Identifying Sleep Apnea in Children
Sleep apnea refers to a sleep disorder in which breathing stops during sleep, usually because the air passage is blocked. This is referred to as obstructive sleep apnea (OSA) and is the form of sleep apnea most common in children. Between two and four per cent of the child population experiences sleep apnea. Factors that increase the risk of OSA include enlarged tonsils or adenoids, obesity, having a small jaw or mid-face, having an enlarged tongue, exposure to tobacco smoke, or having less than average muscle tone (as seen in children with Down syndrome, cerebral palsy, or neuromuscular disorders).
Loud and frequent snoring is the most common symptom of sleep apnea. Approximately ten per cent of children who snore have sleep apnea. Sleep apnea sufferers’ snores are often distinct in that they features pauses, snorts, and gasps, which sometimes wake the child. Children with sleep apnea tend to sleep restlessly and may sleep with their head in unusual positions. They may experience heavy sweating during the night and may frequently wet their bed.
The child may be difficult to wake up in the morning and act sleepy throughout the day, and may even fall asleep during school or other activities. Children with sleep apnea are often inattentive and irritable, and may have social, academic, and behavioral problems due to a lack of rest. Often, they experience headaches, especially in the morning. They may also speak with a nasally voice and breathe primarily through their mouth.
If left untreated, sleep apnea can have lasting effects. Irritability and inattentiveness can lead to social isolation and cause a child to fall behind in school. A lack of rest can interfere with the endocrine system, leading to an under production of growth hormones, leading to slowed growth and development. The body may also become more resistant to insulin. This, combined with the increased fatigue decreasing physical activity, can lead to childhood obesity. Sleep apnea is also associated with an increased risk of high blood pressure, other heart problems, and lung problems. Obesity only amplifies the risk of these issues.
Of course, not every child with academic or behavioral issues has sleep apnea, but if a child snores loudly on a regular basis and is experiencing mood, behavior, or school performance problems, obstructive sleep apnea is a likely cause. If you notice that your child experiences some or all of these symptoms, you should schedule an appointment with a sleep doctor like Dr. Mayank Shukla.
Sometimes a diagnosis can be made based on patient history and a physical exam, but if your child is less than 3 years old or your doctor suspects that your child’s sleep apnea is a result of a craniofacial syndrome, morbid obesity, or a neuromuscular disorder, additional testing may be recommended.
The polysomnography (PSG) is a test for sleep disordered breathing. Muscle tension, breathing, brain waves, blood oxygen level, and eye movement are observed through wires attached to the head and body. However, sleep tests, especially in children, can sometimes produce inaccurate results, so borderline or normal results can still result in a diagnosis based on the doctor’s analysis and parents’ observations.
As the most common cause of obstructive sleep apnea in children is enlarged tonsils and adenoids, the first line of treatment is generally removal of the tonsils and adenoids. Many children see short and long term improvement to their symptoms after removal. Some children may have persistent breathing issues during sleep even after surgery. In this case, additional testing may be necessary. However, if symptoms aren’t severe or posing social or academic problems, the tonsils and adenoids are not enlarged, or the child is near puberty (a time in which tonsils and adenoids often become smaller in size), your doctor may recommend that your child be watched conservatively and only consider surgery if symptoms worsen.
Aside from surgery, weight loss, oral or dental appliances, additional surgery of the airways, or the use of Continuous Positive Airway Pressure (CPAP) may be recommended. If allergies or respiratory problems are suspected to be the cause of sleep apnea, medication or respiratory devices may be used.
Helping Your Child
Dr. Mayank Shukla is an experienced pulmonologist and sleep doctor with over fifteen years of experience helping patients across New York breathe better. While Dr. Shukla treats both adults and children, he finds working in pediatrics especially rewarding and has a passion for helping children breathe better.
If you’re concerned your child may suffer from a sleep disorder like sleep apnea, don’t hesitate to contact our offices today and help your child get on the path to better sleep.