NIH defines sleep apnea (AP-ne-ah) as a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.
Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.
Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into light sleep.
As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness.
Obstructive sleep apnea
A common type of sleep apnea in children, obstructive apnea is caused by an obstruction of the airway (such as enlarged tonsils and adenoids). This is most likely to happen during sleep because that’s when the soft tissue at back of the throat is most relaxed. As many as 1% to 3% of otherwise healthy preschool-age kids have obstructive apnea.
- snoring (the most common) followed by pauses or gasping
- labored breathing while sleeping
- very restless sleep and sleeping in unusual positions
- daytime sleepiness or behavioral problems
Because obstructive sleep apnea may disturb sleep patterns, these children may also show continued sleepiness after waking in the morning and tiredness and attention problems throughout the day. Sometimes sleep apnea can affect school performance. One recent study suggests that some kids diagnosed with ADHDactually have attention problems in school because of disrupted sleep patterns caused by obstructive sleep apnea.
Treatment for obstructive apnea involves keeping the throat open to aid air flow, such as with adenotonsillectomy (surgical removal of the tonsils and adenoids) or continuous positive airway pressure (CPAP), which is delivered by having the child wear a nose mask while sleeping.
Central sleep apnea
Central sleep apnea occurs when the part of the brain that controls breathing doesn’t properly maintain the breathing process. In very premature infants, it’s seen fairly commonly because the respiratory center in the brain is immature.
Mixed sleep apnea
Mixed sleep apnea is a combination of central and obstructive sleep apnea and is seen particularly in infants or young children who have abnormal control of breathing. Mixed apnea may occur when a child is awake or asleep.
Sleep Apnea Symptoms in Children
During the night, a child with sleep apnea may:
- Snore loudly and on a regular basis
- Have pauses, gasps, and snorts and actually stop breathing. The snorts or gasps may waken them and disrupt their sleep.
- Be restless or sleep in abnormal positions with their head in unusual
- Sweat heavily during sleep
During the day, a child with sleep apnea may:
- Have behavioral, school and social problems
- Be difficult to wake up
- Have headaches during the day, but especially in the morning
- Be irritable, agitated, aggressive, and cranky
- Be so sleepy during the day that they actually fall asleep or daydream
- Speak with a nasal voice and breathe regularly through the mouth
Conditions Associated With Sleep Apnea
Kids Health states that Sleep apnea can be seen in connection with:
Apparent Life-Threatening Events (ALTEs)
An ALTE itself is not a sleep disorder — it’s a serious event with a combination of sleep apnea and change in color, change in muscle tone, choking, or gagging. Call 911 immediately if your child shows the signs of an ALTE.
ALTEs, especially in young infants, often are associated with medical conditions that require treatment; these include gastroesophageal reflux disease (GERD), infections, or neurological problems or cardiac disorders.
ALTEs are frightening to see, but can be uncomplicated and may not happen again. However, any child who has one should be seen by a doctor for evaluation immediately.
Apnea of Prematurity (AOP)
AOP can occur in infants who are born prematurely (before 34 weeks of pregnancy). Because the brain or respiratory system may be immature or underdeveloped, the baby may not be able to regulate his or her own breathing normally. AOP can be obstructive, central, or mixed.
Treatment for AOP can involve the following:
- keeping the infant’s head and neck straight (premature babies should always be placed on their backs to sleep to help keep the airways clear)
- medications to stimulate the respiratory system
- continuous positive airway pressure (CPAP) — to keep the airway open with the help of forced air through a nose mask
Premature infants with AOP are followed closely in the hospital. If AOP doesn’t resolve before discharge from the hospital, the baby might be sent home on an apnea monitor and parents and other caregivers will be taught CPR. The family will work closely with the child’s doctor to have a treatment plan in place.
Apnea of Infancy (AOI)
Apnea of infancy occurs in children younger than 1 year old who were born after a full-term pregnancy. Following a complete medical evaluation, if a cause of apnea isn’t found, it’s often called apnea of infancy.
AOI usually goes away on its own, but if it doesn’t cause any significant problems (such as low blood oxygen), it may be considered part of the child’s normal breathing pattern.
Infants with AOI can be watched at home with the help of a special monitor prescribed by a sleep specialist. This monitor records chest movements and heart rate and can relay the readings to a hospital apnea program or save them for future examination by a doctor. Parents and caregivers will be taught CPR before the baby is sent home.
If your child is exhibiting symptoms of sleep apnea, talk to a pediatrician who specializes in sleep disorders.
Undiagnosed and untreated sleep apnea may contribute to daytime fatigue and behavioral problems at school. According to a recent study in CHEST, the official journal of the American College of Chest Physicians, children who snored loudly were twice as likely to have learning problems. Following a night of poor sleep, children are more likely to be hyperactive and have difficulty paying attention. These are also signs of attentiondeficit/hyperactivity disorder ( ADHD). Apnea may also be associated with delayed growth and cardiovascular problems. Source: Sleep Foundation
If you suspect that your child is experiencing an ALTE, call 911 immediately.
Although prolonged pauses in breathing can be serious, after a doctor does a complete evaluation and makes a diagnosis, most cases of sleep apnea can be treated or managed with surgery, medications, monitoring devices, or sleep centers. Many cases of sleep apnea go away on their own.
Surgical removal of the adenoids and tonsils is the most common treatment for pediatric OSA. In uncomplicated cases, the operation results in complete elimination of OSA symptoms in 70 to 90 percent of the time. Although generally an outpatient procedure, some children with chronic medical conditions like obesity or severe OSA or complications of OSA should be carefully monitored overnight following the surgery.because breathing abnormalities may not appear until REM sleep begins several hours in the next extended sleep cycle after the operation.. Owing to post-operative swelling, full resolution of the OSA symptoms may not occur for six to eight weeks.
If adenotonsillectomy is not indicated or if the surgery does not fully resolve the symptoms, positive airway pressure therapy like that commonly prescribed for adults probably will be helpful.. (PAP therapy may also be prescribed before surgery in severe pediatric OSA cases.) PAP should be regarded as palliative rather than curative, however. Optimal pressure settings (sufficient to reduce or eliminate obstructive events without increasing arousals or central apneas) should be determined in an overnight sleep study, and efficacy studies and re-titrations should be regularly conducted: generally yearly or when there are significant weight changes in older children and adolescents.
As in adults, compliance with PAP therapy is a key factor in determining success. Adolescents pose a particular challenge. For many children, however, the dramatic improvement in the way they feel after PAP therapy is begun becomes an important motivating factor.
Other Treatment Steps
Oral appliances for treatment of pediatric OSA are helpful in some cases, especially in adolescents whose facial bone growth is largely complete. One device that rapidly expands the transversal diameter of the hard palate over a six-month to one-year period has been used successfully in children as young as 6.
Weight management, including nutritional, exercise, and behavioral elements, should be strongly encouraged for all children with OSA who are overweight or obese. An adequate nightly duration of sleep is an important component of weight management.
Other treatments are directed towards additional risk factors in individual cases; i.e., allergy medications for children with seasonal/environmental allergies, asthma medications/inhalers and treatment for gastroesophageal reflux.