A child who suffers from pediatric sleep apnea has pauses in breathing while sleeping.
Children as young as 2 to 8 years old are most likely to be affected by sleep apnea in the United States. One in four children in the United States suffers from sleep apnea, according to the American Sleep Apnea Association.
Sleep apnea occurs when the airway stops because of obstructions at the back of the throat or nose. Obstructive sleep apnea is the most common type.
Other types of sleep apnea, called central sleep apnea, occur when the brain part responsible for breathing malfunctions. It does not send the proper signals to the breathing muscles to breathe normally.
Snoring is noticeable differently with obstructive sleep apnea than primary sleep apnea since it’s more prevalent. Based on what is known, however, central sleep apnea is likely to have to snore.
An explanation for sleep apnea symptoms in children
Sleep apneas with and without snoring generally show similar symptoms.
Children experiencing sleep apnea during the night may exhibit the following symptoms:
- loud snoring
- coughing or choking while asleep
- breathing through the mouth
- sleep terrors
- bed-wetting
- pauses in breathing
- sleeping in odd positions
Sleep apnea symptoms don’t occur only during the night. Your child may exhibit signs and symptoms whether his or her sleep is disturbed during the day, including:
- fatigue
- difficult to get up in the morning
- falling asleep during the day
It is important to remember that infants and young children with sleep apnea who do not snore, particularly those with central sleep apnea, may not show any signs of the condition.
A potential consequence of experiencing untreated sleep apnea in children
Untreated sleep apnea often causes difficulty paying attention, resulting in long periods of fatigued days. Poor academic performance may also be caused by untreated sleep apnea.
It is estimated that 45 percent of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) also manifest hyperactivity.
25 percent of children with ADHD may also show signs of obstructive sleep apnea.
Children with sleep apnea may also have difficulties with social functioning and academic performance. In very severe cases, sleep apnea may lead to growth delays along with heart health problems.
High blood pressure results from sleep apnea, increasing the risk of strokes and heart attacks. It may also contribute to childhood obesity.
The causes of sleep apnea in children
Like other sleep disorders in children, OBA causes the muscles in the back of the neck to collapse, making even the strongest sleepers unable to breathe while they sleep.
Obstructive sleep apnea most often develops as a result of obesity in adults, but it may also be caused by being overweight or enlarged tonsils or adenoids in some children. The extra tissue can completely block their airway.
The following factors can contribute to the development of pediatric sleep apnea:
- sleep apnea is a family history
- being overweight or obese
- the person may have certain health conditions (cerebral palsy, Down syndrome, sickle cell disease, or a malformation of the skull or face).
- being born with a low birth weight
- having a large tongue
Central sleep apnea can be caused by:
Heart failure and strokes are some medical conditions
- being born prematurely
- some congenital anomalies
- some medications, such as opioids
How to diagnose sleep apnea in children
Children with sleep apnea should be seen by their pediatrician as soon as possible. Asleep specialists may refer you to your pediatrician.
Symptoms of sleep apnea must be discussed with the doctor along with your child’s physical exam and a sleep study for it to be properly diagnosed.
For the sleep study, your child is given sensors on his/her body that are then monitored nightly by a sleep technician:
- brain waves
- oxygen level
- heart rate
- muscle activity
- breathing pattern
The oximetry test (done at home) is another option if you are unsure whether they need a full sleep study. It measures your child’s heart rate and the amount of oxygen in their blood while sleeping (screened for sleep apnea).
You may be recommended a sleep study by your doctor based on the results of the oximetry test.
Also, your doctor may need to do a sleep study and an electrocardiogram to determine whether your child has a health condition that would require heart surgery. The electrocardiogram records the electrical activity in your child’s heart.
It is important to ensure a proper diagnosis as sleep apnea in children can be overlooked if the child doesn’t display typical signs.
Sleep apnea may result in hyperarousal and mood swings; a child with sleep apnea might snore and take frequent daytime naps, and get diagnosed with behavioral problems.
Make sure you know what causes sleep apnea in children. If your child has these risk factors and shows signs of behavioral issues or hyperactivity, discuss getting your child a sleep study with your doctor.
Sleep apnea treatment for children
There are no common guidelines about when to treat sleep apnea in children widely accepted by medical practitioners. In mild cases of sleep apnea that do not cause symptoms, your doctor may advise against treating the condition, at least not immediately.
Sleep apnea can eventually outgrow some children. This is because doctors initially recommend watching your child see if any improvement occurs. However, the benefit of doing this needs to be weighed against the impact of untreated sleep apnea in the long run.
Many children require one or more of the following topical nasal steroids to relieve congestion due to nasal allergies: fluticasone (Dymista, Flonase, Xhance) and budesonide (Rhinocort). It is recommended that these devices only be used until the congestion has resolved. These devices are not meant for long-term treatment.
The tonsils and adenoids are usually removed in adults and children with obstructive sleep apnea when their size obstructs the airway.
Weight loss and diet may be recommended by your physician if you suffer from obesity.
Occasionally a child will need continuous positive airway pressure therapy (or CPAP therapy) if the apnea is severe or doesn’t resolve with initial treatment.
A continuous flow of air is directed toward your child’s airway while they sleep while wearing a mask that covers their mouth and nose.
People often don’t like wearing a bulky face mask to sleep, so they stop wearing CPAP. CPAP can help symptoms of obstructive sleep apnea, but it won’t cure it.
A dental mouthpiece is also available for obstructive sleep apnea patients while sleeping. CPAP treatment is more effective than mouthpiece therapy in children, so they’re more likely to use it to sleep. These devices are designed to keep the mouth forward and open.
For older children not experiencing facial bone growth, mouthpieces might be an option.
For children with central sleep apnea, a device referred to as NIPPV makes use of machines that have a backup breathing rate. A machine of this kind enhances breathing even when the brain is not signaling for breaths.
Sleep apnea alarms are useful for infants with central sleep apnea. The alarm sounds when the infant breaks apneic episodes. This wakes the infant up and will cause the problem to stop.
The Bottom Line
Some children with either type of sleep apnea find an improvement in their symptoms with weight management or use of oral devices or CPAP machines. About 70 to 90 percent of those who have enlarged tonsils and adenoids reported that surgery eliminated their symptoms.
In the absence of treatment, sleep apnea can lead to serious complications such as cardiovascular or respiratory diseases without proper treatment. Children who have sleep apnea may not focus in school and may be more likely to suffer a stroke or heart attack.
Snoring loudly, breathing pauses while sleeping, hyperactivity or severe daytime fatigue are usually warning signs of sleep apnea. Make sure you talk to your doctor about possible sleep apnea.