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Signs of sleep apnea
The causes and symptoms of obstructive sleep apnea in children, plus how to treat it


May 2016

Whenever 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 explains.

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 sleep."

"They can also be sweaty when they sleep, and sometimes they complain of a headache when they wake up in the morning," adds D’Andrea.

"Most 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."

Nothing good 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.

Properly 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



This story ran in the May 2016 issue of: