Does your child snore? What about issues with hyperactivity, irritability, focus and concentration? All of these are possible signs of pediatric sleep apnea. Which is more common among children than was generally recognized. It’s estimated that between 1 to 5 percent suffer from pediatric sleep apnea, it can occur at any age but many of them being between 2 and 8 years old.
Studies have suggested that as many as 25 percent of children diagnosed with attention-deficit hyperactivity disorder (ADHD) may actually have symptoms of pediatric sleep apnea. And that much of their learning difficulty and behavior problems can be the consequence of chronic fragmented sleep. Bed-wetting, sleep-walking, retarded growth, other hormonal and metabolic problems, even failure to thrive can be related to sleep apnea. Several recent studies show a strong association between pediatric sleep disorders and childhood obesity. Treatment decisions are individualized and depend upon findings from a comprehensive evaluation.
The American Academy of Pediatrics (AAP) guideline recommends that children who frequently snore should be tested for obstructive sleep apnea. The clinical practice guideline “Diagnosis and Management of Childhood Obstructive Sleep Apnea” was published in the September 2012 issue of Pediatrics. The guideline recommends in-lab polysomnography for children with daytime learning problems, labored breathing during sleep and disturbed sleep with frequent gasps, snorts or pauses. The guidelines also call for children and adolescents to be screened for snoring as part of routine physician visits. The AAP recommends adenotonsillectomy as the first-line treatment for children with sleep apnea. Pediatricians may also recommend weight loss in obese patients or CPAP if surgery is ineffective or not conducted.
There are differences between pediatric obstructive sleep apnea and adult sleep apnea. While adults usually have daytime sleepiness, children are more likely to have behavioral problems. The underlying cause in adults is often obesity, while in children the most common underlying condition is enlargement of the adenoids and tonsils. However, obesity also plays a role in children. Other underlying factors can be craniofacial anomalies and neuromuscular disorders. Early diagnosis and treatment are important to prevent complications that can affect children’s growth, cognitive development and behavior.
Signs and symptoms of pediatric sleep apnea might include:
- Difficulty focusing/concentrating
- Pauses in breathing
- Restless sleep
- Snorting, coughing or choking
- Mouth breathing
- Bed wetting
- Sleep terrors
Infants and young children with obstructive sleep apnea don’t always snore. They might just have disturbed sleep.
DURING THE DAY, CHILDREN WITH SLEEP APNEA MIGHT:
- Perform poorly in school
- Have difficulty paying attention
- Have learning problems
- Have behavioral problems
- Have poor weight gain
- Be hyperactive
Besides obesity, other risk factors for pediatric sleep apnea include having:
- Down syndrome
- Abnormalities in the skull or face
- Cerebral palsy
- Sickle cell disease
- Neuromuscular disease
- History of low birth weight
- Family history of obstructive sleep apnea
MAKING A DIAGNOSIS
As in adults, a polysomnography (sleep study) is the only tool for a definitive diagnosis and assessment of the severity of pediatric sleep apnea. It needs to be conducted during an overnight stay in a sleep lab, with the test conducted by technologists experienced in working with children and the data interpreted by a sleep medicine physician with pediatric experience. In addition, since children’s sleep apnea is frequently most pronounced during REM sleep late in the sleep cycle, home sleep studies and daytime nap studies are not useful and can be misleading.
- Surgery-Tonsillectomy and Adenoidectomy
- Mandibular Expanders or Oral Appliance Therapy
- CPAP Therapy
- Weight Management
Surgical removal of the adenoids and tonsils is the most common treatment for pediatric sleep apnea. In uncomplicated cases, the operation results in complete elimination of OSA symptoms in 70 to 90 percent of the cases. 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.
If adenotonsillectomy is not indicated, or if the surgery does not fully resolve the symptoms, positive airway pressure therapy (PAP) like that commonly prescribed for adults probably will be helpful (PAP therapy may also be prescribed before surgery in severe pediatric sleep apnea cases.) Optimal pressure settings (enough to reduce or eliminate obstructive events without waking the child) should be determined in an overnight sleep study, and efficacy studies. Re-titrations should also 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 challenge. For many children, however, the dramatic improvement in the way they feel after PAP therapy is begun becomes an important motivating factor, but family involvement and encouragement is important.
OTHER TREATMENT OPTIONS
Oral appliances for treatment of pediatric OSA are helpful in some cases, especially in adolescents whose facial bone growth is largely complete. A palate expander, another device that rapidly expands the diameter of the hard palate over a six-month to one-year period has been used successfully in children as young as 6 years of age.
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.
FINDING A SPECIALIST
Comprehensive Sleep Care Center offers expert diagnosis, treatment, and care for pediatric sleep disorders for children from the ages of 3 months and up, with the goal of providing a better night’s sleep and a better day ahead for the entire family.
If you suspect that your child or teen has a sleep problem that goes beyond a few nightmares or restless nights, do not delay seeking help. Start with your child’s pediatrician or call and schedule a consult with one of our board-certified pediatric sleep medicine physicians. The earlier a sleep problem is identified and treated, the more quickly a normal sleep routine can be restored—for everyone.
Our Arlington and Lansdowne centers offer a kid themed room, but we can accommodate children at all our centers. Mom, Dad or a guardian is required to be present for patients under 18 years old. Most rooms have an overstuffed recliner to sleep in next to your child. Children are encouraged to bring their own toys, favorite blanket or any items from home that will make their stay more comfortable.