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Sleep apnea in children
Different types of sleep apnea
What happens in your throat while you sleep
Sleep apnea in adults
Return to OSA main page
While many people tend to associate sleep apnea only with adults, a surprising 1-3% of children suffer from the condition as well. OSA is now the most common reason tonsils and adenoids are removed in children.
Sleep apnea in children typically appears between ages two-six, but it can occur from infancy to adolescence. It is believed that the disease affects girls and boys equally, yet often remains undiagnosed.
Symptoms
Causes
How is it diagnosed?
Treatment options
As in adult sleep apnea, pediatric sleep apnea is a serious condition that can have significant consequences for a child's physical, emotional and intellectual health. Untreated OSA in children has been linked to behavior problems, impaired growth, learning difficulties, poor school performance, bedwetting, high blood pressure, heart disease, and more. In fact, many children with pediatric OSA are diagnosed with attention-deficit hyperactivity disorder (ADHD) before they are diagnosed with OSA.
The risk factors associated with an increased incidence of OSA in children include:
- Family history of snoring or OSA
- Physical abnormalities in the skull or facial structures
- Cerebral palsy
- Muscular dystrophy
- Down syndrome
- Sickle cell disease
- Excess weight
- Mouth breathing
- Any condition that may narrow the upper airway
Symptoms of OSA in children
Snoring and sleep disturbance are common symptoms of pediatricsleep apnea, yet many parents do not mention such symptoms to their child's pediatrician. Because pediatric OSA is often associated with hyperactivity, irritability, inattentiveness and aggressive behavior, children with sleep apnea are sometimes diagnosed with attention-deficit-hyperactivity-disorder (ADHD) and given medicine for this disorder, when the real root of the problem is OSA.Symptoms of pediatric OSA include:
- Snoring (though some children with sleep apnea do not snore)
- Pause in breathing while asleep
- Restless sleep
- Bizarre sleeping positions
- Bedwetting
- Hyperactivity
- Disruptive behavior in school
What causes sleep apnea in children?
In children, the cause of sleep apnea is usually large adenoids and large tonsils, though it is important to note that the severity of sleep apnea is not related to the size of the adenoids and tonsils. Some children with relatively small tonsils can have severe OSA, while other children with large tonsils can have very mild OSA or none at all.Sometimes tonsils and adenoids can be temporarily enlarged as a result of an allergy or infection. If the problem does not resolve when appropriate treatment is given for allergy problems or an infection, pediatric OSA should be considered.
The risk factors associated with an increased incidence of OSA in children include:
- Family history of snoring or OSA
- Physical abnormalities in the skull or facial structures
- Cerebral palsy
- Muscular dystrophy
- Down syndrome
- Sickle cell disease
- Morbid obesity
- Mouth breathing
- Any condition that may narrow the upper airway
How is sleep apnea diagnosed in children?
As in adult sleep apnea, a physical exam and medical history are usually required for determining whether or not your child has sleep apnea. Discussing your child's symptoms, sleep habits, and snoring patterns can help your pediatrician determine the likelihood of OSA. Physicians will often request an audiotape or videotape of your child's sleeping patterns to aid the diagnosis.In addition, a polysomnogram (sleep study) may be used to diagnose pediatric OSA and its severity in a particular child. However, they are rarely used for children suspected of sleep apnea, but rather to exclude other sleep disorders like central apnea and narcolepsy. Typically, this test is conducted in a sleep center and measures the child's heart rate, respiration, brain activity, eye movement, and blood oxygen level.
There are age-specific guidelines for conducting and interpreting pediatric sleep studies. For example, an apnea event for an adult has a different clinical definition than an apnea event for a child. An apnea event in children is defined as a cessation of breathing for the equivalent of 2 ½ missed breaths. Most physicians agree that five obstructions per hour (RDI = 5) is definitely abnormal in pediatric patients. And many physicians feel that even one obstruction per hour (RDI = 1) is abnormal for children.
If your child is advised to undergo a sleep study, it is important to make sure that the sleep center you choose is experienced with conducting and interpreting pediatric sleep studies. More sleep study centers now are being structured to accommodate the emotional needs of pediatric patients, too. In these sleep centers, a parent can stay with the child overnight, since the experience can be a little scary for children, even though it is not painful and there are no needles involved.
Home-based sleep studies are also offered to document sleep apnea, but are not widely used. They cannot record the same readings measured by a sleep study conducted in a sleep center. For example, home-based sleep studies do not include an EEG for recording brain activity. This makes the home-based sleep study impractical as a tool for determining whether or not a child's sleep disorder is due to neurological causes.
Treatment options for children
Sleep apnea treatment must depend on the individual child's current physical condition, medical history, and pertinent test results. There are some behavioral and mechanical approaches to treating pediatric OSA. However, since enlarged adenoids and tonsils cause the majority of pediatric OSA cases, surgical methods to reduce or remove the adenoids and tonsils are the most common and effective form of treatment.
Behavioral treatments
Parents of children with OSA are advised to reduce their child's weight, if necessary, since obesity is often associated with pediatric OSA. In addition, children with OSA should not be given sedatives or medications that relax the airway and/or reduce respiratory function.
Mechanical treatments
Some children can be treated by wearing a CPAP device (continuous positive airway pressure) while sleeping. The device maintains an open airway by physically blowing air through the nasal passages. However, this option is not as feasible with young children and is rarely prescribed.
Surgical treatments
The most common procedure to treat pediatric OSA is a tonsillectomy and adenoidectomy (T&A). A T&A is generally 90-95% effective, yet different methods for performing this surgery can vary the amount of post-surgical pain and length of recovery time. More and more surgeons are also reducing the size of turbinates in addition to removing tonsils and adenoids. For more information on reduction of the inferior turbinates please visit www.ObstructedNose.com.
For a discussion of various techniques for performing T&A procedures, click here.
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Version 2.1.0 This webpage was first published on September 07, 2005, and was last updated on August 31, 2007.
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