Pediatric sleep apnea is a sleep disorder that causes children to have pauses in their breathing while they sleep.
Two types of sleep apnea affect children: obstructive sleep apnea and central sleep apnea (central apnea).
Obstructive sleep apnea is caused by a blockage in the back of the throat or nose.
The other type, central apnea, occurs when the part of the brain responsible for breathing doesn’t function properly. It doesn’t send the breathing muscles the normal signals to breathe.
One difference between the two types of apnea is the frequency of snoring. Snoring can occur with central apnea, but it’s more prominent with obstructive sleep apnea. This is because snoring is related to airway obstruction.
Between 7 and 11 percent of children have a nighttime breathing disorder, whether it’s sleep apnea, snoring, or something else. Around 90 percent of them may be undiagnosed.
According to a 2014 review, obstructive sleep apnea affects 1 to 5 percent of children. It often starts when they’re between 2 and 8 years old. Obstructive sleep apnea is significantly more common than central apnea, in both children and adults.
The symptoms of obstructive and central apnea may be similar, aside from differences in snoring.
Common symptoms for children with sleep apnea include:
- loud snoring
- coughing or choking while asleep
- pauses in breathing
- breathing through the mouth
- sleep terrors
- bedwetting
- sleeping in odd positions
Symptoms of sleep apnea don’t only occur at night, though. If your child has a restless night’s sleep because of this disorder, daytime symptoms can include fatigue, falling asleep, and difficulty waking in the morning.
Infants and young children who have sleep apnea may not snore, especially those with central apnea. Sometimes the only sign of sleep apnea in this age group is troubled or disturbed sleep.
Untreated sleep apnea leads to long periods of disturbed sleep, resulting in chronic daytime fatigue.
A child with untreated sleep apnea may have difficulty paying attention in school. This can result in learning problems and poor academic performance.
Some children also develop hyperactivity, causing them to be misdiagnosed with attention deficit hyperactivity disorder (ADHD).
Children with untreated sleep apnea may also have difficulty thriving socially. In more severe cases, untreated sleep apnea is responsible for growth delays, cognitive delays, and heart problems. If sleep apnea is properly treated, these complications will likely improve.
Untreated sleep apnea can also cause high blood pressure, increasing the risk of stroke and heart attack in adults. It may also be associated with childhood obesity.
Obstructive sleep apnea and central apnea have different causes and risk factors.
In obstructive sleep apnea
With obstructive sleep apnea, the muscles in the back of the throat collapse while the child is asleep, making it harder for them to breathe.
The risk factors for obstructive sleep apnea in children often differ from the risk factors for adults.
Obesity is the main trigger in adults. Being overweight can also contribute to obstructive sleep apnea in children. However, in some children, the condition is most likely caused by enlarged tonsils or adenoids. The extra tissue can completely or partially block their airways.
Research suggests that African American children have
Other risk factors for obstructive sleep apnea in children can include:
- a family history of sleep apnea
- having certain medical conditions, such as:
- cerebral palsy
- Down syndrome
- sickle cell disease
- abnormalities in the skull or face
- having a large tongue
In central apnea
Central apnea occurs when the muscles that control breathing fail to activate. It’s rare in children outside of the newborn period.
Having a low birth weight is one of the risk factors for central apnea. A form called apnea of prematurity is seen in premature babies.
Other risk factors for central apnea include:
- some medical conditions that affect your brain stem, spinal cord, or heart, such as heart failure and stroke
- some medications that affect your breathing patterns, such as opioids
- some congenital anomalies
See a doctor if you suspect your child has sleep apnea. The pediatrician may refer you to a sleep specialist.
To properly diagnose sleep apnea, the doctor will ask about your child’s symptoms, perform a physical examination, and schedule a sleep study, if needed.
Sleep study
For the sleep study, your child spends the night in a hospital or sleep clinic. A sleep technician places test sensors on their body, and monitors the following throughout the night:
- brain wave activity
- breathing patterns
- oxygen level
- heart rate
- muscle activity
Electrocardiogram (ECG or EKG)
If your child’s doctor is concerned that they may have a heart condition, the doctor may schedule an electrocardiogram (ECG or EKG) in addition to the sleep study. This test records the electrical activity in your child’s heart.
The importance of testing
Adequate testing is important because sleep apnea is sometimes overlooked in children. This can happen when a child doesn’t display typical symptoms of the disorder.
For example, instead of snoring and taking frequent daytime naps, a child with sleep apnea may become hyperactive, irritable, and develop mood swings, resulting in the diagnosis of a behavioral problem.
If your child meets the criteria for sleep apnea and exhibits hyperactivity or symptoms of behavioral problems, see their doctor.
There are no universal guidelines for treating sleep apnea in children. For mild sleep apnea without symptoms, a doctor may choose not to treat the condition, at least not right away.
Some children also outgrow sleep apnea, so their doctor may monitor their condition to see if there’s any improvement. The benefits of doing this have to be weighed against the risk of long-term complications from untreated sleep apnea.
For children with obstructive sleep apnea, initial treatments include diet and surgery. For children with central apnea, initial treatments include diet and treatment of underlying conditions.
Lifestyle changes
In the case of obesity, your child’s doctor may recommend physical activity and diet to treat sleep apnea.
Nasal steroids
Topical nasal steroids can be prescribed to relieve nasal congestion in some children. These include fluticasone (Dymista, Flonase, Xhance) and budesonide (Rhinocort).
Nasal steroids are usually prescribed for an initial period, which often lasts 1-3 months. The doctor will then reevaluate the treatment plan.
Surgery
When obstructive sleep apnea is caused by enlarged tonsils or adenoids, surgical removal of both the tonsils and adenoids is usually performed to open up your child’s airway.
A 2016 study found that adenoid removal was equally as effective as tonsil and adenoid removal for a child who met the following criteria:
- was younger than 7 years old
- didn’t have childhood obesity
- had moderate, as opposed to severe, obstructive sleep apnea
- had small tonsils
Continuous positive airway pressure (CPAP) therapy
When sleep apnea is severe or doesn’t improve with initial treatment, your child may need continuous positive airway pressure (CPAP) therapy.
During CPAP therapy, your child will wear a mask that covers their nose and mouth while they sleep. The mask is connected to a CPAP machine, which provides a continuous flow of air to keep their airway open.
CPAP can help the symptoms of obstructive sleep apnea, but it can’t cure them. The biggest problem with CPAP is that children (and adults) frequently don’t like wearing a bulky face mask every night, so they stop using it.
Oral appliances
There are also oral appliances that children with obstructive sleep apnea can wear while they sleep. These devices are designed to keep the jaw in a forward position, keep the tongue in place, and keep the airway open. CPAP is more effective, in general, but children tend to tolerate the oral appliances better, so they’re more likely to use them every night.
Oral appliances don’t help every child, but they might be an option for older children who no longer experience facial bone growth.
Noninvasive positive pressure ventilation device (NIPPV)
A device called a noninvasive positive pressure ventilation device (NIPPV) may work better for children with central apnea. These machines allow a backup breathing rate to be set. This ensures that a child takes a set number of breaths every minute even without a signal from the brain to breathe.
Apnea alarms
Apnea alarms can be used for infants with central apnea. When an episode of apnea occurs, the alarm sounds. This wakes the infant and stops the apneic episode. If the infant outgrows sleep apnea, they can stop using the alarm.
Apnea alarms are almost never recommended outside of a hospital setting.
Sleep apnea treatment works for many children.
According to a 2018 review of studies, surgery to remove the tonsils and adenoids reduces obstructive sleep apnea symptoms in anywhere from 27 to 79 percent of children. Children were more likely to experience symptoms after surgery if they were older, had childhood obesity, or had more severe apnea prior to surgery.
A 2013 random trial found that Black children were also more likely than other children to experience symptoms after surgery. However, they also had more severe apnea overall.
Symptoms tend to improve with weight management, a CPAP machine, or an oral appliance.
If left untreated, sleep apnea can worsen and interfere with your child’s quality of life. It can become difficult for them to concentrate in school. If it persists into adulthood, this disorder may put them at risk for complications such as stroke or heart disease.
If you observe any of the following symptoms in your child, speak with their doctor about the possibility of sleep apnea:
- loud snoring
- pauses in breathing while they sleep
- severe daytime fatigue
- hyperactivity