In the past, parents who had issues with their children falling and staying asleep through the night blamed it on sugar, hyperactivity, disobedience, and other reasoning. Many of those cases were more likely to have been sleeping disorders, specifically, obstructive pediatric sleep apnea. It’s absolutely essential for growing children to get deep, restorative sleep as they grow, so those who encountered sleeping issues early on potentially caused by sleep apnea often developed behavioral disorders and other health-related ailments.
Pediatric obstructive sleep apnea is caused when a child’s breathing is partially or entirely blocked while they sleep, often due to a narrowing or blockage of the upper airway. This causes them to have interrupted sleep throughout the night, waking up due to pauses in their breathing. POSA differs from adult sleep apnea because of the causes and effects. While adults will suffer daytime sleepiness, high blood pressure, and elevated risk of heart disease, children will exhibit behavioral problems that can impact their abilities in school and socially. Sleep apnea in adults is usually caused by obesity, while children are more likely to experience POSA due to enlarged tonsils and adenoids.
How Common is Sleep Apnea in Kids?
About 1-4% of children in the US have pediatric obstructive sleep apnea, and it mostly affects the age group between two and eight years old. The condition varies among kids from mild to severe, and some are diagnosed with central sleep apnea. Central sleep apnea occurs when the brain’s area responsible for sending signals to the lungs to breathe is not working correctly and not stimulating the muscles that control breathing, signaling the lungs to inhale and exhale.
The most noticeable difference between obstructive sleep apnea and central sleep apnea in children is the amount of snoring that occurs. POSA will usually exhibit a lot more snoring than central sleep apnea due to the blockage in the back of the nose and throat.
Symptoms to Look for:
- Loud snoring
- Mouth breathing
- Coughing or choking
- Sleep Terrors
- Lapses in breathing
- Odd sleeping positions
- Difficulty waking up
- Daytime sleeping
It’s important to note that very young children and infants will usually not snore but struggle to sleep and often cry or wake up frequently throughout the night.
What Causes Pediatric Obstructive Sleep Apnea?
The skin in the back of the throat also has muscle beneath it. When those muscles collapse during sleep, they obstruct the airway making it difficult for a child to breathe. Overweight children are at risk of developing obstructive sleep apnea and those who have enlarged adenoids and swollen tonsils. Other risk factors can contribute to a child’s chance of developing sleeping disorders, including a family history of sleep apnea, medical conditions such as abnormalities in the skull or face, cerebral palsy, down syndrome, sickle cell disease, born prematurely, and oversized tongue.
Pediatric Obstructive Sleep Apnea Diagnosis
Diagnosing pediatric obstructive sleep apnea in children requires the evaluation of a sleep specialist with a referral from a pediatrician. Doctors will consider the child’s symptoms and perform a medical examination, including scheduling a sleep study. Sleep studies are performed overnight at a hospital or sleep clinic where technicians place sensors on the body to monitor activity while the patient sleeps. They specifically look at brain waves, oxygen levels, heart rate, muscle activity, and breathing patterns.
If the pediatrician is unsure whether a sleep study is necessary or if medical care is cost-prohibitive, another option is to conduct an oximetry test. This test is completed at home and measures the child’s heart rate and blood oxygen while sleeping, a useful initial screening tool for sleep apnea. If the oximetry test shows levels that are indicative of sleep apnea, they will recommend a full sleep study to confirm a diagnosis. Electrocardiograms are also used to rule out the chance of any heart-related conditions by recording the electric activity going on in the child’s heart.
Dangers of Leaving Pediatric Obstructive Sleep Apnea Untreated
Unfortunately, children’s sleeping disorders are much overlooked and can cause health problems for kids later on in life. Many children end up having behavior disorders and have difficulty paying attention in school, resulting in poor performance and grades. Many will be misdiagnosed with hyperactivity disorders, which have caused about 25% of children to be diagnosed with ADHD. These children also tend to suffer socially and even lead some to develop cognitive delays, heart problems, high blood pressure, and future increased risk of heart attack, also closely related to childhood obesity.
How to Treat Pediatric Obstructive Sleep Apnea
The key to treating a sleeping disorder in children is to address any underlying conditions that may contribute to the airway’s blockage in the throat. There are no official guidelines for treating this condition and making children lucky to outgrow their sleep apnea, causing doctors to monitor things before they call for any measures to be taken in mild cases.
Things like topical nasal steroids can be prescribed to relieve nasal congestion, but this solution is only temporary and mostly useful only during seasonal allergies. Other times, doctors may suggest that a child have their tonsils removed to help open up the airway, which solves about 70-90% of POSA cases. Kids with a high BMI that puts them in an at-risk category of overweight or obese will be monitored for weight loss and subsequent sleep apnea improvement.
Less frequently, doctors will advise a CPAP machine or oral device for a child, but usually, those who are older can better tolerate these solutions. A noninvasive procedure called positive pressure ventilation device (NIPPV) works mostly for children with central sleep apnea. Sleep apnea alarms can be used for infants to alert parents if the baby is having an apneic episode. The alarm is no longer needed if the child grows out of their sleep apnea.
The outlook for children with POSA is reasonably positive, outside of unusual cases related to other medical issues. Many children can grow out of their sleep apnea and can significantly be helped with surgery. However, those children who are not screened for sleeping disorders often have a lower quality of life and could face life-threatening health complications down the line. A child’s snoring is a red flag and should not be taken lightly, and their pediatrician should be altered to persistent snoring as soon as possible.