I think it’s pretty safe to say that most of us are aware of sleep apnea, but sleep apnea also happens in children. In the adult world, if not identified and treated appropriately, sleep apnea is often associated with hypertension and other cardiovascular complications, cerebral vascular accidents (AKA strokes), diabetes, and even depression.
Your children are also at risk of sleep apnea, particularly obstructive sleep apnea or OSA. In infants, craniofacial abnormalities are typically the cause of sleep apnea. In pre-school to early grade school children, sleep apnea issues are typically due to hypertrophy (i.e. swelling) of the adenoids and/or tonsils. And for the ‘tweens and teens, being overweight is often associated with sleep apnea. Furthermore, sleep apnea is also often seen with children who have neuromuscular disorders or cerebral palsy.
So how might sleep apnea present? With younger children, snoring is nearly always present but along with the snoring, parents may also hear a period of silence (few seconds) then an uncomfortable arousal. Ultimately, these children are not getting good sleep and are often fatigued and sleepy during the next day. Children who are nighttime bed-wetters and/or may not be performing to their fullest potential at school may also be suffering from sleep apnea.
How to make the diagnosis? Typically, a child’s history will alert the parents and physician to possible sleep issues. On exam, the tonsils are typically easy to visualize but for the adenoids, a lateral neck x-ray is often taken to help determine if they are enlarged. CT scans may occasionally be done if looking for particular craniofacial abnormalities.
But the greatest diagnostic tool is an overnight attended polysomnogram (PSG). A PSG will evaluate how many obstructive events occur during the night and whether oxygen deprivation periods occur. But often, this is not needed if the history and physical exam give enough information to make the OSA diagnosis.
What is the treatment for sleep apnea? Depending upon the underlying etiology, treatment will vary. Surgery is performed for children with tonsil and/or adenoid hypertrophy. If allergies, in particular allergic rhinitis, is contributing to the symptoms, then intranasal steroids may be used to help reduce the inflammation in the nasal passages but otherwise, there is typically no role for medications in the treatment of sleep apnea. For overweight children, appropriate dietary and physical activity guidance is given. In emergency situations, the use of a noninvasive “breathing machine” which involves positive pressure ventilation may be used.
But the bottom line is if you are concerned your child may have sleep apnea, please discuss further with his/her pediatrician.