What Causes Sleep Apnea In Toddlers And Children
Enlarged adenoids and tonsils are the most common cause of Sleep Apnea in toddlers and children. When the tonsils are enlarged the airway can become blocked during sleep, causing apneas to occur.
Some of the risk factors for Sleep Apnea in children include:
- Being overweight
- Family history of Sleep Apnea
- Large tongue, which may fall back and block the airway while sleeping
- Certain medical conditions, such as cerebral palsy or Down syndrome
- Larger neck
- Defects in the structures of the throat, jaw, or mouth that narrow the airway
In rare cases, Sleep Apnea may occur when the brain isnt sending signals to the muscles controlling breathing, resulting in a lack of oxygen in the body. This is known as Central Sleep Apnea and may be caused by head injuries or other conditions that affect the brain. However, Central Sleep Apnea more commonly affects older adults.
What Should I Do If My Child Has Sleep Apnea
Our advice to parents who suspect their child has sleep apnea is to speak with the childs regular physician. The doctor may suggest medication, CPAP or BiPAP therapy, or an oral appliance. If a childs tonsils are overly large, a tonsil removal surgery can eliminate sleep apnea symptoms. Similarly, an adenoid removal surgery can broaden a childs airway.
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.
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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
Curious About Your Childs Potential To Have Osa
If you suspect that your child may be living with obstructive sleep apnea, BEARS is a great screening tool you can use at home. It stands for:
B Bedtime. Does your child have trouble falling asleep or even going to bed?
E Excessive Daytime Sleepiness. Do you find that you have difficulty waking your child? Does he or she appear groggy or tired throughout the day?
A Awakening During the Night. Does your child awaken during the night and experience difficulty returning to sleep? Are other factors disrupting your childs sleep?
R Regularity and Duration of Sleep. How many hours of sleep should your child be getting at his age? What time does he go to bed and wake up during the week and on weekends? Does your child get adequate sleep each day?
S Snoring. Does your child snore? How loud? Is it every night? Does he stop breathing or making gasping and choking sounds while sleeping?
If your answer to any of these questions is yes, then you should contact us here at Houston ENT & Allergy Services today to discuss screening and potential treatment options for obstructive sleep apnea in children. The risks to your childs health are too great to ignore or put off.
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What Is Pediatric Obstructive Sleep Apnea
Obstructive sleep apnea is characterized by pauses in breathing that occur during sleep. These episodes are due to the partial or complete collapse of the upper airway, affecting tissues within the throat or at the base of the tongue. It affects approximately 1 percent of children.
Sleep apnea events last at least ten seconds and are associated with either a drop in blood oxygen levels , an increase in carbon dioxide levels, or an awakening that fragments sleep. Unlike in adults, where an apnea-hypopnea index greater than five is considered abnormal, these episodes can occur just one time per hour in children and be deemed significant.
Obstructive sleep apnea is often due to facial anatomy that contributes to a blockage of the airway. It may be worsened by allergies, colds, or exposure to tobacco smoke. Sleep position, especially sleeping on the back, may also increase the occurrence. Weight gain may also have a role in children who are overweight or obese.
Testing For Obstructive Sleep Apnea
If you are concerned about your childs breathing at night, the first thing you will want to do is speak to your childs doctor. Next is to undergo an examination, possible X-rays, and interviews involving the childs sleep habits and breathing patterns.
After this, the physician may want to refer the child to a specialist in sleep, ENT , or a respiratory specialist. Many initial screenings are non-invasive and help determine the causes of the sleep issue symptoms.
In some cases, a sleep study or polysomnography may be necessary. Sleep studies are performed either at home or at an overnight clinic. Still, professionals prefer to avoid doing sleep studies on children at home.
The cause determines thetreatment and therapyVerified SourceNational Library of Medicine Worlds largest medical library, making biomedical data and information more accessible.View sourcefor obstructive sleep apnea in children. After your doctor has completed their diagnostics and has their results, they create an improvement plan.
The primary cause of OSA is the enlargement of lymph glands such as tonsils and adenoids. The most common surgical solution is a tonsillectomy or adenoidectomy, which removes either the tonsils or adenoids, or an adenotonsillectomy, which removes both. Sometimes there are other surgical remedies from other abnormalities of the cranium as well.
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What Causes Pediatric Obstructive Sleep Apnea
Obesity is a common factor associated with obstructive sleep apnea in adults. In children, however, the most common cause of the problem is enlarged tonsils and adenoids.
Thirty years ago, approximately 90 percent of tonsillectomies in children were done for recurrent tonsillitis infections. That has changed dramaticallytoday, just 20 percent of these surgeries are done for infections, with 80 percent performed as treatment for pediatric obstructive sleep apnea. according to the American Academy of Otolaryngology-Head and Neck Surgery.
Additional causes of obstructive sleep apnea in children include “low airway tone as in cerebral palsy or Down syndrome,” Dr. Canapari notes.
Tests For Obstructive Sleep Apnoea
Your GP will look in your childs throat to check his tonsils. The GP might send your child to an ear, nose and throat specialist if it looks like your childs adenoids and tonsils are the cause of your childs obstructive sleep apnoea.
To help the doctors work out whether its obstructive sleep apnoea, your child might need to undergo a sleep study called a polysomnography. This involves staying overnight in hospital , so that specialists can watch your childs breathing, heart rate, oxygen level, and brain, eye and muscle activity while shes sleeping.
Some children might have an oximetry test. This test also measures your childs heart rate and oxygen levels while hes sleeping, but it can be done at home.
These tests arent usually painful or uncomfortable.
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Treatments For Pediatric Sleep Apnea
According to the Korean Journal of Pediatrics, one of the most common treatments for Sleep Apnea in children is the removal of the tonsils and adenoids if they are enlarged. If your pediatrician feels like your childs Sleep Apnea may be caused by enlarged tonsils or adenoids, you may be referred to an ear, nose, and throat doctor . Your child may need an adenotonsillectomy to remove both the tonsils and adenoids, and for many children, this resolves the problem.
When the adenoids and tonsils arent the cause of Sleep Apnea or the symptoms remain after your childs adenotonsillectomy, then continuous positive airway pressure therapy may be recommended for your child. CPAP therapy involves wearing a mask that covers the mouth and nose while your child is sleeping. The mask is connected to a CPAP machine, which continuously pumps air to keep airways open and deliver air to the lungs. Since children and toddlers have smaller heads than adults, its important to get a pediatric CPAP mask specifically designed for the needs and comfort of a child.
If being overweight is a factor in your childs Sleep Apnea, it will be important to work with your doctor on safe weight loss methods for your child, including exercise and dietary changes. If your childs Sleep Apnea is mild, weight loss may eliminate the problem and your child may not need further treatment.
Other treatments that may be used to address other risk factors in unique cases include:
Can Sleep Apnea Affect Your Children
In fact, you may not think of children as potential sufferers of sleep apnea at all. However, snoring and sleep apnea are increasingly common conditions that can affect children. This condition may have significant consequences on their growth and behavior. Consider 10 surprising signs of sleep apnea as it occurs in children.
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What Does Sleep Apnea In Babies Sound Like
If night after night you find yourself wondering how do i know if my baby has sleep apnea, it would be wise to ask your pediatrician. Thats because sleep apnea sounds like really bad/loud snoring, noisy breathing, and gasps for air that can last up to 10 seconds! If this is the case, consult with your pediatrician. If this happens every single night, and/or while napping, its important to have your baby assessed as other medical conditions might also be present.
Treatment Of Osa Has A Variety Of Benefits
Given the abundance of data linking OSA to medical, behavioral, cognitive, and psychiatric comorbidities, there is great interest in determining the effects of OSA treatment. Various studies support the beneficial effects of treating OSA, with the sequelae often being completely reversible.
In a study of 19 children with OSA who underwent PSG and neurocognitive testing before and after T& A, baseline neurocognitive scores were found to be lower than in age-matched controls. However, following surgery, the PSG normalized compared to controls, as did the neurocognitive scores. Attention should be paid to early recognition and treatment, as evidence of persistent learning deficits with delayed treatment correlates with worse cognitive outcomes. Similarly, the behavioral and psychological comorbidities of OSA, which may manifest with ADHD-like features, irritability, aggression, or excessive daytime sleepiness, appear to improve with treatment.
Apart from neurocognitive and behavior improvements, treatment of OSA is also associated with improvements in quality of life, increased growth, and reversal of cardiovascular sequelae., Given the evidence for widespread dysfunction from OSA and the prominent benefits from treatment, the importance of screening every child for sleep-disordered breathing is evident.
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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.
How Can Child Sleep Apnea Be Diagnosed
Scheduling an appointment at a sleep facility for an overnight polysomnogram is the most efficient way to diagnose or rule out the presence of sleep apnea in your child.
Pediatric polysomnograms are nearly identical to adult polysomnograms in that they measure nearly all of the same activity including brain activity, breathing, muscle movements, heart rate, and blood oxygen levels. One extra piece of equipment is used to diagnose sleep apnea in children is that end tidal CO2 is additionally monitored.
Getting hooked up to the various leads that record all the measurements needed for an accurate diagnosis can be challenging for the lab sleep technicians. Alaska Sleep Clinic’s registered polysomnographic sleep technologist , Meridith Kearse says “for some children, you have to wait until they start dozing off to apply the leads to ensure they won’t pull them off.”
To ensure the comfort and safety of children undergoing a sleep study, parents are encouraged to sleep in the child’s room in a separate bed.
Positive diagnosis for child sleep apnea also differs significantly from a diagnosis in an adult.
Here is the apnea/hypopnea index for diagnosis in adults:
Mild sleep apnea 5-14 episodes of interrupted breathing in an hour
Moderate sleep apnea 15-30
Severe sleep apnea 30 or higher
For children, only 1 event per hour is needed to indicate a positive diagnosis of sleep apnea:
Mild sleep apnea 1-5
Severe sleep apnea 15 or higher
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Symptoms Of Obstructive Sleep Apnea In Children
While only a professional can properly diagnose pediatric obstructive sleep apnea, there are signs to look for if you are concerned. Some of themore common symptomsVerified SourceMedline PlusOnline resource offered by the National Library of Medicine and part of the National Institutes of Health.View sourceinclude:
While your child may exhibit one or more of these symptoms if they have sleep apnea, it is always best to seek a professional opinion. The cause may not be sleep apnea as several issues can easily cause these symptoms. Your family doctor or sleep specialist is best for a diagnosis.
What Is The Treatment
- Removal of the tonsils and adenoids cures sleep apnoea in 80-90 percent of children who do not have other contributing medical problems to the sleep apnoea.
- Your doctor may refer you to others service and health professionals to help with other areas of concern for your child such as weight management.
- Children with long term nasal allergies may be treated with combination of medical treatments.
- A small number of children with severe sleep apnoea or special conditions may need a CPAP machine to help them breathe while sleeping.
Some children may need to return to the sleep clinic if they have severe sleep apnoea or do not improve six to eight weeks after surgery. Parents should also advise their doctor if their child continues to snore or has difficulty breathing after surgery.
How Is Obstructive Sleep Apnoea Treated
The decision to start treatment is made on a case-by-case basis once OSA has been confirmed. Surgery to remove the adenoids and/or the tonsils is the most common treatment for paediatric OSA. This procedure can usually be done at a local hospital although some children have risk factors which may mean that this procedure will need to be done in a specialist unit with intensive care facilities.
If removal of the adenoids and/or tonsils is not indicated or if surgery does not fully resolve the symptoms then Positive Airway Pressure therapy may be used. This requires the patient to wear a mask over the nose while a positive pressure is applied from a ventilator to keep the airway open while asleep.
Other treatments may include the use of a nasopharyngeal airway which acts as a splint to maintain an open airway and keep the tongue from falling back. This treatment is predominantly used in children less than one year of age.
Another alternative treatment is the use of nasal steroids or montelukast to clear any inflammation of the nasal passage. Orthodontic procedures may also be appropriate including mandibular advancement to move the jaw forward.
Children with OSA who are overweight or obese are strongly encouraged to follow a weight management program, including nutritional advice, exercise regime, and behavioural recommendations .