Pediatric Obstructive Sleep Apnea

Obstructive sleep apnea is when a child briefly stops breathing while sleeping. It happens because of a blockage in the upper airway. This is the passages through the nose and mouth to the windpipe and lungs. The pause in breathing may occur many times in a night, disrupting the child’s sleep. Most children will snore, but other symptoms such as wetting the bed or sleep walking may also occur.

The condition is most commonly found in children ages 3 to 6.

The muscles in the head and neck help keep the upper airway open. When a child falls asleep, these muscles tend to relax. That allows tissues to fold closer together. If the airway is partially closed while awake, falling asleep may cause the passage to close completely.

In children, the most common cause for such a blockage is enlarged tonsils and adenoids. These glands are located at the back and to the sides of the throat. They may grow too large. Or an infection may cause them to swell. They may then briefly block the airway during sleep.

Obstructive sleep apnea may also be caused by:

• Being overweight
• A tumor or growth in the airway
• Certain syndromes or birth defects, such as Down syndrome and Pierre-Robin syndrome

Symptoms can occur a bit differently in each child. They can include:

• Loud snoring or noisy breathing (gasping or snorting) while sleeping
• Pauses in breathing, lasting usually a few seconds up to a minute
• Mouth breathing
• A nasal voice
• Restlessness during sleep
• Too much daytime sleepiness or irritability
• Hyperactivity during the day
• Behavioral problems
• Sleep walking or night terrors
• Bed wetting
• Need for a nap past the age of napping
• Learning problems
• Morning headaches

The symptoms of obstructive sleep apnea can be like other health conditions. Have your child see his or her healthcare provider for a diagnosis.

The healthcare provider will ask about your child’s symptoms, health history and sleep patterns. He or she will give your child a physical exam. Your child may also have a sleep study.

A sleep study is the best way to diagnose obstructive sleep apnea. But the test may be hard to do with younger children or those who don’t want to cooperate. For the study, your child may need to sleep in a special lab. While sleeping, he or she will be connected to monitors that check:

• Brain activity
• Electrical activity of the heart
• Oxygen and often carbon dioxide content in the blood
• Movement of the chest and abdominal wall
• Muscle activity
• Amount of air flowing through the nose and mouth

Your child’s healthcare provider may refer your child to a sleep expert for more evaluation. Sometimes sleep apnea testing may be done with a device used in your own home.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

The treatment for obstructive sleep apnea is based on the cause. It may include:

• Surgery to remove the enlarged tonsils and adenoids. Your child’s healthcare provider will discuss the risks and benefits with you.
• Weight loss. If your child is overweight, losing weight may ease symptoms.
• Continuous positive airway pressure (CPAP). While sleeping, your child wears a special mask that delivers a steady stream of air to keep his or her airway open. Some children may have trouble getting used to the mask.
• Rapid maxillary expansion. This is a device put in place by an orthodontist. The device widens the palate and nasal passages.
• Inhaled steroids. These medicines may help children with mild or moderate obstructive sleep apnea caused by enlarged tonsils.
• Staying away from secondhand smoke, indoor pollutants and allergens. This is important for children who also have nasal congestion.

Sometimes the condition can cause your child to have less oxygen in the blood than normal. This is because the condition can make it hard for air and oxygen to flow in and out of the lungs. If this pattern continues, your child's lungs and heart may have permanent damage. Chronic sleep apnea can also lead to poor growth and development.