I let my kids stay up late (and I do so more often than I like to
admit), I always feel guilty about it. Aside from providing your child
with a healthy diet, ensuring he or she gets enough sleep may be the
most important thing parents can do for their child’s health. For
many parents, getting their kids into bed on time is not the problem.
Researchers and clinicians are finding that sleep apnea, which most
people tend to think of as an adult sleep disorder, is relatively
common in children as well.
Dr. Lynn D’Andrea,
medical director of pulmonary services at Children’s Hospital of
Wisconsin, says that 2 percent of the children who visit the Sleep
Center suffer from obstructive sleep apnea (OSA). "At Children’s
Hospital of Wisconsin, we have two sleep laboratories dedicated solely
to the care of children. Every year we see hundreds of children with
sleep apnea. It is seen most commonly in children between the ages of
4 and 10, and then again in adolescents. In the younger children, the
most common cause of sleep apnea is enlarged tonsils and adenoids, and
obesity is the primary cause of sleep apnea in adolescents," she
When tonsils and
adenoids are enlarged, they narrow the upper airway and obstruct the
normal flow of air, possibly leading to obstructive sleep apnea.
According to board-certified oral and maxillofacial surgeon Dr. Mark
Kortebein, a child’s sleep should appear effortless, quiet and
peaceful. "Noisy breathing or snoring is not normal in
children," he says. "Signs to watch for are if your child
seems to be exerting effort to breathe while sleeping, waking often
during the night, or if they are excessively sleepy during the day
despite getting the appropriate hours of
also be sweaty when they sleep, and sometimes they complain of a
headache when they wake up in the morning," adds D’Andrea.
parents that bring their child to the Sleep Center at Children’s
Hospital of Wisconsin do so because the child is snoring or they are
alarmed by how the child looks when he/she sleeps, with very labored
breathing," D’Andrea continues. "Other times the child is
having difficulty in school — maybe the teachers have commented that
the child can’t concentrate or focus on their schoolwork. Many
parents are aware of the association between ADHD and sleep apnea and
want to have the child evaluated."
comes from a child not getting enough quality sleep. D’Andrea says
that sleep apnea can adversely affect cognitive function, causing
difficulty with concentration and hyperactive behavior. "Left
untreated, sleep apnea can be associated with hypertension (high blood
pressure) and weight gain," she cautions.
diagnosing sleep apnea in children entails a detailed clinical
history, comprehensive physical examination and diagnostic tests. The
most common test for sleep apnea is an overnight sleep study to
confirm the child has sleep apnea and to also determine how serious
the condition is.
If a child is
diagnosed with OSA, treatment depends on the cause and severity.
"The removal of tonsils and adenoids is the most frequent
surgical treatment in young children. In some cases, OSA is caused by
craniofacial anomalies, primarily mandibular hypoplasia
(underdeveloped mandible). In these cases, surgery is required to
correct skeletal structural abnormalities. Nonsurgical treatment
consists mainly of splints that reposition the lower jaw to aid in
opening the upper airway," says Kortebein.
According to D’Andrea,
some children need to sleep with the same continuous positive airway
pressure (CPAP) device often used for adult sleep apnea. "This is
mostly an option for older children who are not surgical candidates or
who have residual sleep apnea after surgery. In overweight children,
the solution may be as simple as losing some of the excess
weight," she says. m