Obstructive Sleep Apnea in Children – All About It

Sleep apnea in children is a very common problem seen these days. Obstructive sleep apnea (OSA) is the most common type of sleep apnea, which is characterized by repetitive upper airway obstructions during sleep. It is associated with a reduction in blood oxygen saturation in the body. Obstructive sleep apnea is recognized by daytime attention seeking irritable behavior problems in children. Unlike adults, children suffering of OSA are more difficult to diagnose.

Symptoms of Sleep Apnea in Children

  • Excessive sleepiness in the daytime
  • Frequent obstructed breathing during sleep (the child may not be aware of this but the parents will be)

Associated features:

  • Restlessness
  • Snoring loud and squeakily
  • Nocturnal gasping and choking (the child may wake up through his sleep)
  • Irregular and heavy breathing
  • Bedwetting
  • Nightmares
  • Night terrors
  • Sleeping with the mouth open (causing dry mouth and throat which leads to choking)
  • Chest retraction in younger children (causing the chest to pull in)
  • Learning problems
  • Sleeping in strange positions
  • Developing a high blood pressure and getting overweigh
  • Hyperactive behavior
  • Personality changes
  • Upper respiratory infections frequently

Sleep Apnea Seriousness

Sleep apnea is a life threatening condition, which requires medical attention immediately. Undiagnosed OSA in children leads to learning, developmental and behavioral problems. In some cases it hinders growth and causes high blood pressure and heart problems at such a young age. In addition to this, sleep apnea in children causes excessive daytime sleepiness which result in personality changes, functional and productive problems in school and interpersonal relationships. Sleep apnea makes children lag in many areas of development which affects their personalities directly. Children tend to be very irritable and get depressed very regularly. The severity of the symptoms in children may vary from mild, moderate to severe.

Determining Whether a Child Has OSA

How can obstructive sleep apnea be detected in children? Doctors usually use a test called “polysomnography” to diagnose sleep apnea. The records or results collected in polysomnography are referred to as polysomnograms. There are two types of polysomnograms; the overnight test and the home monitoring test.

  • Overnight Polysomnography – This involves monitoring of brain waves, respiration, eye movements, blood oxygen levels, muscle tension and audio monitoring.
  • Home Monitoring Polysomnography – In this method, a specialist hooks the child up with electrodes and instructs the parents on how to record the child’s sleep patterns, using a computerized polysomnograph. Parents collect this polysomnograph every morning and show it to the specialist for assessment.

Both the tests are painless, and are usually covered by insurance.

Treatment

In children, removing the adenoids and tonsils can help. In cases where this may not help, the problem can be treated with the use of a Bi-level positive airway pressure or CPAP (continuous positive airway pressure). CPAP is a machine that blows air at a higher pressure into the nose through an air mask. This keeps the airway unobstructed and open, making it easier to breathe. The BI-level has an inspirator pressure that is higher than the expiratory pressure. The physician or doctor prescribes the use of these devices, and the healthcare company sets them up and gives the necessary instructions on how to use it.

When Does a Child Need To Use A Machine?

Some children have certain deformities which lead to breathing problems and sleep apnea. It may simply be that their jaw is smaller than normal, or they may have a smaller opening at the back of their throat. Some children have large tongues and enlarged tonsils, or some other tissue problems that make it difficult to breathe. Fixing a deviated septum solves the problem and opens up the nasal passages. Removing the adenoids and tonsils helps too.

Until the early 1980’s, the only available treatment for severe cases of apnea was Tracheostomy. This is a surgical procedure in which a small opening is cut on the throat, and a tube is let into the opening. The tube has a valve, which is closed during the day so that the patient can speak. At night the valve is left open, which enables easy breathing while the patient sleeps. Today, this procedure is looked as a last resort to avoid breathing distress or more serious medical problems.

Facts to Know

Sleep apnea causes complications both in adults and children. These complications include high blood pressures, poor growth, severe headaches, and lung and heart problems. These days, OSA in children is being seen as the most common cause of performance and behavioral problems at school. The moment parents notice any signs of sleep apnea in children, they should immediately consult a doctor before the condition gets worse.

Children suffering of down syndrome are at a greater risk of developing obstructive sleep apnea disorder. Such children should most importantly be watched for signs and symptoms of sleep apnea. Also, other medical conditions such as Treacher Collins Syndrome, Crouzon Syndrome, Pierre Robin Sequence, including abnormalities of the neuromuscular, craniofacial and central nervous system, are often associated with obstructive sleep apnea in children.