Pediatric sleep apnea is a sleep disorder where a child has brief pauses in breathing while sleeping.
It’s believed that 1 to 4 percent of children in the United States have sleep apnea. The age of children with this condition varies, but many of them are between 2 and 8 years old, according to the American Sleep Apnea Association.
Two types of sleep apnea affect children. Obstructive sleep apnea is due to a blockage in the back of the throat or nose. It’s the most common type.
The other type, central sleep 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 breath.
One difference between the two types of apnea is the amount of snoring. Snoring can occur with central sleep apnea, but it’s much more prominent with obstructive sleep apnea because it’s related to airway obstruction.
Except for snoring, the symptoms of obstructive and central sleep apnea are basically the same.
Common symptoms of sleep apnea in children during the night include:
- loud snoring
- coughing or choking while asleep
- breathing through the mouth
- sleep terrors
- pauses in breathing
- sleeping in odd positions
Symptoms of sleep apnea don’t only occur at the night, though. If your child has a restless night’s sleep because of this disorder, daytime symptoms can include:
- difficulty waking up in the morning
- falling asleep during the day
Keep in mind that infants and young children who have sleep apnea may not snore, especially those with central sleep 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 trigger learning problems and poor academic performance.
Some children also develop hyperactivity, causing them to be misdiagnosed with attention-deficit/hyperactivity disorder (ADHD). It’s estimated that symptoms of obstructive sleep apnea may be present in up to 25 percent of children with a diagnosis of ADHD.
These children may also have difficulty thriving socially and academically. In more severe cases, sleep apnea is responsible for growth and cognitive delays and heart problems.
With obstructive sleep apnea, the muscles in the back of the throat collapse while asleep, making it harder for a child to breathe.
The cause of obstructive sleep apnea in children often differs from the cause in adults. Obesity is a main trigger in adults. Being overweight can also contribute to obstructive sleep apnea in children. But in some children, it’s most often caused by enlarged tonsils or adenoids. The extra tissue can completely or partially block their airway.
Some children are at risk for this sleep disorder. Risk factors for pediatric sleep apnea include:
- having a family history of sleep apnea
- being overweight or obese
- having certain medical conditions (cerebral palsy, Down syndrome, sickle cell disease, abnormalities in the skull or face)
- being born with a low birth weight
- having a large tongue
Some things that can cause central sleep apnea are:
It’s important to see a doctor if you suspect sleep apnea in your child. Your 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.
For the sleep study, your child spends the night in a hospital or a sleep clinic. A sleep technician places test sensors on their body, and then monitors the following throughout the night:
- brain waves
- oxygen level
- heart rate
- muscle activity
- breathing pattern
If your doctor isn’t sure whether your child needs a full sleep study, another option is an oximetry test. This test (completed at home) measures your child’s heart rate and the amount of oxygen in their blood while asleep. This is an initial screening tool to look for signs of sleep apnea.
Based on the results of the oximetry test, your doctor may recommend a full sleep study to confirm the diagnosis of sleep apnea.
In addition to the sleep study, your doctor may schedule an electrocardiogram to rule out any heart conditions. This test records the electrical activity in your child’s heart.
Adequate testing is important because sleep apnea is sometimes overlooked in children. This can happen when a child doesn’t display typical signs 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.
As a parent, make sure you know the risk factors for sleep apnea in children. If your child meets the criteria for sleep apnea and exhibits signs of hyperactivity or behavioral problems, talk to your doctor about getting a sleep study.
There are no guidelines discussing when to treat sleep apnea in children that are accepted by everyone. For mild sleep apnea without symptoms, your doctor may choose not to treat the condition, at least not right away.
Some children outgrow sleep apnea. So, your doctor may monitor their condition for a while 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.
Topical nasal steroids can be prescribed to relieve nasal congestion in some children. These medications include fluticasone (Dymista, Flonase, Xhance) and budesonide (Rhinocort). They should only be used temporarily until the congestion has resolved. They’re not intended for long-term treatment.
When enlarged tonsils or adenoids cause obstructive sleep apnea, surgical removal of the tonsils and adenoids is usually performed to open up your child’s airway.
In the case of obesity, your doctor may recommend physical activity and diet to treat sleep apnea.
When sleep apnea is severe or doesn’t improve with improve from initial treatment (diet and surgery for obstructive sleep apnea and diet and treatment of underlying conditions for central sleep apnea), your child may need continuous positive airway pressure therapy (or CPAP therapy).
During CPAP therapy, your child will wear a mask that covers their nose and mouth while asleep. The machine 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 it. 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.
There are also dental mouthpieces that children with obstructive sleep apnea can wear while asleep. These devices are designed to keep the jaw in a forward position and keep their airway open. CPAP is more effective, in general, but children tend to tolerate the mouthpieces better, so they’re more likely to use it every night.
Mouthpieces don’t help every child, but they might be an option for older children who no longer experience facial bone growth.
A device called a noninvasive positive pressure ventilation device (NIPPV) may work better for children with central sleep apnea. These machines allow a backup breathing rate to be set. This ensures that a set number of breaths are taken every minute even without a signal to breath from the brain.
Apnea alarms can be used for infants with central sleep apnea. It sounds an alarm when an episode of apnea occurs. This wakes the infant and stops the apneic episode. If the infant outgrows the problem, the alarm isn’t needed anymore.
Sleep apnea treatment works for many children. Surgery eliminates obstructive sleep apnea symptoms about 70 to 90 percent of children with enlarged tonsils and adenoids. Likewise, some children with either type of sleep apnea see an improvement in their symptoms with weight management or use of a CPAP machine or an oral device.
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, and this disorder puts them at risk for life-threatening complications like stroke or heart disease.
If you observe loud snoring, pauses in breathing while asleep, hyperactivity, or severe daytime fatigue in your child, speak with your doctor and discuss the possibility of sleep apnea.