*Nothing in this article constitutes medical advice. Seek the guidance of a physician if you have any questions.*
According to the American Sleep Organization “obstructive sleep apnea occurs in 1 to 5% of healthy children but can be higher in certain conditions, such as Downs Syndrome, children with craniofacial abnormalities, and neuromuscular disorders”. Sleep apnea in children differs from sleep apnea in adults in terms of causes and symptoms, which makes it a bit more difficult to diagnose. For example, adults suffering from sleep apnea are usually overweight, but children with sleep apnea are not normally overweight. It is also common for healthy children who do not have a sleep disorder to snore. Dr. Iannelli found that “10 and 20 percent of normal children snore (primary snoring) on a regular or intermittent basis”. However, there are specific symptoms exhibited by children with sleep apnea, including behavior disorders caused by hyperactivity, usually related to lack of sleep. This article will discuss some of those symptoms as well as the treatment of sleep apnea in children.
In general, pediatric sleep apnea is a sleep disorder that causes a child to pause in breathing while sleeping. Obstructive sleep apnea and central sleep apnea are the two different types of sleep apneas. Obstructive sleep apnea is the most common type in both adults and children and is usually caused by some type of blockage in the throat, or nose. In some instances, some children have enlarged tonsils and adenoids which narrows the upper airway during sleep. Central sleep apnea is when the brain stem fails to relay the signal for the body to breathe during sleep.
Children with Obstructive Sleep Apnea
The symptoms of adults and children differ although both may suffer from the same sleeping disorder. For example, adults usually feel drowsy and may fall asleep several times during the day. Obstructive sleep apnea in children can be a catalyst for several health problems in children like inattention, hyperactivity, and malnutrition. Children may experience a slower than normal growth rate in terms of height and weight due to sleep apnea decreasing the growth hormone. The nasal and airway obstruction in children make it harder for them to swallow food and drink. Children who experience obstructive sleep apnea may also burn more calories as they sleep than other children because their bodies work harder to burn off calories. However, just as there are problems with malnourishment and poor growth, this type of sleep apnea can lead to obesity. Experts found that some children get so drowsy during the day because they do not get enough exercise which leads to weight gain. Other signs and symptoms of obstructive sleep apnea in children include:
- Snoring that occurs most nights.
- Restlessness with sleep.
- Weight gain or weight loss.
- Enlarged tonsils and adenoids.
- Frequent nightmares.
- Excessive sleeping during the day.
- Morning headaches.
- Daytime cognitive and behavior.
Central Sleep Apnea in Children
Central sleep apnea in children also causes a pause in breathing during sleep, but it does not usually involve snoring or gasping for air. This type of sleep apnea will happen to everyone over time, but if it happens too often or over a long period it can be detrimental. Central sleep apnea occurs in the section of the brain that controls breathing, specifically the restart of the breathing process after a small delay. People living in higher altitudes usually have central sleep apnea, because higher altitudes stimulate fast breathing to raise oxygen levels. The higher the altitude the more likely it is that a person suffers from central sleep apnea, even children. This type of sleep apnea is common in premature babies because the breathing center of their brain is not mature yet.
Diagnoses of Sleep Apnea in Children
It is important to see a doctor immediately if you suspect that your child may have sleep apnea. Your child’s pediatrician may send your child to a sleep specialist for a physical exam and a sleep study. For a sleep study, your child would spend one night at a hospital or a sleep clinic. Before the sleep study, a sleep technician will place sensors on your child’s body to monitor the following during sleep:
- Breathing patterns.
- Oxygen levels.
- Heart rate.
- Brain waves.
- Muscle activity.
Some doctors may not feel like a child needs a full sleep study and will issue an oximetry test instead. This is simply monitoring the child’s heart rate and the amount of oxygen in the blood while sleeping. This test will indicate whether a full sleep study is needed for the child.
Treatment of Sleep Apnea in Children
Each physician differs in the treatment/therapy for a child suffering from sleep apnea. Some specialists simply ask parents to monitor their child while sleeping. Monitoring a child during sleep is advised usually for very mild sleep apnea. The benefits of monitoring a mild case of sleep apnea outweighs the long-term effects of untreated sleep apnea.
Topical nasal steroids are prescribed to some children, but these drugs are only intended for short-term use. If the problem is obstructive sleep apnea, then the recommendation may be for the child to have his or her tonsils/adenoids removed. On the other hand, if obesity is causing sleep apnea, a physician may recommend that your child lose weight. Some children will have to use a CPAP machine, which will provide a continuous flow of air and keep the air passage open. The CPAP machine will not cure a child’s sleep apnea disorder, but it will improve symptoms. The issue with children using a CPAP machine is the mask, because it is big and bulky. Wearing a face mask during sleep is much harder for a child to adjust, compared to an adult. One option, which may be a better option for children who no longer experience facial bone growth, involves dental mouthpieces. Dental mouthpieces push the jaw forward and keeps the airway open during sleep. Each child is different with how they experience symptoms, making it harder to get diagnosed. Treatment varies but your child’s pediatrician will work closely with a sleep specialist to find the appropriate treatment.