Sleep apnea affects over 2% of children and can impair health and development. Learn about symptoms, diagnosis and medical treatments for pediatric sleep apnea.
Sleep Apnea in Children – A Serious Breathing Disorder
Sleep apnea is a relatively common breathing disorder that affects at least 2% of children in the United States, with many cases going undiagnosed. When left untreated, sleep apnea can negatively impact a child’s health, behavior, development and quality of life.
What is Sleep Apnea?
Sleep apnea is characterized by pauses in breathing or instances of shallow breathing during sleep. These disruptions in respiration can last from a few seconds to minutes, and may occur 5 to 30 times or more within an hour.
In the most common form, known as obstructive sleep apnea (OSA), airway collapse occurs during sleep, blocking airflow. The other type is central sleep apnea where the brain fails to properly signal the muscles that control breathing. Both types deprive the body and brain of oxygen.
Causes and Risk Factors of Sleep Apnea in Children
There are several factors that put a child at increased risk for developing sleep apnea:
- Enlarged Tonsils/Adenoids – The tonsils and adenoids are lymph tissues in the throat that can become swollen and block breathing. This is a prime cause of OSA in children.
- Obesity – Excess weight around the neck and throat region can narrow airways. Fat deposits around the abdomen may also impair breathing.
- Structural Abnormalities – Children born with abnormalities of the nose, throat, jaw or facial bones have a higher risk. Conditions like cleft palate or Down syndrome affect airway anatomy.
- Neuromuscular Disorders – Weak throat muscles unable to keep airways open may lead to apnea. Conditions like cerebral palsy and muscular dystrophy increase risk.
- Allergies/Sinus Issues – Inflammation from allergies or sinus infection can block nasal airways.
- Family History – Having close relatives with sleep apnea increases a child’s chances.
Signs and Symptoms of Sleep Apnea in Children
It’s important to recognize the signs of sleep apnea in children:
- Loud snoring on most nights
- Snorting, gasping or choking sounds while sleeping
- Breathing stops briefly during sleep
- Restless sleep, frequent waking
- Bedwetting, especially after toilet training
- Sleepiness or fatigue during the day
- Difficulty concentrating, attention problems
- Aggressive behavior, hyperactivity
- Poor academic performance
- Slow growth and weight gain
- Headaches upon waking
Consult your pediatrician if these symptoms occur regularly. Sleep apnea often goes undiagnosed in children. Timely treatment is needed to avoid complications.
Diagnosing Sleep Apnea in Children
If sleep apnea is suspected based on symptoms and a physical exam, your pediatrician may recommend further evaluation through a sleep study. This test is called a polysomnogram or PSG.
During the PSG, your child will sleep overnight in a specialized sleep lab. Sensor electrodes will be painlessly attached to the scalp, face, chest and limbs to record brain activity, heart rate, breathing patterns, oxygen saturation and sleeping stages throughout the night. Video and audio recording are also done.
The PSG provides definitive diagnosis of sleep apnea based on the number of apnea events per hour. It also determines the type and severity. This helps devise the optimal treatment plan.
Consequences of Untreated Pediatric Sleep Apnea
When left undiagnosed and untreated, sleep apnea can impose serious long term effects on a child’s wellbeing, including:
Physical Effects of Sleep Apnea
- Impaired growth
- High blood pressure
- Increased risk of heart disease
- Bedwetting
- Headaches upon waking
Mental and Behavioral Effects of Sleep Apnea
- Cognitive problems, poor memory and concentration
- Deficits in learning and academic performance
- ADHD symptoms – inattention, hyperactivity
- Aggression, oppositional behavior
- Depression, anxiety
- Excessive daytime sleepiness
Overall Impact of Sleep Apnea in Children
- Weakened immune function, frequent illnesses and infections
- Delayed motor development
- Failure to thrive, weight issues
- Metabolic disorders
- Reduced quality of life
Clearly, sleep apnea demands prompt diagnosis and treatment to prevent or minimize these adverse effects on a child’s health and development.
Treatment Options for Pediatric Sleep Apnea
The main treatments for sleep apnea in children include:
- Adenotonsillectomy Surgery
This is the most common and highly effective treatment for most kids with sleep apnea. The tonsils and adenoids are removed in a simple surgical procedure. It creates more space in the airway to facilitate easy breathing.
Success rates are excellent – between 80 to 90% of children with enlarged tonsils and adenoids are cured with adenotonsillectomy. Positive effects are seen quickly. Risks are minimal with a skilled ENT surgeon.
- CPAP Therapy
This is the gold standard treatment for OSA in adults. A CPAP (continuous positive airway pressure) machine blows pressurized air via a face mask worn at night. This air splints the airway open to facilitate breathing.
CPAP may be used for children if adenotonsillectomy cannot be done or remains ineffective. Newer CPAP masks are smaller and more child-friendly. With support, children adjust to this treatment.
- Oral Devices and Positional Therapy
Custom fitted oral appliances reposition the jaw or tongue to keep airways open during sleep. Monitoring body position can also minimize apnea episodes in some children. Gentle vibrations to the side of the neck have helped as well. These are relatively non-invasive options.
- Other Therapies and Surgery
Children with conditions like Down syndrome and congenital disorders may need additional surgical procedures to remove obstructions and improve nasal or throat anatomy. Tracheostomy is rarely needed. Supplemental oxygen and medications may also be prescribed.
Following Up After Treatment of Sleep Apnea
Ongoing follow up is crucial after treatment for sleep apnea begins. Children’s PSG results should be rechecked periodically to ensure apnea has resolved or adequately improved. Adherence to CPAP use needs to be monitored. Any residual effects of sleep apnea also need to be managed, like high blood pressure.
With proper treatment and follow up care, pediatric sleep apnea can be effectively managed in most cases, enabling restful sleep and healthy development.
FAQs about Pediatric Sleep Apnea
- At what age can a child develop sleep apnea?
Sleep apnea can occur in children of any age, though it becomes more common after age 2. Peak prevalence is between ages 3 to 6 as tonsils/adenoids enlarge. Infants can also be affected.
- How does sleep apnea affect behavior in children?
Untreated OSA often causes excessive daytime sleepiness, hyperactivity, aggression, irritability and other behavioral issues in children. Their sleep deprivation impairs emotional and cognitive regulation.
- Does sleep apnea affect development?
Yes, pediatric sleep apnea can impair growth, learning, academics and motor development. But with early diagnosis and treatment, these effects can be minimized or reversed.
- Can a child outgrow sleep apnea?
In some milder cases, yes. But moderate to severe pediatric sleep apnea will usually persist over time without proper treatment. Regular monitoring is recommended.
- Is snoring alone indicative of sleep apnea?
Not always. While frequent loud snoring is a primary symptom of sleep apnea, some children snore due to other reasons like sinus congestion or allergies. Consult a doctor to identify the underlying cause.
- Can sleep apnea be fatal if left untreated?
Though rare, untreated moderate to severe OSA can in extreme cases be fatal if breathing is obstructed for an extended period. But diagnosis and prompt treatment prevents mortality.
- Do children with Down syndrome have higher sleep apnea risk?
Absolutely – due to their smaller mid face, large tongue, hypotonia, and other anatomical factors, children with Down syndrome are more prone to developing obstructive sleep apnea.
- Can sleep apnea cause bed wetting?
Yes, sleep apnea often leads to increased bedwetting or enuresis as the child fails to awaken fully from deep sleep to use the bathroom. This can persist even after toilet training.
- What’s better for sleep apnea – surgery or CPAP?
For most children, adenotonsillectomy surgery provides a permanent cure. CPAP is reserved for cases where surgery fails or cannot be done. Overall success rates are higher with surgery.
- Can lifestyle changes resolve pediatric sleep apnea?
While medical therapy is usually needed, certain lifestyle modifications like losing excess weight, exercise, avoiding smoke exposure and having good sleep habits can further help manage childhood sleep apnea.
In summary, pediatric sleep apnea has become increasingly prevalent but can be overlooked. Recognizing symptoms like chronic loud snoring, breathing struggles at night, and excessive daytime fatigue and paying prompt attention is key. With timely diagnosis and treatment of sleep apnea, children can sleep, develop and thrive well.
External Resources: