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Obstructive Sleep Apnea in Children

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Obstructive sleep apnea is common and affects between 1-5% of children, while snoring can be found in 4-12% especially in 2-6 years olds. Problems that obstructive sleep apnea can cause includes impacts on daytime learning, behavior, and emotion. The most common cause of obstructive sleep apnea is enlarged tonsils and adenoids in the upper airway. Infections may cause these glands to enlarge. If your child makes noise when breathing during sleep or snoring becomes noticeable, you should consult a doctor.

Knowing obstructive sleep apnea

            Obstructive sleep apnea is a medical condition in which children have breathing difficulties when they are asleep. When children fall asleep, muscles around the airway relax causing the throat and upper airway to narrow. This leads to partly or totally blocked airway. Parents may notice snoring. Sometimes, the inability to circulate air and oxygen in and out of the lungs results in lowered blood oxygen levels. The blockages tend to be intermittent because the brain triggers a movement or awakening that re-opens the airway. These brief awakenings can significantly disturb sleep. Consequences of untreated obstructive sleep apnea include failure to thrive, attention-deficit disorder, behavioral problems, poor academic performance, and cardiopulmonary diseases.

Types of obstructive sleep apnea

  1. Obstructive sleep apnea is caused by narrow or blocked airway
  2. Central sleep apnea is caused by the brain not sending proper signals to the muscles that control your breathing

Etiology

In children, obstructive sleep apnea is more common than central sleep apnea. The common causes of the disease are:

  1. Enlarged adenoids and tonsils
  2. Obesity
  3. Airway obstruction or neuromuscular weakness

Symptoms

The signs of sleep apnea can be observed during your child’s sleep, while some of the symptoms may manifest during the day.

  • Snore at some points while sleeping
  • Snore at the beginning of sleep
  • Snore frequently but not every night

Other symptoms

  • Mouth breathing
  • Loud breathing
  • Breathing pauses during sleep
  • Coughing or choking at night
  • Frequent awakenings or restlessness
  • Sweating heavily during sleep
  • Bedwetting
  • Poor attention span
  • Behavioral or emotional issues

Complications

Obstructive sleep apnea is a common condition during childhood and can result in severe complications such as cardiovascular disease if left untreated.

  • Failure to thrive
    Growth hormone is released when a child sleeps at night, and sleep apnea can interrupt this process.
  • Behavioral or emotional issues
    poor attention span, hyperactivity, disruptive behavior, aggression

Diagnosis

  1. Patient’s history and physical examination
  2. An overnight polysomnogram is the most efficient way to diagnose or rule out the presence of sleep apnea in your child. This will let the doctor know the severity of the condition and further treatment options can be decided accordingly.
  3. Other investigations: x-ray to determine adenoid size, echocardiogram

Other investigations might also include home sleep test, oxygen level and pulse monitoring, and recording your child when sleeping.

Treatment

  • Surgical removal of the adenoids and tonsils is the most common treatment for pediatric obstructive sleep apnea. This can be performed by otolaryngologist. The doctor will also determine severity of the condition, risks, and other complications before choosing any treatment options. Research shows that children with obstructive sleep apnea who undergo adenotonsillectomy demonstrate improvement in measures of neurocognitive function.
  • Other treatment options such as positive airway pressure - considered the first line of treatment for those children who are not candidates for surgery
  • Close follow up and repeat polysomnographic evaluation every 6 months for non-severe case
  • Weight management in children with obesity
  • Proper sleep position
  • Allergy treatment
  • Avoid tobacco smoke, pollutants, and allergens

Recovery and recurrence

Obstructive sleep apnea in children generally responds to adenotonsillectomy. Those who are not likely to respond are as follows.

  1. Children with obesity
  2. Severe sleep apnea
  3. Children who have other medical conditions such as down syndrome and craniofacial abnormalities

After the surgery, patient should follow-up and might require additional polysomnographic evaluation.

Are kids with no tonsils and adenoids more susceptible to infections?

Surgical removal of tonsils and adenoids does not put kids at risk for more infections. In fact, some kids get fewer throat infections after the surgery. When tonsils and adenoids are removed, other tissues in the body take over their role to help prevent infection.

  

Reference: Dr. Passara Liangthanasarn, pediatrician, Pediatric Center, Bangkok Hospital


For more information:

Pediatric Center, Bangkok Hospital

Call 0 2310 3006, 0 2755 1006, or 1719