Sleep Apnea and Children

Tuesday, May 16, 2017

Sleep Apnea and Children

Sleep apnea is a disorder characterized by temporary loss of breath during sleep. As frightening as this sounds, the loss of breath is almost always non-life-threatening. However, sleep apnea often leads to sleep disruption, which can take a major toll on your mind and body. Sleep apnea is also considered a predictor for more serious conditions, including cancer, depression, and cardiovascular disease.

Sleep apnea is relatively rare in children. According to the American Sleep Apnea Association, 1% to 4% of children live with sleep apnea, the majority of which fall between the ages of two and eight years. However, these percentages represent between 742,000 and 2.97 million children in the U.S. alone. This post will discuss symptoms, risk factors, and treatment options for children with sleep apnea. First, let's look at how sleep apnea is currently defined.

Types of Sleep Apnea
Sleep apnea is classified as a type of 'sleep-disordered breathing'. Two primary types of sleep apnea have been identified, as well as a syndrome that is essentially a hybrid of the two others.

Obstructive sleep apnea (OSA) is the most common type of sleep apnea diagnosed in children and adults today. OSA is characterized by physical blockage to the upper airway that leads to episodes of shallow breathing or loss of breath during sleep; each episode lasts roughly 20 to 40 seconds in length ― though more than 100 episodes may occur in the span of just one hour.

Central sleep apnea (CSA) is not caused by obstruction, but rather poor communication between the brain and the breathing muscles. CSA is quite rare in children and healthy adults, and most commonly diagnosed in patients 65 and older who have experienced a stroke, heart disorders, and other conditions that impair the brain's ability to send signals to other areas of the body.

Complex sleep apnea syndrome (CSAS) is diagnosed in patients who experience both OSA and CSA symptoms. Like CSA, CSAS is primarily found in older adults; this condition affects roughly 15% of men and 5% of women.

Risk Factors and Symptoms of Sleep Apnea in Children
Obesity is considered one of the major risk factors for childhood sleep apnea. Family history of apnea and sleep-disordered breathing is another important consideration. Other factors may include oral or facial defects that restrict the amount of airflow, or unusually large tongues that move around inside the mouth. Back-sleeping has also been linked to higher incidences of sleep apnea; side-sleeping is considered a better alternative for people with this condition.

For most children (and adults) with sleep apnea, the most common symptom is severe snoring. This symptom is also one of the most overlooked, due to the widespread misconception that snoring is innocuous (if not a little annoying).

Other sleep apnea symptoms shared by children and adults include heavy or shallow breathing while sleeping, fitful sleep, and nighttime waking. Additionally, children with sleep apnea often experience enuresis, or bedwetting. Daytime sleepiness and behavioral problems in school have also been noted in children with apnea; in many cases, apnea symptoms are mistaken for attention deficit-disorder (ADD) and other learning disabilities.

Diagnosing and Treating Children with Apnea
If you suspect your child is experiencing sleep apnea, the first step should be to consult a pediatrician that specializes in sleep disorders. The ASA notes that polysomnography testing is the "only tool for definitive diagnosis and assessment" of sleep apnea in children. Polysomnography involves an overnight stay in a sleep research laboratory, during which the child's sleep patterns will be monitored and evaluated. Be sure to prepare children for this experience, as it can be somewhat unsettling, particularly for young kids.

Due to the rarity of sleep apnea diagnoses in children, formal treatment is typically reserved for patients who exhibit moderate to severe symptoms. Children are rated using two scales: the apnea index (AI); and the apnea hypopnea index (AHI), which measures both apnea symptoms and hypopnea events, such as shallow breathing or low respiration. An AI index score of 5 or higher usually warrants treatment, as does an AHI index score of 5 to 10; both of these scores indicate moderate to severe apnea in children 12 and younger.

For a large segment of children with sleep apnea, the best treatment will be a simple adenotonsillectomy, since overgrown tonsils and/or adenoids can cause OSA through airway obstruction. These procedures eliminate all symptoms in roughly 70% to 90% children with sleep apnea.

If surgical procedures don't work, then a good alternative may be continuous positive airway pressure (CPAP) therapy. This form of therapy requires a machine that increases air pressure in the nose and throat. CPAP machines are designed for nightly use. This form of therapy does not eliminate apnea symptoms, but will reduce them on a nightly basis for as long as they are present. Your child should be tested to determine proper air pressure levels prior to using a CPAP machine.

An oral appliance may also help alleviate apnea symptoms in children as young as six. The appliance should cover the entire hard palate. Improvements have been noted in most users after continuous daily use for six months to one year.

Tips for Pediatric Sleep Apnea Management
In addition to medical treatments and positive airway pressure therapy, parents can help their children manage sleep apnea symptoms in the following ways:
  • If your child is overweight and experiencing apnea symptoms, then try restricting their diet and encouraging them to get more exercise in order to lower their body mass.
  • Limit the amount of sugar and caffeine (found in soft drinks and chocolate) your child consumes before bedtime. These substances increase alertness, which can exacerbate their sleep disruption and nighttime waking.
  • Since back-sleeping is considered a risk factor for sleep apnea, you can help your children learn to sleep on their sides. Another alternative is buying them an adjustable bed that allows them to elevate their upper body while sleeping.  

Ben Murray is a writer and researcher for sleep science hub He can usually be found running, hiking, biking or kayaking around the Pacific Northwest ― though he enjoys a good nap as much as the next person.

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