OSBORNE HEAD & NECK INSTITUTE

Pediatric Sleep Apnea

Sleep problems in children fall on a large spectrum called sleep disordered breathing, which includes simple snoring and true sleep apnea, among other problems.

Snoring

Snoring is simply noisy breathing while sleeping.  This may indicate something simple and easily treatable such as large adenoid tissue or nasal allergy.  However, it may also represent a more significant sleep problem, such as sleep apnea.  It is important to have a snoring child evaluated to rule out concerning problems.

Pediatric obstructive sleep apnea

Pediatric sleep apnea is diagnosed when the child stops breathing during sleep.  This may appear like snoring, as the child will also snore.  However, in children with obstructive sleep apnea (OSA), the snoring progresses to where the child stops breathing.

The usual history is that of a child who snores and then, for a few seconds, makes no noise and then gasps or snorts, wakes up a little, breathes normally, and then resumes snoring.  This cycle continues throughout the night.

OSA occurs due to physical obstruction of the airways during sleep.  This is most commonly due to large tonsils and adenoid tissue.  During sleep, the body normally relaxes, which causes collapse of the muscles of the throat.  When the patient is awake, the tonsils do not touch but with the collapse of muscles during sleep, the tonsils touch and obstruct the airway.  The obstruction causes a drop in oxygen, which signals the brain to try to relieve the obstruction.  It does so by waking the child, so that the muscles are no longer relaxed and the airway is open.  The child then falls back asleep and the cycle resumes.

The most important part of this cycle is that during the period of poor oyxgen flow, the body goes into a state of stress, which disrupts sleep quality and can be strenuous on the body.  Poor sleep quality in children results in many symptoms including:

  • Change in the child’s temperament: the sleep-deprived child may become cranky, moody, inattentive, and disruptive at home and school.
  • Poor school performance
  • Lack of energy
  • Bedwetting
  • Slower growth or stunted growth
  • Attention deficit disorder (ADD) / attention deficit hyperactivity disorder (ADHD)

Diagnosis of sleep disordered breathing

There is perhaps no one more important in the diagnosis of pediatric sleep problems than the parent or caregiver.  The parent may observe snoring, gasping, snorting, and thrashing in bed as well as unexplained bedwetting.  They will receive reports from school about misbehavior and poor school performance or may notice their child does not appear their usual selves.

While it is important to bear in mind that not all children with poor school performance suffer from a sleep problem, it should be a consideration when snoring and social/school issues are noted.

The sleep study is the standard diagnostic test for sleep disordered breathing. This test can be performed in a sleep laboratory with the parents present. While not 100% reliable, they may give clues as to the nature of a child’s sleep problems.  They may also help the clinician by leading towards or away from certain treatment choices.

How is sleep disordered breathing treated?

After thorough evaluation by the pediatrician and pediatric otolaryngologist, many treatment options may be considered including:

  • Tonsillectomy
  • Adenoidectomy
  • Nasal sprays
  • Nasal surgery

Tonsillectomy and adenoidectomy is not necessary in every snoring child.  It is critical to form a treatment plan with your pediatric otolaryngologist.  If it is determined that surgery is the right course for your child, tonsillectomy and adenoidectomy have an extremely high success rate at curing sleep disordered breathing.

A special group of children are those with craniofacial abnormalities, primarily abnormalities of the jaw bones, tongue, and associated structures.  These children often have sleep disordered breathing. This must be managed and treated as the child grows.

PREPARING FOR YOUR APPOINTMENT

DOES YOUR CHILD HAVE RECURRENT EAR INFECTIONS?

DOES YOUR CHILD HAVE RECURRENT STREP THROAT / TONSIL INFECTIONS?

DOES YOUR CHILD HAVE RECURRENT SINUS INFECTIONS?

DO YOU HAVE CONCERNS ABOUT YOUR CHILD’S HEARING OR DID YOUR CHILD FAIL A HEARING SCREEN?

ARE YOU CONCERNED ABOUT YOUR CHILD’S SNORING AT NIGHT?

DOES YOUR CHILD ALWAYS HAVE A STUFFY NOSE?

DOES YOUR CHILD HAVE A LUMP IN THEIR NECK?

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