Parents Press / June 2012 / The Doctor Is In

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The Doctor Is In

Sleep Apnea in Children When Snoring May Mean Something More Serious

     We all need a good night’s sleep. For your child, sleep is especially important because it directly affects children’s mental and physical development. However, around 10 percent of children may not be getting enough sleep because they snore, which is a common symptom of sleep disordered breathing, or SDB. The most extreme form of SDB, obstructive sleep apnea, can interfere with a child’s growth and other important developmental milestones.
     Around 2 to 4 percent of all U.S. children suffer from obstructive sleep apnea, which involves snoring accompanied by pauses in breathing lasting for a few seconds to more than a minute. Children with this disease are at increased risk for developmental and cognitive delays, which can greatly affect performance in school and at home.

What Is Childhood Sleep Apnea?
     Sleep apnea is derived from the Greek word meaning “without breath.” Although everyone experiences pauses during breathing once in a while, obstructive sleep apnea is a chronic condition that occurs when an airway is collapsed or blocked during sleep. This obstruction causes breathing to stop long enough to decrease oxygen levels and disrupt sleep.
     When breathing stops and oxygen levels drop, the body’s nervous system responds as if it is choking, and the heart rate slows as blood pressure rises, alerting the brain to wake the sleeper. Because children can stop breathing 10 to 60 times a night, a child with sleep apnea is constantly being awakened.

When Snoring Is Cause for Concern
     The most common sign of sleep apnea is snoring, accompanied by pauses in breathing. Your child may have sleep apnea if he or she snores every night, regardless of the sleeping position, followed by gasping and pauses in breathing.
     Sleep apnea manifests differently in adults and children. Adults with sleep apnea tend to become sleepy during the daytime, which can lead to falling asleep at the wheel or taking a nap at work. Conversely, children with sleep apnea will become hyperactive, which causes poor concentration at school and contributes to attention deficit disorder, or ADD. Other physical effects caused by sleep apnea include nocturnal enuresis, or bed-wetting, and slowed growth due to disruptions in the nightly release of growth hormone.
     The most common cause of childhood sleep apnea is the enlargement of lymph tissue in the throat known as tonsils and adenoids. Because children’s throats are small, oversized tonsils and adenoids can obstruct airways, resulting in sleep apnea. Other causes of obstructive sleep apnea include childhood obesity, which can narrow the airway and interfere with the ability of the chest to expand sufficiently and take in air; poor muscle tone and increased amounts of pliable tissue in the throats of children with Down’s syndrome; or abnormalities affecting the jawbones, tongue and throat.

Next Steps: Diagnosis and Treatment
     To diagnose childhood sleep apnea, doctors conduct a physical exam and take a medical history by talking with the child and parents regarding symptoms such as snoring, pauses in breathing, unexplained bed-wetting and restless sleep. Other parental observations important to a diagnosis include changes in mood, energy, behavior, social skills and academic performance.
     A common diagnostic method for sleep apnea in adults involves a sleep study, which requires that patients fall asleep in a laboratory to monitor physiological responses such as their breathing, head and eye movements, and level of blood oxygen. While sleep studies are very effective in adults, the American Academy of Otolaryngology-Head and Neck Surgery does not recommend them as a diagnostic method for most children because they are frequently inaccurate due to the difficulty many children have in falling asleep in the unfamiliar surroundings of a lab.
     When a child’s symptoms are not severe, doctors will often recommend that a parent watch and wait to see if symptoms worsen. For children who are obese, losing weight under the guidance of a nutritionist often significantly improves symptoms. In severe cases of sleep apnea caused by enlarged tonsils and adenoids, doctors will recommend removing them in a surgical procedure called an adenotonsillectomy.
     This procedure has a 90 percent success rate of curing pediatric sleep apnea. So it’s not surprising that 75 percent of the approximately 400,000 adenotonsillectomies performed in the United States each year in both children and adults are for the purpose of treating sleep disordered breathing.
     Because of recent surgical improvements, an adenotonsillectomy can be performed on children older than 3 on an outpatient basis with no overnight stay and with a return to normal activity and diet within one week.
Sleep apnea can cause your child to lose more than sleep, and the long-term effects can adversely impact your child’s development. If you are concerned, have your child screened for obstructive sleep apnea at your doctor’s office and safeguard your child’s developmental process.

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Melissa Amorn, M.D., is a Sutter East Bay otolaryngologist. This information was compiled originally by Julie Ruiz-Wibbelsmann, writer/publications coordinator for Sutter Health East Bay Region, for Sutter’s Your Health publication.