SLEEP APNEA

Sleep apnea, also known as obstructive sleep apnea, is a serious disorder in which there are pauses in breathing during sleep. Sleep apnea is usually thought of as an adult disorder, but it is often experienced by children. For some children apnea is serious and the parents, while aware of the problem, don't know where to turn for help. In many instances, however, the parents aren't even aware that their child has sleep apnea and do not seek medical help.

Symptoms of Sleep Apnea in Children

Does your child suffer from sleep apnea? There are a number of symptoms to look for that are common in children with sleep apnea. Some children will have most of these symptoms, whereas others may only have one or two.

I. Nighttime Symptoms

1. Snoring. Many children with sleep apnea snore. However, not all children with apnea snore, and not all children who snore have sleep apnea.

2. Breathing pauses. Breathing pauses are the hallmark of sleep apnea.

3. Difficulty breathing while sleeping. You may notice that your child seems to have difficulty breathing while he is asleep or he may be a noisy breather.

4. Mouth breathing. Most children with obstructive sleep apnea breathe through their mouths at night.

5. Coughing or choking. Coughing or choking in sleep can also be a sign of a breathing problem.

6. Restless sleep. Many children with sleep apnea are restless sleepers.

7. Sleeping in unusual positions. Some children with sleep apnea will sleep in an unusual position. For example, they will sleep with their head hanging over the side of the bed or will sleep with their head raised on several pillows or stuffed animals. They do this subconsciously to try to keep their airway open and help them breathe while asleep.

8. Sweating. Many children with sleep apnea sweat profusely while they sleep.

II. Daytime Symptoms

1. Appearing sleepy during the day. Children with sleep apnea are not getting enough sleep because their nighttime sleep is frequently interrupted.

2. Appearing hyperactive during the day. Many children who do not get enough sleep do not look and act sleepy. Instead, they become wired and hyperactive.

3. Daytime behavioral problems. Some children may have daytime behavior problem, such as being irritable, cranky, easily frustrated, or having difficulty focusing their attention.

4. Falling asleep at inappropriate times or at times other than nap time. Another sign that your child is not getting enough sleep is if he is falling asleep at inappropriate times, such as while at meal times.

III. Symptoms Associated with Sleep Apnea in Older Children (ages 6 and up)

1. Bed wetting. Older children with sleep apnea often continue to wet their beds.

2. Morning headache. Some children will complain of having a headache in the morning.

3. Difficulty in school. In older children, the effects of sleep apnea may result in poor performance in school. These children may be labeled as "slow" or "lazy" and may have difficulty focusing their attention on their schoolwork.

Causes of Sleep Apnea in Children

The most common cause of obstructive sleep apnea in children is enlargement of the adenoids and tonsils. During sleep there is a considerable drop in muscle tone which affects the airway and breathing. Many of these children have little difficulty breathing when awake; however, with decreased muscle tone during sleep, the airway becomes smaller making the flow of air more difficult and the work of breathing harder. An analogy can be made of breathing through a small, flimsy straw with the straw occasionally collapsing and obstructing air flow. These obstructions result in frequent brief arousals from sleep. These short pauses (lasting only a few to 20 seconds) cause a brief arousal that increases muscle tone, opens the airway, and allows the child to resume breathing. Although the actual number of minutes of arousal during the night may be small, the repeated disruptions in sleep can lead to significant daytime symptoms in children. (A comparable image would be answering a wrong number on the telephone 15 to 30 times a night.) The child is usually unaware of waking up, and the parent often describes very restless sleep but usually does not describe the child's waking up completely.

Prevalence of Sleep Apnea in Children

Sleep apnea occurs in about 2% of all children. That is, one out of every 50 children have sleep apnea, a total of about 640,000 children between the ages of 1 and 9 in the United States. Sleep apnea can begin as early as during the newborn period but the average age of onset is 14 months.

Treatment for Childhood Sleep Apnea

For most children with sleep apnea, removal of enlarged tonsils and adenoids is the first treatment. An ear, nose, and throat specialist will evaluate whether your child should have a tonsillectomy and/or adenoidectomy. Once the tonsils and/or adenoids are removed, the airway will not be blocked and breathing during sleep can occur normally. Another effective treatment that is commonly prescribed for adults with sleep apnea is continuous positive airway pressure (CPAP). Thistreatment is now becoming more common for children. In this highly effective therapy, a mask is worn over the nose during sleep and pressure from an air compressor forces air through nasal passages and into the airway. This air pressure keeps the airway open and allows the child to breathe normally during sleep without the disturbing arousals.

Who Should You See For Help?

Children with suspected sleep apnea should be seen by a sleep specialist who can evaluate and treat sleep apnea. An extensive interview, physical examination, and an overnight sleep study will likely be conducted. To find out about a sleep disorders center near you, call the American Sleep Disorders Association at (507) 287-6006, or ask your pediatrician.

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