stroke and early death. Other consequences are bedroom disharmony, excessive daytime sleepiness, weight gain, poor performance at work, failing personal relationships and increased risk for accidents, including motor vehicle accidents.
Sleep disordered breathing in children, from infancy through puberty, is in some ways a similar condition but has different causes, consequences and treatments. A child with SDB does not necessarily have this condition as an adult.
Pediatric Obstructive Sleep Apnea
The premiere symptom of sleep disordered breathing is loud snoring that is present every night regardless of sleep position, and is ultimately interrupted by complete obstruction of breathing with gasping and snorting noises. Approximately 10 percent of children are reported to snore. Ten percent of these children (one percent of the total pediatric population) have obstructive sleep apnea.
When an individual, young or old, obstructs breathing during sleep, the body perceives this as a choking phenomenon. The heart rate slows, the sympathetic nervous system is stimulated, blood pressure rises, the brain is aroused, and sleep is disrupted. In most cases a child’s vascular system can tolerate the changes in blood pressure and heart rate. However, a child’s brain does not tolerate the repeated interruptions to sleep, leading to a child that is sleep deprived, cranky and ill behaved.
Results of Untreated Pediatric Sleep Disordered Breathing
- Snoring: A problem if a child shares a room with a sibling and during sleepovers.
- Sleep deprivation: The child may become moody, inattentive, and disruptive, both at home and at school. Classroom and athletic performance may decrease along with overall happiness. The child will lack energy, often preferring to sit in front of the television rather than participate in school and other activities. This may contribute to obesity.
- Abnormal urine production: SDB also causes increased nighttime urine production. In children, this may lead to bedwetting.
- Growth: Growth hormone is secreted at night. Those with SDB may suffer interruptions in hormone secretion, resulting in slow growth or development.
- Attention deficit disorder (ADD) / Attention deficit hyperactivity disorder (ADHD): Research findings identify sleep disordered breathing as a contributing factor to attention deficit disorders.
Diagnosis of Sleep Disordered Breathing
The first diagnosis of sleep disordered breathing in children is made by the parent’s observation of snoring. Other observations may include obstructions to breathing, gasping, snorting, thrashing in bed andunexplained bedwetting. Social symptoms are difficult to diagnose but include alteration in mood, misbehavior, and poor school performance. (Note: Every child who has sub par academic and social skills may not have SDB, but if a child is a serious snorer and is experiencing mood, behavior and performance problems, sleep disordered breathing should be considered.)
A child with suspected SDB should be evaluated by an otolaryngologist. If the symptoms are significant and the tonsils are enlarged, the child is strongly recommended for tonsillectomy and adenoidectomy or T&A (removal of the tonsils and adenoids). Conversely, if the symptoms are mild, academic performance remains excellent, the tonsils are small, and puberty is eminent (tonsils and adenoids shrink at puberty), it may be recommended that SDB be treated only if matters worsen. The majority of cases fall somewhere in between, and physicians must evaluate each child on a case-by-case basis.
There are other pediatric sleep disorder diagnoses. Sudden infant death syndrome (SIDS) and apparent life threatening episode (ALTE) are considered forms of sleep disordered breathing. Children with these conditions warrant a thorough evaluation by a pediatric sleep specialist. 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. Sleep tests can produce inaccurate results, especially in children. Borderline or normal sleep test results may still result in a diagnosis of SDB based on parental observation and clinical evaluation.
Treatment for Sleep Disordered Breathing
Enlarged tonsils are the most common cause for SDB, thus tonsillectomy/adenoidectomy is the most effective treatment for pediatric sleep disordered breathing. T&A achieves a 90 percent success rate for childhood SDB. Of the nearly 400,000 T&As performed in the U.S. each year, 75 percent are done to treat sleep disordered breathing.
Not every child with snoring should undergo T&A. The procedure does have risks and possible complications. Aside from the mental anguish experienced by the parent and child, potential problems include anesthesia risks, bleeding and infection.