Obstructive Sleep Apnea in Children

Obstructive Sleep Apnea (OSA) is common in adults. Did you know that childhood sleep apnea is becoming a big problem world-wide? Between 1-4% of children world-wide have it.  Doctors are even diagnosing infants with sleep apnea. Black children are 3.5 times more likely than white children to develop OSA.

Why is obstructive sleep apnea such a big problem?

The main reason why more kids have OSA is that kids are getting fatter. An obese child is 4-5 times more likely to have breathing-related sleep problems than a non-obese child. So unfortunately, pediatricians are seeing the types of sleep problems that used to be seen only by adult doctors.

The other major cause of childhood sleep apnea is big tonsils and adenoids. It used to be the case that kids got their tonsils out for repeated bouts of throat infections. These days, most tonsillectomies in kids are done for obstructive sleep apnea.

The other cases of childhood sleep apnea happen because of genetic conditions such as Down Syndrome. These result in noses and throats that don’t work like they should. A fair number of kids with chronic nasal congestion from allergies get childhood sleep apnea as well.

So why is childhood sleep apnea a problem? Because if it isn’t treated somehow, it can lead to some serious consequences:

  • Failure to thrive in babies and small children
  • Developmental delay
  • Behavior problems
  • High blood pressure and heart disease

Childhood sleep apnea is different from adult OSA

It turns out that if you apply the adult standard definition of OSA to kids, you’ll miss a whole lot of cases.  That’s because children’s lungs are smaller and they breathe at faster rates. Unfortunately, there’s no good world-wide definition for children. Nevertheless, the risks of missing the diagnosis in kids are bad; It could not hurt to investigate if you suspect your baby or child may have it!obstructive sleep apnea 3

Sometimes, childhood sleep apnea is discovered during the course of an evaluation for ADHD, or even for bedwetting.  Many children thought to have attention deficits simply aren’t sleeping well! And children with disrupted sleep patterns tend to wet the bed more often.

Diagnosing obstructive sleep apnea

Diagnosis happens the same way as with adults, with the overnight sleep study. It’s important to make sure that the child really has the problem, and not merely “simple snoring”.  In children, it’s important to pay attention to inadequate breathing (hypopnea) in addition to obstructions. This is because hypopnea can lead to the same consequences as obstruction.

Need a SLEEP COACH?

Treatment

Because so much childhood sleep apnea is related to obesity, weight loss programs are effective, and can forestall the need for surgery. Healthy diet and regular exercise are good recommendations for anyone, but for children with sleep apnea, these habits can prevent early death from heart disease.

If weight loss is not an immediate option, removal of tonsils and/or adenoids is the treatment of choice.

Teen drivers with sleep apnea tend to be less alert and get into more accidents.  Until they receive therapy for OSA, it’s best that parents limit their driving.

Some kids with allergies have OSA due to constantly stuffy noses. Nasal sprays appear to help. Many varieties are available over-the-counter in the US.

Prognosis

Here the news is mixed: One study found that after tonsil removal, only about 1 in 4 children got better from their obstructive sleep apnea. However, a more recent study showed that many small children have a better quality of life after surgery.obstructive sleep apnea 2

The Bottom Line

The major take-home point is that obesity is a major cause of childhood sleep apnea. These kids live with these symptoms for many years before entering adulthood. It’s important to for them to lose weight while they’re still young!

Snoring: Why Your Toddler Does It

I can hear my kid snoring from down the hall!

She snores like an old man!

There are two kinds of snoring: the kind you don’t have to worry about and the other kind. How can you tell which is which?

Two Kinds of Snoring

There are two kinds of answers: the short answer and the long answer. The short answer is “see your pediatrician if you have any questions or concerns about your child’s snoring”. The longer answer is… well, read on!
Snoring is more than just loud breathing. When you sleep, the muscles in your upper airway (nose, mouth and upper throat) relax and become narrower. As you inhale, the upper airway wants to get even more narrow. This is because the air pressure goes down (you wouldn’t be able to inhale air into your lungs if the pressure didn’t go down in your airway – so this is a good thing).

Sometimes the airway becomes so narrow that the walls of the mouth and throat slap together audibly. This is the sound of snoring. If someone’s upper airway is narrower than normal, or floppier than normal, the more likely the “slapping together” is going to happen, giving rise to snoring.

Big Tonsils, Big Adenoids

One thing that can make an upper airway narrower than normal is big tonsils and adenoids.snoring

Before going on, we should talk a little about adenoids, because many people have heard of them but don’t really know what they are. As you can tell from the picture, one reason you may not know what adenoids are is that you can’t see them in most people’s mouths. They’re located high up at the place where the nose meets the throat.

Adenoids are part of your immune system. In people with allergies, adenoids can get large. They can get so large that they can partially or totally block off the nasal passages. People in this situation need to breathe through their mouths all the time. If they need to breathe through their mouths only during sleep, the person is more likely to snore. When adenoids are so large that they cause serious breathing problems, and trials of medical therapy do not work, patients and their doctors often choose to have them removed.

Snoring because of tonsils is easier to understand because you can see really big tonsils can get in the way of air flow. People with allergies can have big tonsils, as can people who have lots of throat infections. It used to be that frequent bouts of tonsillitis were the main reason tonsils were removed. This is no longer the case. Today, the most common reason for tonsillectomy is obstructive sleep apnea (OSA).

Need a SLEEP COACH?

What is OSA?

snoring 3
Uh-oh. Obstruction

The problem of OSA is defined by its name. The upper airway becomes obstructed during sleep, leading to pauses in breathing. Apnea literally means “cessation of breathing”.

It may be obvious why pauses in breathing can be a problem, but the consequences may not be well known. While snoring, people with OSA, including children, send signals to their brains that they are not inhaling enough oxygen. The signal causes the person in deeper sleep to arouse enough to shift, move, and sometimes fully awaken. Normal rhythm of sleep is disrupted. These people do not get enough restful sleep.

In children, this chronic lack of restful sleep can lead to behavior problems. In fact, many children who carry the diagnosis of ADHD are in fact suffering from chronic sleep deprivation due to OSA. I have seen a few children who had been diagnosed with ADHD cured by tonsillectomy/adenoidectomy.

For reasons that are not well understood, some children who wet the bed frequently do so because their breathing is disrupted during sleep. Again, many cases of bedwetting have been cured by treatment for OSA and other causes of “sleep disordered breathing“.

Young drivers with sleep disordered breathing tend to be less alert and are known to get into more frequent accidents.

Big Kids

Sadly, OSA is becoming more common in childhood because of the rapid rise of obesity. The thicker one’s neck is, the narrower the upper airway. Sometimes the only way to reverse airway obstruction is weight loss. And of course, the best, healthiest way to do this is healthy diet and exercise (see how diet, exercise and sleep all tie together?)

snoring
Not my fault I snore. I was bred this way

Does everybody who snores have OSA?

No. Sometimes it’s just plain “simple snoring”. This is loud breathing during sleep that does not lead to all the negative consequences I’ve detailed here. I lay out all this detail because it may not be immediately obvious that behavior problems or bedwetting may be related to sleep disordered breathing. The only way to tell sometimes would be to perform an overnight sleep study.

Non-surgical Therapies

Not everybody with OSA has to have surgery. For allergy sufferers who snore, even toddlers, the treatment may involve removing allergic triggers from the child’s environment, or simple over-the-counter allergy medications. Consult your child’s pediatrician about this if you suspect allergies.

Take Care of It Early

OSA can be annoying and lead to behavior consequences and bedwetting. But these symptoms tend only to occur in childhood. The reason to pay close attention to snoring in childhood is because over time, OSA can cause cardiovascular problems such as high blood pressure and heart disease. The sooner OSA is reversed, the easier it is to reverse these complications.

So if you have any question at all as two whether your child’s snoring is the normal, boring kind, or the kind that deserves attention, I recommend seeking medical attention. The impact on your child’s lifetime health and wellbeing may be substantial.