Pediatric obstructive sleep apnea
Make an Appointment
Talk to DoctorOverview
Pediatric obstructive sleep apnea is a condition characterized by brief pauses in a child’s breathing pattern during sleep. These pauses occur due to blockages or obstructions in the airway. While it can affect children of any age, it is most commonly observed in those between 2 and 6 years old. The prevalence of pediatric obstructive sleep apnea ranges from 2% to 5%.
Compared to adult sleep apnea, pediatric obstructive sleep apnea presents with distinct differences. While adults typically experience daytime sleepiness as a common symptom, children are more likely to exhibit behavioral problems. The underlying causes also differ between the two groups. Obesity is often the primary factor in adults, whereas in children, enlarged adenoids and tonsils are frequently responsible. Adenoids are small tissue pads located in the back of the nose, while tonsils are oval-shaped pads situated at the back of the mouth.
Early diagnosis and treatment of pediatric obstructive sleep apnea is crucial in order to prevent complications that can negatively impact a child’s growth, cognitive development, and behavior.
Symptoms
Pediatric sleep apnea symptoms could manifest while the child is sleeping such as:
- Noisy or loud breathing, snoring, or breathing through the mouth while sleeping.
- Temporary pauses in breathing or difficulty breathing during sleep.
- Restless sleep characterized by frequent tossing and turning.
- Excessive sweating during sleep.
- Bedwetting
- Sleeping in unusual positions, such as with the neck hyperextended.
- Difficulty paying attention and lack of focus in school.
- Experiencing extreme sleepiness during the day, including falling asleep regularly in school.
- Poor academic performance.
- Irritability, aggression, or other behavioral problems, including hyperactivity.
- Growth issues, as severe obstructive sleep apnea (OSA) can hinder proper development.
- Morning headaches.
Obstructive sleep apnea in infants and young children is not often accompanied by snoring. They might simply have had a restless night.
During the daytime, children with sleep apnea may exhibit the following symptoms:
- Trouble learning or behavioral issues
- Not doing well in school
- Being extremely active
- Decreased attention span
- Problems gaining weight
If your child consistently displays behavioral issues and wakes up feeling fatigued, schedule a consultation with their doctor.
Causes
Sleep apnea in children is often caused by enlarged tonsils and adenoids that block their airway and hinder breathing during sleep. The relative size of these structures in comparison to the child’s airway is a key factor. When the child is awake, the muscles in the head and neck are more effective at keeping the airway passages open. However, during sleep, muscle tone decreases, allowing the tissues to come closer together and obstruct the airway. Additionally, other factors such as tissues in the nose, neck, and tongue can also contribute to the obstruction.
Various factors can contribute to obstructive sleep apnea (OSA) in children. These include obesity, a narrow facial bone structure, retrognathia (a small jaw), a history of cleft palate or pharyngeal flap surgery, low muscle tone (hypotonia) as seen in neuromuscular diseases, high muscle tone (as in cerebral palsy), and rarely, the presence of a tumor or growth in the airway. Children with syndromes that affect facial structure, such as Down syndrome, are also more prone to developing sleep apnea. Furthermore, children with nasal allergies, asthma, stomach acid reflux, and frequent upper airway infections are at an increased risk of developing OSA.
Risk factors
In addition to obesity, the following conditions increase the risk of pediatric sleep apnea:
- Neuromuscular disease
- Decreased weight at birth
- Obstructive sleep apnea in the family
- Down syndrome
- Congenital facial or skull defects
- Cerebral palsy
- Sickle cell disease
Diagnosis
When a child’s doctor suspects sleep apnea, they may suggest seeing a sleep specialist. The specialist will perform various tests to determine if the child has sleep apnea. These tests may include:
- Sleep history: The doctor will ask about the child’s sleeping patterns and habits.
- Upper airway evaluation: The doctor will examine the child’s head, neck, nose, mouth, and tongue to assess any potential issues.
- Polysomnogram (sleep study): This test is conducted in a sleep laboratory, usually with a parent present. It measures various parameters such as brain activity, heart rate, airflow through the nose and mouth, blood oxygen and carbon dioxide levels, muscle activity, and movements during sleep. It is a non-invasive procedure and does not cause any pain or involve needles. In some cases, a similar study may be done at the bedside if the child is hospitalized.
- Oximetry: This is an overnight recording of oxygen levels, typically done at home. While it cannot provide a definitive diagnosis of obstructive sleep apnea, the results may help the doctor determine if further testing for sleep apnea is necessary.
Treatment
Treatment options for childhood sleep apnea depend on the cause of the obstruction and may include:
- Lifestyle modification: If the child is overweight, weight loss through diet and exercise can be helpful in managing obstructive sleep apnea (OSA).
- Medications: Some children with mild OSA may find relief from symptoms through the use of topical nasal steroids like fluticasone and budesonide. Allergy medications like montelukast may also help relieve symptoms, particularly when used in combination with nasal steroids.
- Tonsil and adenoid removal: For moderate to severe sleep apnea, a pediatric ear, nose, and throat specialist may recommend the removal of the child’s tonsils and adenoids. This procedure, known as adenotonsillectomy, can open up the airway and improve obstructive sleep apnea. Other upper airway surgeries may be suggested based on the child’s specific condition.
- Positive airway pressure therapy: Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP) machines are used to gently blow air through a tube connected to a mask worn over the child’s nose or nose and mouth. This air pressure helps keep the airway open during sleep. Pediatric obstructive sleep apnea often requires positive airway pressure therapy when other treatments are ineffective. It is important to ensure proper mask fitting and adjust the mask as the child grows to ensure comfort.
- Oral appliances: Some children may benefit from oral appliances such as dental devices or mouthpieces. These devices can help expand the palate and nasal passages, as well as move the jaw and tongue forward to maintain an open upper airway. However, not all children will find oral appliances effective for their sleep apnea.
