What a Parent Needs to Know About Sleep Apnea in Children

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Since the 1970's, it has been recognized that sleep apnea* can occur in children as well as adults. It is estimated that 2-4% of children overall have sleep apnea, but these percentages are likely much lower than the reality. As in adults, sleep apnea often goes unrecognized, undiagnosed and untreated in children, with equally, if not more severe, consequences to health, development and well-being. Below are some basic facts about sleep apnea in children of which all parents should be aware.

Dr. Judith Owens

Risk Factors

While any child may have sleep apnea, there are certain conditions that increase the risk. These include:

 

  • Large tonsils and adenoids

  • Being overweight or obese

  • Asthma and environmental allergies

  • A family history of sleep apnea

  • Premature birth

  • Some ethnic/racial groups (African-American, Latino, Asian)

  • Certain medical conditions (Down syndrome, Pierre-Robin syndrome, Prader-Willi syndrome) that may result in a smaller size face and upper airway or obesity

Symptoms

Symptoms of sleep apnea in children may be similar but differ in some important ways from those in adults. If parents have any concerns related to the below, they should speak to their pediatrician. The next steps in terms of diagnosis typically includes an overnight sleep study in a sleep lab to monitor breathing and oxygen levels and confirm a diagnosis of sleep apnea.

At Night

  • Loud frequent snoring (not just with colds)

  • Breathing pauses (less frequent than in adults)

  • Mouth breathing during sleep

  • Choking, gasping in sleep

  • Restless sleep

  • Sweaty in sleep

  • Needing to sleep with several pillows

During the Day

  • Feeling sleepy, dozing off, starting to take naps again (this is more common in older and obese children, and those with more severe sleep apnea)

  • Difficulty waking in the morning in spite of getting enough sleep

  • Hyperactivity, poor attention span, impulsivity, aggressive behavior (these are common signs of poor sleep, especially in younger children, and may be mistakenly diagnosed as attention deficit hyperactivity disorder (ADHD))

  • Mood swings, irritability

  • Difficulties performing in school; decrease in grades

Treatment

Sleep apnea in children has different causes and presents with different symptoms compared to adults. Parents are usually the first ones to recognize the symptoms, and so should alert their child's healthcare provider about their concerns. There are many effective treatment options available, so the importance of early recognition and diagnosis is critical to prevent the important potential consequences of sleep apnea on brain development. behavior. mood, health and well-being.

Treatments include:

  • Some children may outgrow the symptoms of mild sleep apnea over time

  • Surgery (removal of the tonsils and adenoids); this requires consultation with an ENT (Ears Nose and Throat) specialist

  • Weight loss

  • Drug treatment of inflammation on the nose and throat (Flonase and Singulair)

  • Dental appliances (to increase the size of the upper breathing passages)

  • Exercises to improve the function of upper breathing passages (myofunctional therapy)

  • Breathing assistance: the most common treatment for sleep apnea in adults is CPAP (continuous positive airway pressure) using a device that delivers air under pressure to open the airways; this treatment can also be successful in children who are appropriate patients. Special masks and CPAP units are available for children to make this treatment more acceptable.

Depending on risk factors and severity of sleep apnea, some may involve "Watchful waiting".

*A distinction should be made between obstructive sleep apnea, in which there is some blockage to breathing and central sleep apnea, which especially in infants may be related to immature control of breathing

** Parents should ask if the sleep lab is equipped to study children and has accommodations for parents

Dr. Judith Owens is Director of Sleep Medicine at Boston Children’s Hospital in Boston Massachusetts and a Professor in Neurology at Harvard Medical School. She is an internationally-recognized authority on pediatric sleep and the author of over 175 original research and review articles in peer-review journals, chapters, and books on the topic.