Sleep-Disordered Breathing and Sleep Apnea in Children

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Sleep-disordered breathing is a general term for breathing difficulties occurring during sleep. Sleep-disordered breathing can range from frequent loud snoring to Obstructive Sleep Apnea, a condition involving repeated episodes of partial or complete blockage of the airway during sleep. When a child’s breathing is disrupted during sleep, the body perceives this as a choking phenomenon. The heart rate slows, blood pressure rises, the brain is aroused, and sleep is disrupted. Oxygen levels in the blood can also drop.

Approximately 10 percent of children snore regularly and about 2-4 % of the pediatric population has obstructive sleep apnea. Recent studies indicate that mild sleep-disordered breathing or snoring may cause many of the same problems as obstructive sleep apnea in children.

Symptoms of Sleep-Disordered Breathing

The most obvious symptom of sleep-disordered breathing is loud snoring that is present on most nights. The snoring can be interrupted by a complete blockage of breathing with gasping and snorting noises and associated with awakenings from sleep. Due to a lack of good quality sleep, a child with sleep-disordered breathing may be irritable, sleepy during the day, or have difficulty concentrating in school. Busy or hyperactive behavior may also be observed. Bed-wetting is also frequently seen in children with sleep apnea.

A common physical cause of airway narrowing contributing to sleep-disordered breathing is enlarged tonsils and adenoids. Overweight children are at increased risk for sleep-disordered breathing because fat deposits around the neck and throat can also narrow the airway. Children with abnormalities involving the lower jaw or tongue or neuromuscular deficits such or cerebral palsy have a higher risk of developing sleep-disordered breathing.

Symptoms of Pediatric Sleep Apnea

Symptoms of sleep apnea are different for children than for adults. Children may experience a problem with bedwetting, asthma exacerbations, hyperactivity, and learning and academic performance issues.

Children are also more at risk for sleep apnea if they have enlarged tonsils and adenoids.

Consequences of Untreated Pediatric Sleep Disordered Breathing

Social. Loud snoring can become a significant social problem if a child shares a room with siblings, at sleep-overs, or summer camp.

Behavior and learning. Children with sleep-disordered breathing may become moody, inattentive, and disruptive both at home and at school. Sleep-disordered breathing can also be a contributing factor to attention deficit disorders in some children.

Enuresis. Sleep-disordered breathing can cause increased nighttime urine production, which may lead to bed-wetting.

Growth. Children with sleep-disordered breathing may not produce enough growth hormone, resulting in abnormally slow growth and development.

Obesity. Sleep-disordered breathing may cause the body to have increased resistance to insulin or daytime fatigue with decreases in physical activity. These factors can contribute to obesity.

Cardiovascular. Obstructive Sleep Apnea can be associated with an increased risk of high blood pressure or other heart and lung problems.

Diagnosing Sleep-Disordered Breathing in Children

Sleep-disordered breathing in children should be considered if frequent loud snoring, gasping, snorting, and thrashing in bed or unexplained bed-wetting is observed. Behavioral symptoms can include changes in mood, misbehavior, and poor school performance. Not every child with academic or behavioral issues will have sleep-disordered breathing, but if a child snores loudly on a regular basis and is experiencing mood, behavior, or school performance problems, sleep-disordered breathing should be considered. If you notice that your child has any of those symptoms, have them examined by one of our ENT physicians. Sometimes physicians will make a diagnosis of sleep-disordered breathing based on history and physical examination. In other cases, such as in children suspected of having severe obstructive sleep apnea due to craniofacial syndromes, morbid obesity, or neuromuscular disorders or for children less than 3 years of age, additional testing such as a sleep test may be recommended.

The sleep study or polysomnogram is an objective test for sleep-disordered breathing. Wires are attached to the head and body to monitor brain waves, muscle tension, eye movement, breathing, and the level of oxygen in the blood. The test is not painful and is generally performed in a sleep laboratory or hospital. Sleep tests can occasionally produce inaccurate results, especially in children. Borderline or normal sleep test results may still result in a diagnosis of sleep-disordered breathing based on parental observations and clinical evaluation.

Treatment For Sleep-Disordered Breathing

Enlarged tonsils and adenoids are common causes for sleep-disordered breathing. Surgical removal of the tonsils and adenoids is generally considered the first line of treatment for pediatric sleep-disordered breathing if the symptoms are significant and the tonsils and adenoids are enlarged. Of the over 500,000 pediatric tonsil and adenoid procedures performed in the U.S. each year, the majority are currently being done to treat sleep-disordered breathing. Many children with sleep apnea show both short and long- term improvement in their sleep and behavior after tonsils and adenoids are removed.

Not every child with snoring should undergo tonsil and adenoid removal, as the procedures do have risks. Potential problems can include anesthesia or airway complications, bleeding, infection, and problems with speech and swallowing.

Surgery is usually not indicated for children who have mild or intermittent symptoms, whose academic performance and behavior are not an issue, whose tonsils are small, and who are near puberty (tonsils and adenoids often shrink at puberty). These children will be watched conservatively and treated surgically only if symptoms worsen.

Recent studies have shown that some children have persistent sleep-disordered breathing after tonsil and adenoid removal. A postoperative polysomnogram (or sleep study) may be necessary after surgical intervention, especially in children with persistent symptoms or increased risk factors for persistent apnea such as obesity, craniofacial anomalies, or neuromuscular problems. Additional treatments such as weight loss, the use of Continuous Positive Airway Pressure (CPAP) or additional surgical procedures may sometimes be required.

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If your child is showing symptoms of sleep-disordered breathing and sleep  apnea, please call Integrated ENT at (303) 706-1616 to schedule an appointment. You may also request an appointment online.