Sleep Apnea in Children: Information Every Parent Should Have

Obstructive sleep apnea in children is common. It is estimated that approximately 3 to 12% children snore, of which sleep apnea affects 1 to 10%. Most of these children are between 2 and 8 years old.

It is a potentially life-threatening condition that demands quick medical attention. Undiagnosed and untreated sleep apnea in children could lead to:

–          Learning and developmental problems

–          Failure to grow

–          Heart ailments

–          High blood pressure

–          Changes in personality

–          Interpersonal relationship problems

–          Frustration and depression

–          Excessive daytime sleepiness

–          Enuresis

–          Bed wetting

–          Sleep walking

There is growing evidence that untreated sleep apnea in children can lead to a host of health conditions. In fact, close to 25% of children diagnosed with attention-deficit hyperactivity disorder may be experiencing symptoms of OSA resulting in chronic fragmented sleep.

Sleep disordered breathing impacts certain ‘executive functions of the brain’ like cognitive flexibility, self monitoring, planning and organization abilities, etc.

What causes sleep apnea in children?

–          Adenotonsillar hypertrophy, neuromuscular disease, and craniofacial abnormalities.

–          Facial deformities like smaller jaw, smaller opening at the back of the throat

–          Enlarged tonsils or adenoids, large tongue or tissues partially blocking the airway

–          Deviated septum causing nasal blockage

What are the symptoms

–          Excessive daytime sleepiness

–          Frequent pauses in breathing during sleep including gasping and choking

–          Loud snoring

–          Restless sleep

–          Irregular breathing

–          Heavy sweating during sleep

–          Nightmares

–          Pulling in of chest in younger children

–          Adopting strange positions during sleep which is usually with mouth open

–          Feeling of confusion on waking; irritability

–          Obesity

–          And more…

How is the condition diagnosed?  

Though polysomnography is the golden standard for diagnosing sleep apnea, its role in diagnosing sleep apnea in children remains controversial where one of the reasons is the lack of consensus on interpretation of polysomnogram results.

Polysomnographic criteria for diagnosing sleep apnea in adults and children:

Criteria Adults Children (1 to 12 years of age)
Apnea-hypopnea index (average number of apneas and hypopneas per hour of sleep) >5 >1
Minimum oxygen saturation (%) <85 <92

The role of physical examination is important. It reveals adenotonsillar hypertrophy in most children. The examination must include evaluation of the child’s general appearance, with careful attention to craniofacial characteristics including midface hypoplasia, etc. Evaluation for nasal obstruction depends on the child’s age. Septal deviation must be considered in infants. In older children, nasal polyps and turbinate hypertrophy must be ruled out.

When to seek medical treatment?

In the absence of any accepted guidelines as to when the condition is sufficiently serious to demand medical intervention, most child specialists consider an apnea index (AI) of more than 1 or an apnea hypopnea index (AHI) of 1.5 as abnormal and most recommend treatment of any child with an AI greater than 5.

Removal of tonsils and adenoids has been found to be the most common treatment method for sleep apnea in children which results in complete elimination of the apnea symptoms in 70 to 90% cases. However, due to risks of post-operative swelling, the symptoms may not totally disappear till after 6 to 8 weeks.

If this type of surgery is not warranted, PAP (positive airway pressure) therapy might prove to be effective. Polysomnography results are needed to determine the optimal pressure settings.

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