Pediatric sleep apnea is a sleeping disorder in children that causes the child to stop breathing while sleeping.
According to the American Sleep Apnea Association, 1 to 4 percent of U.S. children suffer from sleep apnea. Although the age of children who have the condition varies, the most common age during which it occurs is between 2 and 8 years old.
Two versions of sleep apnea occur in children and infants. Obstructive sleep apnea is the most common type. This typically occurs because of a blockage in the airway.
On the other hand, central sleep apnea develops when the section of the child’s brain that regulates breathing doesn’t function well. As a result, the breathing muscles don’t get the required signals to breathe.
Although it’s possible for some children to outgrow sleep apnea, sleep studies suggest timely treatment. When untreated, pediatric sleep disorders like sleep apnea can take a heavy toll on a child’s overall health condition. As a result of a clinical trial, 25 percent of children diagnosed with ADHD may have symptoms of obstructive sleep apnea. Furthermore, much of the behavioral problems and learning difficulties these children face can be the result of chronically interrupted sleep.
Finally, several recent studies have shown a significant association between sleep apneas and childhood obesity. It seems like specialists believe that healthy sleep is just as important as a healthy diet and exercise in preventing childhood obesity.
Signs of Sleep Apnea
When it comes to sleep apnea in children symptoms, they may vary from child to child, but here is a list of the most common ones:
- Snoring: Loud snoring or another kind of noisy breathing (snorting or gasping) during sleep can be signs of pediatric obstructive sleep apnea. Chronic snoring in children is a sign of abnormal airflow through the airway, and allergies, enlarged tonsils or adenoids often cause it. Most often, snoring walks hand in hand with obstructive sleep disorders like sleep apnea.
- Bedwetting: Although it may occur due to stress, infections, or other medical conditions, bedwetting can also often be a sign of sleep apnea. While it isn’t uncommon for kids to wet the bed at night, if it occurs more than twice a week beyond the age of 5, doctors consider it a problem.
- Restless sleep: Extremely restless sleep may be a sign of the child’s struggles during the night. When difficulty in breathing occurs, as it does with sleep apnea, it may manifest in excessive movement during sleep. Therefore the child might be switching positions attempting to find a way to breathe and sleep simultaneously.
Most noteworthy, signs of sleep apnea don’t only occur in the nighttime. When a child has disturbed sleep because of the condition, symptoms during daytime occur, too. They include:
- Fatigue: When a child repeatedly awakens during the night, the body doesn’t get enough rest, and the child feels tired during the daytime. In other words, along with difficulties waking up in the morning, fatigue during daytime is a common sign of sleep apnea.
- Behavioral problems: Sleep apnea is a frequent contributing cause to behavioral problems in children, including ADHD. Symptoms include difficulty paying attention which may manifest in poor performance at school.
For more, you can read our article and find out how to know if you have sleep apnea.
Causes and Risk Factors
When a child stops breathing during sleep, oxygen levels in the body drop while carbon dioxide levels rise. As a result, it triggers the child’s brain to wake him up to breathe. In most cases, this awakening happens quickly, and the child gets right back to sleep without ever knowing it woke up. In obstructive sleep apnea, this pattern may repeat itself all night. Children who have it are unable to reach a more profound, restful level of sleep.
While obesity is the main trigger for sleep apnea in adults, enlarged tonsils or adenoids are the most common cause of the same condition in children. During sleep, the muscle tone decreases, and the airway becomes smaller. The extra tissue from tonsils and adenoids partially or entirely blocks the airway, making it difficult or impossible for the child to grasp air. Each pause causes brief arousal that builds back muscle tone enough for the airway to open and for the child to resume breathing.
Moreover, being overweight is also a contributor to developing obstructive sleep in children. It is more common for children who are obese or overweight to have sleep apnea. However, some of the children with enlarged tonsils and adenoids are often underweight. Other children who may be at high risk of developing sleep apnea are those with a tiny jaw, muscle weakness, and other various medical conditions.
The most known sleep apnea risk factors in children include:
- Enlarged tonsils or adenoids
- Down syndrome
- Face or skull anomalies
- Having a family history of sleeping disorders
- Low weight at birth
- Certain medical conditions
On the other hand, the probable causes of central sleep apnea include:
- Heart failure
- Premature birth
- Congenital anomalies
- Neuromuscular disease
- Cerebral palsy
The Effects of Untreated Disease
A child that has sleep apnea may have difficulty catching up and paying attention in school. As a result of chronic daytime fatigue, the obstructive sleep condition can trigger poor performance and learning problems.
Furthermore, pediatric sleep apnea does more than making a child sleepy all the time. For example, it may contribute to various diseases when untreated, including heart disease and diabetes. Also, children with sleep apnea are more likely to develop depression. Studies connect sleep apnea to memory loss, mental confusion, weakened immune system, and high blood pressure. Likewise, liver problems such as fatty liver disease occur, as well as abnormal cholesterol levels, fatigue, etc.
Diagnosing and Treating Pediatric Sleep Apnea
Young children with sleep apnea don’t always snore. Therefore it is often hard for parents to recognize the condition. If your child continuously wakes up feeling tired in the morning and has behavioral problems, it’s time to see a doctor.
When diagnosing sleep apnea in children, specialists usually recommend sleep studies. A polysomnogram (or sleep study) is the only way to diagnose the severity of the condition. A child spends the night in a hospital or sleep center, where technicians check various parameters during the child’s sleep. From breathing patterns and brain function to muscle tone and eye movement, they record everything. As a result, over a thousand sheets of readings help the doctors diagnose the condition.
Treatment depends on the child’s age, symptoms, general health, and also on the severity of the condition. In the case of mild obstructive sleep apnea, a doctor might suggest checking the child’s sleep for some time to monitor if the symptoms get better. But, currently, there aren’t any accepted parameters on when sleep apnea in children is severe enough to need treatment. Most pediatric sleep specialists recommend treatment for children who have an apnea index (AI) higher than five.
Surgically removing the tonsils and adenoids is the most common way of treating pediatric OSA since they are the most common cause of sleep apnea in children. But, when surgery isn’t helpful, doctors turn to a treatment called Continuous Positive Airway Pressure (CPAP). It involves wearing a mask during sleep attached to a machine that blows air through the nose into the airway and hence keeps it open to allow the child to breathe. On the other hand, in the case of an overweight child, the doctors will recommend sleep apnea in children’s natural treatment and weight loss to ease the symptoms.
Treating Central Sleep Apnea
When it comes to children with central sleep apnea, treatment usually includes a so-called noninvasive positive pressure ventilation device (NIPPV). The tool allows you to set an automatic breathing rate that ensures the child takes a preset amount of breaths every minute while sleeping. Above all, with the help of a NIPPV, a child can breathe continuously even though the brain doesn’t send the necessary signal to the muscles.