Sleep Apnea Is More Common In Children With Neurologic Disorders
Children with neurologic disorders are at higher risk of OSA. Children with hypoxic-ischemic encephalopathy, meningitis, or other CNS insult may have poor pharyngeal tone, thereby increasing susceptibility to OSA.
Children with neuromuscular disorders also have a high risk of OSA due to poor pharyngeal motor movement, but are also at risk of hypoventilation due to respiratory muscle weakness. OSA is a comorbidity of epilepsy, with evidence of improved seizure frequency with treatment of OSA. Finally, patients with neurogenetic disorders such as Down syndrome, Prader-Willi syndrome, and Beckwith-Wiedemann syndrome are particularly prone to OSA not just from a decrease in muscle tone, but also due to complicating factors such as obesity or macroglossia. The predisposition to OSA in neurologically impaired children was explored in a study of 16 neurologically impaired children compared to 40 controls. Children with neurologic abnormalities were found to have a significantly higher rate of OSA and lower oxygen saturation nadirs than normal controls. The neurologic disorders included cerebral palsy, meningomyelocele, severe global delay, Prader-Willi syndrome, tuberous sclerosis, Duchenne muscular dystrophy, Crouzon syndrome, and microcephaly with seizures. Clinicians should have a high index of suspicion in any child with a neurologic disorder who snores, thereby leading to further evaluation.
Untreated Osa Can Have Many Negative Impacts On Children
Children who have OSA are likely not getting the full amount of healthy and restful sleep that they need each night. They may experience health problems like growth and heart issues as a result, in addition toÂ learning and behavior problems, according to Nemours Children’s Health System.
If you notice that your child is frequently tired or falling asleep during the day and having trouble paying attention or being hyperactive in class, it could be a sign of OSA. Sometimes, educators mistake symptoms of OSA as ADHD or other learning problems. Appropriate professional evaluation and testing will be needed for a proper diagnosis.Â
Things You Can’t Change
- Aging. Sleep apnea is most common in people age 30 and older.
- Being male. Sleep apnea is more common in men.
- Family history. If other members of your family have sleep apnea, you are more likely to have it than someone who doesn’t have a family history of it.
- Ethnicity. Hispanics and Indigenous peoples have a greater risk of sleep apnea than whites. Blacks tend to get sleep apnea at a younger age than whites.
- Deformities of the spine. Deformities of the spine, such as scoliosis, may interfere with breathing and contribute to sleep apnea.
- Conditions that may cause head and face abnormalities. Conditions such as Marfan’s syndrome and Down syndrome may result in abnormalities and increase the risk for sleep apnea.
- Menopause. Sleep apnea tends to occur more often in women who have been through menopause than in women who have not. After menopause, women get sleep apnea at a rate similar to men.footnote 3 Experts don’t know why or how menopause increases the risk of sleep apnea.
What It Is How It Harms Chilrdrens’ Sleep And Health And How It Can Be Treated
Sleep apnea is a condition in which breathing is interrupted during sleep. These pauses in breathing affect sleep quality and can lead to daytime sleepiness and behavior issues in children.
The two types of sleep apnea are obstructive sleep apnea and central sleep apnea . In OSA, a person tries to breathe but is unable to because of a constricted or blocked airway. In CSA, there is typically a lack of effort to inhale, so a person briefly stops taking breaths. Similar to adults, OSA is much more common in children than CSA.
Researchers estimate that between 1-5% of children have obstructive sleep apnea. Although studies have shown obstructive sleep apnea to be relatively rare in children, it is also commonly underdiagnosed.
Knowing the causes and symptoms of sleep apnea in children can help you determine when to see a pediatrician. There are tests available to diagnose sleep apnea and treatments that can help manage or resolve this condition.
What Is Sleep Apnea
Apnea refers to breaks, interruptions, or cessations of breathing. An apnea event can last seconds and happen multiple times in the course of sleep.
Infants can experience apneas or hypopneas . These apneas may be central, obstructive, or mixed. Per the American Academy of Sleep Medicine , an infants breathing can be unstable and become part of the development.
For a cessation to be considered an apneic event, it must be 20 seconds or shorter if associated with bradycardia or cyanosis , according to this study.
Sleep Apnea Can Present Differently In Children Than In Adults
Symptoms of OSA vary slightly between children and adults. Some symptoms are the same, while others differ significantly. Common symptoms of OSA in adults include:
- Suddenly waking up gasping or choking
- Waking often to pee at night
- High blood pressure
- Gastroesophageal reflux disease
Certain symptoms of OSA in children can be less obvious and harder to connect to OSA. These symptoms include:
- Drooling during sleep
- Learning and behavior problems at school
- Sluggishness or sleepiness, sometimes mistaken for laziness
- Teeth grinding
- Unusual sleeping positions
Sleep Problems In Children
Issues that might seem minor to us are often very significant to a child, so events like a new sibling, teething, an illness, a different place, a new caregiver, a change in schedule, or minor complaints like allergies, colds, and ear infections can all take their toll on your childs sleep.
In addition to these common problems, as many as 50 percent of children suffer from sleep disorders at some point. Sleep disorders are intricately intertwined with mental and physical health issues, with one exacerbating the other in a cycle that can be hard to break. Additionally, some sleep disorders are not evident to the sleeper, or they may mirror other conditions such as epilepsy, making them difficult to diagnose.
Some of the most common sleep disorders in children are night terrors and nightmares, sleep apnea, sleep talking and sleepwalking, snoring, and restless leg syndrome.
Tips On How To Make Sure Your Child Gets A Full Nights Sleep
Sleep needs change as your child grows older, but whether youre dealing with a 2-year-old toddler or a stubborn teenager, research shows that a consistent bedtime routine is helpful for making sure your child gets enough sleep. Whatever activities you choose, try to do the same ones every day in the same order so your child knows what to expect.
A typical bedtime routine might include:
- Putting on pajamas and brushing teeth
- Reading a light book, singing a lullaby, or taking a bath
- Picking a stuffed animal or security blanket for the night for toddlers
The best time to put your child to bed is when theyre sleepy, not when theyre already asleep. This helps them learn how to fall asleep on their own. If preschool children wake up in the middle of the night, walk them back to their bed. Its best not to let infants sleep in your bed, as co-sleeping increases the risk of sudden infant death syndrome.
What Causes Obstructive Sleep Apnea In Children
There are several causes of obstructive sleep apnea in children:
- Enlarged tonsils and adenoids: A widely recognized risk factor for childhood OSA is enlarged tonsils and adenoids. Tonsils and adenoids are glands located at the back of the throat and are part of the immune system. The tonsils and adenoids may be enlarged due to genetics, frequent infections, or inflammation. When enlarged, these glands constrict the airway, making breathing during sleep more difficult.
- Childhood obesity: OSA in children is also frequently caused by obesity, which also constricts the airway. Obstructive sleep apnea occurs in 60% of obese children.
- Other risk factors: Other causes of OSA include having a small jaw or an overbite, the use of sedatives or opioids, and tongue and throat muscle weakness due to conditions like Down syndrome or cerebral palsy. Having nasal allergies, being around adults who smoke, and having a family history of obstructive sleep apnea are also found to be risk factors for childhood OSA.
What Are The Symptoms Of Obstructive Sleep Apnoea
The first symptom most parents notice is snoring. Snoring is the sound made by the airway vibrating as it reopens after a partial collapse. Parents may also notice their child is sleeping in an unusual body position that may help them to breathe more easily. Recurrent breathing problems may also cause frequent, brief arousals throughout the night and this can make the child sleepy during the day.
Younger children who suffer from sleep deprivation may actually be hyperactive or aggressive, whereas older children may feel tired. A child with sleep apnoea may have difficulty concentrating or behave differently. They may awake from sleep feeling tired and unhappy, with a headache, or may refuse breakfast. Poor growth and weight gain, poor school performance, a lack of concentration and aggressive behaviour may also be seen.
Obstructive Sleep Apnea Symptoms
The following are the most common symptoms of obstructive sleep apnea. However, every child is different and symptoms may vary. Symptoms may include:
- Snoring loud snoring or noisy breathing during sleep.
- Periods of not breathing although the chest wall is moving, no air or oxygen is moving through the nose or mouth into the lungs. The duration of these periods is variable and measured in seconds.
- Mouth breathing the passage to the nose may be completely blocked by enlarged tonsils and adenoids leading to the child only being able to breathe through his mouth.
- Restlessness during sleep the frequent arousals lead to restless sleeping or “tossing and turning” throughout the night. Many children will move all over their bed, or wake up in completely different positions from when they went to sleep
- Sleeping in odd positions the child may arch his neck backwards in order to open the airway or sleep sitting up.
- Behavior problems or sleepiness may include irritability, crankiness, frustration, hyperactivity and difficulty paying attention.
- School problems children may do poorly in school, even being labeled as “slow” or “lazy.”
- Bedwetting also known as nocturnal enuresis, although there are many causes for bedwetting besides sleep apnea.
- Frequent infections may include a history of chronic problems with tonsils, adenoids and/or ear infections.
Why Does My Child Snore
Snoring happens during sleep when the throat muscles relax and the airway narrows. When the throat muscles relax, the nose is blocked. Snoring is common in children and may be a cause for concern.
Large tonsils and adenoids are the most common reason a child snores. When children have a lot of upper respiratory infections, their tonsils and adenoids get bigger.
Less common causes are nasal blockage and obesity. Colds, allergies, or other medical problems can cause nasal blockage. Obesity causes snoring more often in adults, but having too much fat in the neck also can affect breathing in children.
What Is Obstructive Sleep Apnea
Sleep apnea is when a person stops breathing during sleep. It usually happens because something obstructs, or blocks, the upper airway. This is called obstructive sleep apnea .
Obstructive sleep apnea can make the body’s oxygen levels fall and interrupt sleep. This can make kids miss out on healthy, restful sleep. Untreated obstructive sleep apnea can lead to learning, behavior, growth, and heart problems.
Why Is Sleep Important For Children
Sleep plays a crucial role in the development of young minds. In addition to having a direct effect on happiness, research shows that sleep impacts alertness and attention, cognitive performance, mood, resiliency, vocabulary acquisition, and learning and memory. Sleep also has important effects on growth, especially in early infancy. In toddlers, napping appears to be necessary for memory consolidation, executive attention, and motor skill development.
Treating Children’s Sleep Apnea
Sleep apnea, derived from the Greek word for “without breath,” is a serious condition. Breathing temporarily pauses during sleep for more than 10 seconds in adults and longer than two breath cycles in children, and this can happen up to 70 times an hour. Oxygen levels in the blood plummet, and the body responds as if choking.
Sometimes young children outgrow OSA as their throats get larger and airways stiffen, says Rosen. Those with large tonsils and adenoids may need surgery , which typically cures 80% to 90% of children, says Rosen.
Joshua was diagnosed with OSA and needs additional treatment since tonsil surgery was unsuccessful. His parents are consulting another sleep specialist.
“I’m relieved I have a diagnosis,” says Chin-Lee. “A lot of people, and probably a lot of kids, have sleep apnea and don’t know it.”
Certain Things Can Increase A Child’s Risk
While the causes of some forms of sleep apnea are typically unknown, that does not mean that there are not things that are known to put a child at risk for developing one of them. A great example is obstructive sleep apnea since kids who have large tissue near the back of their throat have a much higher chance of having this condition than those who do not. Also, there are things that can increase one’s risk of having other types of health issues, as well. Smoking during pregnancy can increase an unborn child’s risk of developing it.
Causes Of Sleep Apnea
The most common cause of obstructive sleep apnea in children is enlarged tonsils and/or adenoids. Both the tonsils and adenoids are lymph tissue. The tonsils are located in the back of the throat, and the adenoids are located at the back of the nose. During sleep there is a considerable decrease 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, and the tonsils and adenoids block the airway. This makes the flow of air more difficult and increases the work the child has to do to breathe. It can be compared to breathing through a small, flimsy straw with the straw occasionally collapsing and blocking airflow. Many of the short pauses in breathing 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 can result in a poor night’s sleep, which can lead to significant daytime problems in children. The child is usually unaware of waking up because he/she is not waking up completely. The parents often describe the child as a very restless sleeper.
Other Devices To Help You Breathe
Oral breathing devices reposition your tongue and jaw during sleep, which opens up your airways. They may be used for people who have mild to moderate sleep apnea. They may also be used for people with severe sleep apnea who try CPAP but find out that it does not work out for them. A dentist will shape the device to fit your mouth.
Your doctor may suggest that you use nasal dilators to help keep your airways open while you sleep. Nose strips widen the nostrils and improve airflow. Nasal disks have a valve that makes it harder for you to breathe out. This causes a little back-pressure in the airways that may help keep them open. You can get many of these devices without a prescription. Talk to your doctor or pharmacist about your options.
What Causes Central Sleep Apnea In Children
Central sleep apnea can occur for a variety of reasons in children. It is important to note that a few central apnea events during sleep is considered normal. Central sleep apnea has been associated with rare genetic disorders in children, such as congenital central hypoventilation syndrome. It may also be present when children have health conditions that interfere with parts of the central nervous system that controls breathing.
What Are The Types Of Sleep Apnea Affecting Children
The three kinds of sleep apnea that affect children are as follows.
1. Obstructive Sleep Apnea
This is the most common type of sleep apnea and sleep-disordered breathing . Muscles, including those that support the head and neck, relax when one sleeps. The muscles can relax too much, causing the upper airway to collapse. That makes it difficult for air to pass through the lung, making breathing difficult.
Enlarged tonsils and adenoids can cause this blockage, and this condition is most prevalent in preschoolers, according to the AASM. The event occurs in children two to six years old when the adenoids and tonsils are larger than the throat.
What causes snoring?
The air that squeezes through the narrowed passage can produce snoring. When the passageway is completely blocked, the level of oxygen drops and the level of carbon dioxide increases. The brain alerts you to wake up briefly to breathe, thereby opening your airway and disrupting your sleep in turn.
2. Central Sleep Apnea
This happens when the brain is unable to send signals to the muscles in charge of breathing. The underlying cause of CSA is the instability of the breathing control system due to serious diseases that involve the lower brainstem, where respiratory activities are produced and modulated.
OSA vs. CSA
The main difference between the two apneas is:
3. Complex Sleep Apnea Syndrome
Obstructive Sleep Apnea Treatment
The treatment for obstructive sleep apnea is based on its cause. Since enlarged tonsils and adenoids are the most common cause of obstructive sleep apnea in children, surgical removal of the tonsils and adenoids is usually the recommended treatment . An ear, nose and throat specialist will evaluate for and make the recommendation for surgical removal. Other types of surgery are occasionally needed in children with craniofacial abnormalities. Weight loss and treatment of other medical problems may also be helpful in the management of obstructive sleep apnea. Oftentimes, the child can be referred to the Healthy Weight Clinic, which can help focus on ways to improve health and contribute to healthy weight loss.
In cases where surgery is not helpful, another effective treatment is continuous positive airway pressure . CPAP involves wearing a mask over the nose during sleep. This mask is attached to a machine that blows air through the nasal passages and into the airway. This will be managed by a lung specialist, or pulmonologist.
If left untreated, obstructive sleep apnea can cause poor growth , high blood pressure and heart problems. Obstructive sleep apnea can also affect behavior and cognition. Therefore, it is important to get it evaluated early.
When Should We See A Doctor
It is a good idea to consult a doctor anytime abnormal sleep symptoms are present. Also, children who are not sleeping well may have trouble focusing, display irritability, or have poor impulse control. If a child is struggling with behavior concerns, it could be helpful to ask the doctor whether a sleep disorder such as sleep apnea may be a contributing factor.
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Bedwetting Could Be A Sign Of Obstructive Sleep Apnea
Bedwetting could be a symptom of OSAâespecially if your child hasÂ previously been dry overnight. According to Cedars-Sinai, OSA is most commonly observed in children between the ages of 3 and 6.Â
If your child is newly experiencing bedwetting overnight, be sure to include it in the list of symptoms that you share with your childâs healthcare provider.
The Most Common Cause Of Osa In Children Is Enlarged Tonsils And Adenoids
The most common cause of blockage in a childâs airway that leads to OSA is enlarged tonsils and adenoids, according to Cedars-Sinai. These glands, which are located towards the back and sides of the throat, can grow too large or swell due to infection.
Additional risk factors for OSA in children include being overweight, having a tumor or growth that blocks the airway, or being born with certain conditions, such as Down syndrome or Pierre-Robin syndrome.
Testing After Initial Treatment
To see how well your treatment is working, you may need sleep tests after treatment begins.
If your sleep apnea has not improved after initial treatment, and if enlarged tissues in your mouth and throat are causing it, your doctor may do one or more tests before suggesting surgery to remove the excess tissue. These tests may include:
- Fibre-optic pharyngoscopy, to see whether your airway is too narrow or collapses during breathing.
- CT scan of the head to look for an overly large tongue and excessive soft tissue in the neck, as well as to locate the narrowest part of your airway.
- X-rays. A cephalometric X-ray is a type of head X-ray that allows your doctor to see bone deformities of the skull. This type of X-ray test may not be available in every hospital.
Risk Factors For Osa Are Different In Children And Adults
OSA occurs in both children and adults, but the risk factors change with age. In adults, âthe main risk factors of sleep apnea include age , narrowed airways, obesity, alcohol consumption, sex , nasal congestion, and certain medical conditions, including high blood pressure and asthma,â Alex Savy, certified sleep science coach and founder of SleepingOcean, tells WebMD Connect to Care.
While weight and certain medical conditions in children are risk factors for OSA, children do not share the majority of the risk factors for OSA with adults.
What Are Signs And Symptoms Of Sleep Apnea In Children
Children with sleep apnea can exhibit the following signs and symptoms.
At night or bedtime they may:
- Snore loudly and regularly
- Pause, gasp, snort, and stop breathing during sleep
- Show actual difficulty in breathing
- Feel restless and sleep in strange positions
- Experience night terrors with episodes of screaming, shouting, flailing, etc.
- Sweat heavily
During the day or in general, they may:
- Show difficulty in waking up in the morning or ask for more time to sleep in
- Experience morning headaches
- Be irritable, agitated, and cranky
- Have social and behavioral problems at school
- Be sleepy or fall asleep during the day
- Breathe through the mouth regularly
- Have a nasal voice
Children with obstructive sleep apnea can exhibit symptoms similar to adults, like snoring and noisy breathing. It can also be that the disorder works differently across age groups, whereby adults can experience daytime sleepiness and childhood behavioral problems, according to the Mayo Clinic.
Maintain A Healthy Weight
Doctors commonly recommend people with sleep apnea to lose weight. Obesity, specifically in the upper body, can increase the risk of airway obstruction and narrow nasal passages. These obstructions can cause you to stop breathing suddenly or for lengths of time while sleeping.
Maintaining a healthy weight can keep your airways clear and reduce sleep apnea symptoms. Research shows that modest weight reduction in people with obesity can eliminate the need for upper airway surgery or long-term CPAP therapy.
In some cases, weight loss can eliminate sleep apnea. However, if you regain the weight, its possible for the condition to return.
Better Sleep For Healthy Kids
More research is needed, but experts agree that healthy kids need to sleep better. Many kids show signs of sleep disorders such as snoring or teeth grinding.
If you think your kid has sleep apnea symptoms, consult your GP or Dentist right away.
Have you spotted sleep apnea symptoms in your kids? Share your experiences in the comment section below.
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