Sleep apnea is a common sleep disorder in children that causes interrupted breathing during sleep. Periodical cessation of breathing may occur a few times to several times anytime during sleep. This may affect sleep quality and often result in daytime sleepiness and behavioral problems in children.
A child who stops breathing during sleep is partially awake since their brain is awakened from a deep sleep stage to maintain breathing. Lack of proper rest for the brain may decrease the quality of life.
Read this post to know about the causes, symptoms, risk factors, diagnosis, and treatment of sleep apnea in children.
Types Of Sleep Apnea
Sleep apnea can be of three types (1).
- Obstructive sleep apnea (OSA): This is the most common form of sleep apnea due to complete or partial blockage of the airway, resulting in absent or decreased breathing during sleep.
- Central sleep apnea (CSA): This happens when there is a lack of effort to inhale due to the brain failing to signal the respiratory muscles. In such cases, there is no blockage in the airway.
- Mixed or complex sleep apnea: This is a combination of obstructive and central sleep apnea.
Causes And Risk Factors For Sleep Apnea
Any conditions causing partial or complete airway blockage during sleep could result in obstructive sleep apnea. Risk factors for obstructive sleep apnea in children may include the following (2).
- Enlarged adenoids and tonsils
- Small jaw
- Overbite (the upper jaw overlaps the lower jaw)
- Nasal allergies
- Tongue and throat muscle weakness, especially in children with cerebral palsy and Down syndrome
- Positive family history
- Second-hand smoke
Medical conditions affecting the brainstem may result in central sleep apnea in some children. In this case, the brain may temporarily fail to send signals to respiratory muscles to control breathing.
The following conditions may increase the risk of central sleep apnea in children (3).
- Brain infections
- Heart failure
- Use of opioids or other sedatives
- Congenital central hypoventilation syndrome; a rare genetic disorder that causes shallow breathing during sleep
Signs And Symptoms Of Sleep Apnea
Snoring is the main symptom of obstructive sleep apnea. However, not all children who snore have sleep apnea. You may hear snoring or choking sounds or a loud gasping when a child takes a deep breath during sleep apnea. Although children with central sleep apnea may snore, it is not a prevalent symptom.
Other signs and symptoms of sleep apnea during sleep may include (4):
- Breathing from mouth while sleeping
- Night sweats
- Sleep terrors
- Talking in sleep
Children with sleep apnea may also experience the following signs and symptoms when awake (4).
- Concentration issues
- Daytime sleepiness
- Headaches in the morning
- Behavioral problems, such as ADHD, impulsiveness, and rebelliousness
- Inability to manage emotions
Sleep apnea can impact the physical and mental wellbeing of a child. You may seek pediatric care to determine the presence of sleep apnea if your child has any of the above-listed symptoms.
Diagnosis Of Sleep Apnea
Doctors may ask the caregivers or parents about the child’s sleep habits, nighttime and daytime symptoms, and health history. Physical examination of the mouth and throat may be done to look for signs of enlarged tonsils or adenoids (5).
Doctors may order polysomnography, a sleep test, if the initial diagnosis suggests sleep apnea. This test is done overnight at a sleep clinic, and it measures specific bodily activities when a person sleeps.
The American Academy of Pediatrics and the American Academy of Sleep Medicine do not recommend home sleep tests to monitor breathing patterns and effort and oxygen saturation for children. These tests will have to be done in a clinical setting to determine the presence of sleep apnea in the child.
Treatment For Sleep Apnea
First-line treatment involves managing the underlying cause of central or obstructive sleep apnea. Treatment may vary depending on the cause and severity of sleep apnea and may include the following measures (6).
- Adenotonsillectomy: This is the surgical removal of enlarged adenoids and tonsils, curing obstructive sleep apnea.
- Myofunctional therapy: It is also called oropharyngeal exercises or mouth and throat exercises and may improve snoring and obstructive sleep apnea in some children.
- Continuous positive airway pressure (CPAP) pumps air into the airway through a pump and mask.
- Orthodontics approaches, such as maxillary expansion and mandibular advancement devices, use dental appliances to create more space in the mouth to increase the airflow.
- Medications for sinusitis, tonsillitis, and allergies, including steroid nasal spray, anti-allergens, and saline nasal rinses, may reduce sleep apnea in some children.
- Bilevel positive airway pressure (BPAP): This also pumps air to the airway like in CPAP but adjusts air level during inhalation and exhalation.
- Adaptive-servo ventilation (ASV): This device monitors breathing and pumps air according to the requirements.
- Phrenic nerve stimulation: This is a new FDA-approved therapy for central sleep apnea. In this treatment, the phrenic nerve is stimulated by pacemaker-like devices to control breathing.
Natural Treatments For Sleep Apnea
Children with mild sleep apnea without any specific symptoms are monitored without giving treatments. Doctors may suggest some sleep habits and natural methods to reduce sleep apnea in such cases (6).
- Weight loss can reduce the risk of sleep apnea in obese children. A pediatrician or a dietician can help plan a healthy diet and exercise regime for your child.
- Physical therapy, such as nasal breathing retraining or myofunctional therapy, helps the child breathe well.
- Avoiding allergic substances, such as mold and pollen, may reduce allergic rhinitis, curing sleep apnea over time.
- Positional therapy teaches the child to sleep in various positions to reduce sleep apnea symptoms.
These treatments are usually recommended for a few children with mild sleep apnea. You may seek medical care to know appropriate treatment for your child.
Can A Child Grow Out Of Sleep Apnea?
Most children with mild symptoms may outgrow this condition. Treatments of underlying causes may cure or improve sleep apnea in a few children. If left untreated, sleep apnea may complicate into the following conditions.
- Attention deficit disorders
- Poor academic performance
- Enuresis (inability to control urination)
- Behavioral issues
- Cardiopulmonary problems
When To See A Doctor?
You may seek pediatric care if your child has any symptoms of sleep apnea. Academic and behavioral problems in children also require medical analysis to identify and treat the cause. Pediatricians can evaluate the child and refer to a sleep medicine specialist for detailed evaluation.
Although obstructive sleep apnea is the most prevalent form of sleep apnea in children, most get better with specific treatment. However, many cases of central sleep apnea may require lifelong care. Continuous positive airway pressure may help to manage symptoms of both obstructive and central sleep apnea in children. Seeking early medical care for your child’s sleep apnea symptoms may improve the outcome.
2. Obstructive Sleep Apnea; Children’s Hospital of Philadelphia
3. Central Sleep Apnea; Sleep Foundation
4. Obstructive Sleep Apnea In Children; Cedars-Sinai Medical Center
5. Obstructive Sleep Apnea In Children; American Thoracic Society
6. Children and Sleep Apnea; Sleep Foundation
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