Obstructive sleep apnea (OSA) is a common and potentially serious sleep disorder which affects approximately 2-4% of American children, with up to 10% of children experiencing disruptive snoring which can result in problems similar to those of OSA. Obstructive sleep apnea in children is a condition in which a child’s airway becomes partially or completely blocked during sleep causing a temporary cessation in breathing (apnea). These apneas can happen many times per hour for 20-40 seconds per episode which not only disrupts sleep, but can cause oxygen levels to fall. Obstructive sleep apnea in children can range from mild to severe and can be a contributing factor to:
- Disruptive behavior
- Learning difficulties
- Slow growth or development
- High blood pressure
- Metabolic or hormonal problems
- Heart and lung conditions
Causes of Obstructive Sleep Apnea in Children
Obstructive sleep apnea occurs when the muscles in the back of the throat over-relax during sleep and collapse the airway. The most common cause of pediatric sleep apnea is enlarged tonsils and adenoids (tissue located at the back of the nasal cavity which aids in fighting germs). Other causes of obstructive sleep apnea in children are:
- Being overweight: Fat deposits in the throat or neck can result in a narrow airway which becomes blocked when muscles relax
- Structural abnormalities: Jaw, throat, or mouth defects can affect the airway
- Certain medical conditions: Patients with cerebral palsy or Down syndrome have a higher risk for OSA
- Family history: Conditions that contribute to OSA can be hereditary
- Large tongue or neck
Symptoms of Obstructive Sleep Apnea in Children
Children with obstructive sleep apnea usually exhibit loud snoring which may occur in conjunction with gasping, snorting, or pauses in breathing. Other signs that your child may have OSA include:
- Daytime drowsiness
- Difficulty concentrating
- Restless sleep
- Unusual sleep position
- Behavioral problems
- Hyperactive behavior
- Night sweats
Obstructive sleep apnea prevents children from getting a full, healthy night’s sleep which often results in difficulty waking up and being overly tired during the day. Studies suggest that many attention and behavioral problems are misdiagnosed as attention deficit hyperactivity disorder (ADHD) when actually the child is suffering from symptoms caused by obstructed sleep apnea.
Diagnosing Obstructive Sleep Apnea in Children
Diagnosing obstructive sleep apnea generally requires an overnight sleep study called a polysomnogram (PSG). During a polysomnogram, which is usually performed at a sleep center or in a hospital setting, specially trained technologists will monitor your child’s:
- Heart rate
- Eye and leg movement
- Blood oxygen levels
- Brain waves
- Sleep position
Information is collected by placing sensors on the child’s body which transmit information to a computer while the child is sleeping. A polysomnogram is painless and the most definitive method of assessing and diagnosing pediatric OSA.
Treating Obstructive Sleep Apnea in Children
Because the most common cause of obstructive sleep apnea in children is enlarged tonsils and adenoids, an adenotonsillectomy is often the recommended treatment for pediatric OSA. Adenotonsillectomy is a low-risk outpatient procedure in which the tonsils and adenoids are surgically removed.
Over 500,000 adenotonsillectomies are performed yearly in the U.S., the majority of which are in treatment of sleep related disorders such as OSA. In most cases, adenotonsillectomy results in the elimination of all symptoms related to obstructive sleep apnea.
If your child’s OSA symptoms are mild or your child is nearing puberty (when tonsils and adenoids tend to shrink), the best conservative treatment may be a watch and wait approach. Other treatments for OSA not caused by enlarged tonsils and adenoids include:
- Weight management: Exercise and nutritional/lifestyle changes are recommended if obesity is a factor
- Continuous positive airway pressure (CPAP): Therapy which involves opening the airway by way of air being pumped through a mask worn by the patient while sleeping
- Orthodontic appliances: Oral devices which prevent the tongue and soft tissues of the throat from collapsing during sleep
- Treatment of other medical conditions: Asthma, allergies, and gastroesophageal reflux disease (GERD) may contribute to OSA symptoms
While a percentage of children may eventually outgrow some sleep disorders, the chronic fragmented sleep caused by untreated obstructive sleep apnea can result in learning and behavioral problems that can be difficult to overcome in the future. If your child is exhibiting loud snoring or other symptoms of obstructive sleep apnea, contact our office to schedule an appointment with Dr. Trimble or Dr. Wu.