Although sleep apnea is not as common in children as it is in adults, more than 3% suffer from obstructive sleep apnea (OSA) and its associated health risks.
Sleep apnea is a medical disorder that results in partial or complete obstruction of the throat when a person in asleep. It can occur in all age groups and increases in frequency with age and weight. However, sleep apnea in toddlers and children is more common than generally recognised and has been highly under-diagnosed or treated incorrectly. Approximately, 1-4% of children aged 2 to 8 suffer from sleep apnoea, and 2-3% suffer from obstructive sleep apnea.
When a child falls asleep, the muscles relax and can cause the upper airway, the passage through the nose, mouth, windpipe and lungs, to become partially or completely blocked by the tonsils and adenoids. As a result, children may snore in their sleep and experience pauses in their breathing numerous times throughout the night, ultimately disrupting a child’s sleep and potentially leading to slower growth, irritability and poor concentration.
What causes obstructive sleep apnea in children?
Tonsils, turbinates & adenoids
The most common cause of sleep apnoea is enlarged tonsils in the back of the throat, turbinates (small structures inside the nose that cleanse and humidify air that passes through the nostrils into the lungs) or adenoids in the back of the nose. The tonsils and adenoids grow most quickly between pre-school years and the ages 2 to 7. Undergoing surgery to remove these often cures pediatric obstructive sleep apnea in 80-90% of children. However, sometimes the adenoids may grow back, thus requiring more surgery. These glands are situated at the back and sides of the throat and may grow too large or become infected, thus causing them to swell. Ultimately, the extra tissue can block the airway partially or completely.
Moreover, obesity as a trigger of sleep apnea is becoming more prevalent in children. Similar to how obesity can cause sleep apnea in adults, being overweight can also contribute to OSA in children. Research indicates that obesity can increase the risk of sleep apnea and affects 50% of obese and overweight children compared to 1-5% of the the general paediatric population. However, studies have also found that children suffering from obstructive sleep apnea may also be underweight.
Other causes of paediatric sleep apnea may include:
- Very small jaws
- Flat faces
- Long-term allergy or hay fever
- A tumor or growth in the airway
- A large tongue
- A family history of sleep apnea
- Low birth weight
- Genetic or neurological disorders
- Certain medical conditions eg. Cerebral palsy, Down syndrome, Pierre-Robin syndrome, sickle cell disease
What are the signs of sleep apnea in children?
Signs of sleep apnea in children often vary. During the night common symptoms include:
- loud snoring in children: approximately 15-20% of children snore
- pauses in breathing, lasting usually a few seconds up to a minute
- choking, coughing or snots throughout their sleep
- breathing through the mouth
- sleep terrors
- sleeping in odd positions eg. propped up high on pillows
- sleep walking
However, if you child has experienced a restless night’s sleep, daytime symptoms may also persist. These include:
- difficulty waking up in the morning
- fatigue and irritability
- falling asleep during the day
- blocked nose
- poor and erratic appetite
- problems swallowing
- a nasal voice
Furthermore, the signs of obstructive sleep apnea in babies are similar to a child’s. These are most likely to occur over the age of 9 months:
- audible noisy breathing
- mouth breathing
- restless sleeping
- frequent night wakings
- early morning rising (4-5am)
- spinning 360 degrees in crib
- unusual sleeping positions
- snoring in babies
Can Sleep Apnea kill a child?
A new study has revealed that children with obstructive sleep apnoea are 6.5 times more likely to die prematurely compared to other children. However, the majority of these children may only present mild symptoms and many outgrow the condition. Thus, whilst it is not something that can kill your child, it is an issue that should be consulted with your paediatrician as the disorder can affect your child’s growth, development and overall quality of life.
Leaving OSA untreated can result in the risk of threatening complications such as hypertension (high blood pressure), strokes and heart disease. Long pauses in breathing further strains the heart and in worst cases, may cause brain damage. Additionally, OSA can cause structural changes such as a thicker left and right ventricular wall, thus making early detection and treatment crucial.
Moreover, some children can develop hyperactivity, causing them to be misdiagnosed with attention-deficit/hyperactivity disorder (ADHD), of which 25% display signs of obstructive sleep apnea.
For more information about the effects of untreated sleep apnea, click here.
How does sleep apnea affect a child?
Untreated OSA can lead to extended periods of disturbed sleep, thus resulting in chronic daytime fatigue. As a result, your child may have difficulty concentrating during school, thus triggering learning problems and lower academic performance. A recent study found that 18% of kids with OSA performed in the lowest 10% of first grade and were approximately 6 years old.
Furthermore, your child may also have trouble thriving in social situations. Children with mild pediatric obstructive sleep apnoea or those who do snore but do not have OSA, have been associated with measurable cognitive deficits as a group. Obstructive sleep apnoea is further associated difficulty paying attention, daytime behavioural difficulties and impairments in memory.
In more serious cases, sleep apnoea is responsible for cognitive delays, heart problems and growth.
What are the warning signs of sleep apnea?
It should be noted that some young children and toddlers with sleep apnoea may not snore and only exhibit disturbed or troubled sleep. However if your child is experiencing the below medical conditions and sleep apnoea symptoms, it is recommended that you contact your pediatrician, pediatric sleep specialist or an ear, nose and throat specialist.
- Recurrent tonsilitis
- Recurrent ear infections: large adenoids can prevent the ear canal from draining properly, thus resulting in infections
- Chronic illness
- Uncontrolled asthma
- Acid reflex: the reflux can cause the tonsils and adenoids to become swollen and inflamed
- Development problems: growth hormones are secreted when we sleep. Thus, when a child’s sleep is disturbed, there are few growth hormones to trigger development
Diagnosis and treatment for sleep apnea in children
If you suspect your child has pediatric obstructive sleep apnoea, the doctor will ask about your child’s symptoms, perform a physical examination and may suggest an overnight sleep study at a hospital or sleep clinic for proper diagnosis. During this sleep study, a sleep technician places test sensors on the body and monitors the following while your child is sleeping:
- oxygen levels
- muscle activity
- heart rate
- brain waves
- breathing pattern
Once a diagnosis has been made, treatment will depend on the severeness of the condition, your child’s age, general health, symptoms and cause of sleep apnea. Treatment includes:
- Surgery to remove enlarged adenoids and tonsils
- Exercise and a weight-management program for those who are overweight
- Continuous Positive Airway Pressure (CPAP) machines for those with severe sleep apnoea or special conditions
- A mix of varying medical treatments for those with chronic nasal allergy
Obstructive sleep apnea treatment works for many children and some may outgrow the sleep disorder. Moreover, surgery for enlarged tonsils and adenoids removes 70-90% of symptoms. However, if your child is still snoring, having difficulty breathing when sleeping or still showing symptoms of obstructive sleep apnoea six to eight weeks after surgery, speak to your doctor for further treatment options.
Ultimately, leaving sleep apnea untreated puts your child at risk of life long health implications and poor growth and development. If you suspect your child is showing symptoms speak to your doctor to discuss the possibility of sleep apnoeas and early detection.
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