Sleep Apnea in Children

Is obstructive sleep apnea in children common?

Yes. However, it is very under-diagnosed in children. Up to 10% of children snore on a frequent basis.Many of these children will have sleep apnea. Like most disorders, there is a wide-spectrum of severity. Because of the time required to take a detailed medical history and sleep history, most physicians do not screen children properly. Additionally, an overnight sleep study (polysomnography) is often necessary to accurately diagnose sleep apnea in children and adults.

What breathing changes during sleep are seen in children with obstructive sleep apnea?

The range of breathing changes is quite variable. Some children will appear to be breathing normally. Other children will appear to stop breathing briefly throughout the night. Most children with obstructive sleep apnea will breathe through their mouth and snore on a regular basis. However, snoring may not begin until REM sleep starts- often several hours after falling asleep. Additionally, children may subconsciously sleep with their head extended to help open their airway. This may decrease the snoring intensity and frequency. Siblings who sleep with a child suspected of having sleep apnea are often the best source of information on whether your child is a frequent snorer.

The following symptoms are often found in children with obstructive sleep apnea:

• Mouth-breathing/ snoring while sleeping
• Restless sleep
• Excessive sweating during sleep
• Frequent bed-wetting (out of proportion for age)
• Sleeping with head in unusual positions (hyper-extended or propped up with pillows)
• Gasping, labored breathing, or brief pauses in breathing

What are the symptoms of obstructive sleep apnea in children?

Symptoms of obstructive sleep apnea in children can be very similar to symptoms seen in children with persistent snoring. Persistent snoring is likely a part of the same spectrum as obstructive sleep apnea. This spectrum has been referred to as sleep disordered breathing. There is considerable overlap between children that snore on a regular basis and those that have obstructive sleep apnea.

What is the age of most children with obstructive sleep apnea?

Obstructive sleep apnea can occur at any age. However, obstructive sleep apnea in children is often related to enlarged adenoids and tonsils. Since peak adenoid and tonsil size occurs from ages 2-6, this corresponds with a large peak in childhood obstructive sleep apnea. Following puberty, adolescents may also begin to develop signs of obstructive sleep apnea. In adolescents and adults, the causes of obstructive sleep apnea are typically different than in younger children.

Factors that contribute to the development of obstructive sleep apnea in adolescents and adults include:

• Soft palate and uvula: in many patients with obstructive sleep apnea, the soft palate and uvula are large and floppy which decreases the size of the airway in the back of the throat
• Tongue: adults with obstructive sleep apnea frequently have a tongue that is either too large and/or positioned too far back in the mouth, which allows the airway to collapse at night
• Recessed lower jaw and chin: a lower jaw (mandible) and chin that is recessed (set farther back) increase the risk of obstructive sleep apnea
• Large tonsils: large tonsils can contribute to obstructive sleep apnea but are rarely the primary cause
• Small airway and narrow jaw structure: during development, many environmental and genetic factors can lead to a smaller airway and narrow jaw
• In adolescents and adults, obesity can contribute significantly to worsening obstructive sleep apnea.

Are children with obstructive sleep apnea over-weight?

The majority of younger children with obstructive sleep apnea are not overweight. This is because the airway obstruction is typically caused by:

• Enlarged adenoids and tonsils
• Swollen nasal passage
• Narrow jaw structure

However, following puberty, adolescents can begin to develop signs of obstructive sleep apnea that continues into adulthood. In many of these patients, obesity can contribute significantly to worsening sleep apnea. Weight loss should be one of the primary forms of treatment in these individuals.

Are allergies common in children with obstructive sleep apnea?

Some evidence does suggest that children with allergies are more likely to have persistent snoring and obstructive sleep apnea. However, the exact association is not yet known. Nasal congestion caused by childhood allergies can lead to poor quality sleep. Identifying and treating a child’s environmental allergies should a part of the treatment plan for many children with obstructive sleep apnea.

What are the treatment options for children with obstructive sleep apnea?

Generally speaking, treatment options for obstructive sleep apnea in younger children are the same as those with persistent snoring. Additionally, treatment with a CPAP (continuous-positive airway pressure) machine can be used in some children with obstructive sleep apnea.