Catching Z’s: Sleep Apnea in Children

Quick answer: pediatric obstructive sleep apnea affects roughly 1-5 percent of children, most commonly age 2-8 when tonsillar and adenoidal tissue is largest relative to airway size (American Academy of Pediatrics). Children present differently than adults -- behavioral issues, hyperactivity, attention problems, bedwetting, and morning headaches often appear before the parents notice snoring or breathing pauses. Diagnosis requires in-lab polysomnography (not a home sleep test, which is not validated in pediatric populations under AAP / AASM guidance). First-line treatment for otherwise healthy children with enlarged tonsils is adenotonsillectomy, which resolves OSA in roughly 70-80 percent of cases. Children with obesity, Down syndrome, or craniofacial differences may have residual OSA after surgery and may require additional treatment such as positional therapy, weight management, or pediatric CPAP under pediatric sleep medicine specialist care.

Although there are some differences, small children, like adults, can experience sleep apnea. Pediatric obstructive sleep apnea occurs when your child’s breathing is blocked, either partially or fully during their sleep. While many adults are able to quickly and easily feel the effects of sleep apnea, it can be harder to diagnose in children. If you suspect that your child may not be getting a restful night’s sleep, continue reading to become more familiar with the causes and symptoms of pediatric obstructive sleep apnea.

Causes

Naturally, when we sleep, our muscles relax from your toes all the way to the muscles in your throat that keep your airway open. For children with obstructive sleep apnea, these throat muscles can over-relax and cause the airway to collapse. This can make it hard for your child to breathe without them ever noticing something is amiss.

Other Causes

There are many things that can cause sleep apnea, which is why it’s always smart to reach out to an expert, like Dr. Mostafavi, if you or a loved one suspects that a child may be suffering from the effects of this sleep disorder. Some additional causes of pediatric obstructive sleep apnea are:

• Enlarged tonsils or adenoids
• Family history
• Certain medical conditions such as cerebral palsy
• Being overweight

By knowing these causes, there are several symptoms you can look for when your child is both sleeping and awake.

Symptoms During Sleep

While your child is sleeping, you may be able to notice some of the more recognizable symptoms of sleep apnea. These signs include:

• Snoring
• Restless sleep with tossing and turning
• Pauses in breathing
• Snorting, coughing and choking
• Occasional or complete mouth breathing
• Nightmares
• Bed wetting

Symptoms During Waking Hours

Even if you haven’t noticed loud snoring or pauses in breathing in your child, they may exhibit other symptoms of sleep apnea. There is a wide range of indicators including:

• Difficulty paying attention
• Poor performance in school
• Learning issues
• Behavioral issues
• Hyperactivity
• Overtired
• Lost interest in daytime activities
• Bedwetting

Testing and Diagnoses

Because there is such a wide range of causes and symptoms of pediatric obstructive sleep apnea, your doctor may order additional tests to properly diagnose your child. Three common tests are polysomnogram, oximetry and an electrocardiogram.

• Polysomnogram1: This sleep test is typically an overnight study. It requires sensors to be placed on the body to record brain waves, breathing, snoring, oxygen levels, heart rate and muscle activities. In combination, these results can help your doctor properly diagnose your child.
• Oximetry: Pulse-oximetry records oxygen saturation levels within the body. Used in conjunction with polysomnogram testing, this measurement has been shown2to accurately help diagnose sleep apnea conditions.
• Electrocardiogram: Another proven3way to diagnose specific cases of sleep apnea is by using an electrocardiogram. This device measures electrical impulses given off by the heart to determine if there is an underlying heart problem causing the issue.

Treatment

If your child is diagnosed with obstructive sleep apnea, there are a few treatment options available. Your doctor will be able to discuss the options with you as well as what treatment plan is best. These treatments may include:

• Medication: Mild obstructive sleep apnea may be resolved with topical nasal steroids such as Flonase or Rhinocort. For those children whose apnea is caused by allergies, Singulair may be prescribed alone or in conjunction with nasal steroids.
• Continuous Positive Airway Pressure and Bilevel Positive Airway Pressure: Both CPAP and BiPAP machines can be used to help alleviate sleep apnea symptoms. These machines gently blow air through a tube into a mask that is attached to your nose and/or mouth. This creates pressure in your child’s throat that helps to keep airways open.
• Tonsil and Adenoid Removal: If your doctor believes that enlarged tonsils or adenoids are the culprits of your child’s symptoms, they may refer you to an ear, nose and throat specialist. Removal of the tonsils or adenoids may alleviate your child’s sleep apnea symptoms.

With a better understanding of pediatric obstructive sleep apnea, if you believe your child is showing symptoms, reach out to your doctor today and then schedule a sleep test with us. The earlier you address the issue, the better your child will be able to grow and develop. Help your child catch some z’s and reach out to us today!

“Pediatric Obstructive Sleep Apnea.”Mayo Clinic, Mayo Foundation for Medical Education and Research, 18 Sept. 2018,www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/diagnosis-treatment/drc-20376199.

Romem, Ayal, et al. “Diagnosis of Obstructive Sleep Apnea Using Pulse Oximeter Derived Photoplethysmographic Signals.”Journal of Clinical Sleep Medicine, American Academy of Sleep Medicine, 15 Mar. 2014, jcsm.aasm.org/ViewAbstract.aspx?pid=29378.

Zywietz, C W, et al. “ECG Analysis for Sleep Apnea Detection.”Methods of Information in Medicine, U.S. National Library of Medicine, 2004, www.ncbi.nlm.nih.gov/pubmed/15026838.