Understanding Sleep Apnea
With pediatric sleep apnea, a child’s breathing pauses during sleep because the airway has become narrowed or partly blocked.
During sleep, all of the muscles in the body become more relaxed. This includes the muscles that help keep the throat open so air can flow into the lungs. This can lead to sleeping problems.
Normally, the throat remains open enough during sleep to let air pass by. However, some children have a narrow throat. This is often because of large tonsils or adenoids, which partially block the airflow resulting in disturbed sleep. When the muscles in their upper throat relax during sleep, the tissues close in and block the airway. This stop in breathing is called apnea.
Other factors that also may increase the risk of pediatric sleep apnea in children include:
- A small jaw
- Certain shapes of the roof of the mouth (palate)
- Large tongue, which may fall back and block the airway
- Poor muscle tone due to conditions such as Down syndrome or cerebral palsy
The American Sleep Apnea Association estimates that 1% to 4% of children and adolescents may have Sleep Apnea. Sleep Apnea in kids can also contribute to hyperactivity and attention issues, and leads to more serious medical complications. Symptoms of Sleep Apnea in children can be caused by many different risk factors. Read on to learn how Sleep Apnea could possibly be impacting your child and learn how the Professionals at El Paso Sleep Center can help with the management of obstructive sleep in children.
The American Sleep Apnea Association estimates that Sleep Apnea affects between 1% to 4% of children, and many of these children are between 2 and 8 years of age. Although it’s possible for children to outgrow Sleep Apnea, these sleep disorders can still cause many problems for children while they persist.
According to the American Journal of Respiratory and Critical Care Medicine poor sleep makes it difficult for children to pay attention and may increase hyperactivity, while apnea is also associated with heart problems, learning difficulties, behavioral issues, and delayed growth. Since Sleep Apnea has such an impact on a child’s overall health and well-being, it’s important to be aware of the symptoms of pediatric Sleep Apnea. If your child has any symptoms, seek treatment immediately. The Professional pediatric sleep specialists at the El Paso Sleep center can be your pediatric sleep apnea doctors. We specialize in pediatric sleep apnea in El Paso.
Sleeping is required for normal growth and development. Sleep disorders are common in children and can have a negative impact on their health and well-being.
Early diagnosis and treatment are important to prevent complications that can impact children’s growth, cognitive development and behavior.
Pediatric sleep disorders require careful and extended evaluations that include interviewing the parents, child, teachers, as well as assigning and reviewing sleep diaries. Parents should be encouraged to record children’s sleep-wake habits using sleep diaries over a 24-hour period for at least two continuous weeks prior to initial visit. This can be useful to support the reported sleep-related complaints as well as guide routine history taking. Sleep diaries also assist in detecting day-to-day variability in sleep patterns that can often be missed during routine history and physical exams. It’s important to work with your care team on the development of a sleep diary
Current evidence indicates that chronically disrupted sleep in children and adolescents can lead to problems in cognitive functioning, behavioral problems, such as attention, learning, and memory. Behavioral interventions, especially in young children, have been shown to produce clinically significant improvements. This is of particular importance given the relative lack of data regarding use of pharmacological interventions for sleep difficulties in children.
Graphic diaries appear to be more helpful in understanding sleep-wake cycles in pediatric patients rather than descriptive data. An example of a graphic sleep diary can be found at the sleep education website endorsed by the American Academy of Sleep Medicine (AASM) and is available for free download at its Web site. A simple acronym like BEARS (4), which stands for bedtime resistance/sleep onset delay; excessive daytime sleepiness; awakenings at night; regularity, patterns, and duration of sleep; and snoring and other symptoms, can be useful during initial screening of a child’s sleep difficulties. Another alternative is do allow for an overnight sleep study which can be scheduled through the El Paso Sleep Center.
Self-report sleep questionnaires, such as the School Sleep Habits Survey and Children’s Sleep Habits Questionnaire (CSHQ) are useful to screen for more specific sleep disorders in target populations, such as adolescents and school-aged children(6) The Sleep Disturbance Scale for Children (SDSC) is a useful 26-item parent questionnaire that was developed for children and adolescents to screen for primary sleep disorders such as obstructive sleep apnea.
Obtaining a detailed and accurate history followed by a physical exam, including screening for developmental delays and cognitive dysfunction, appears to be a cornerstone for diagnosing pediatric sleep complaints. It is equally important to involve family members in the clinical interview to understand the potential causes of sleep disturbances because children and adolescents often do not recognize events that can disturb sleep. For example, they are usually not aware of snoring or leg movements that occur during sleep. Patients are unaware if they get deep and restful sleep. They may be sleeping but not getting “good” sleep.
The physical exam may provide clues to treatable medical causes. Diagnostic tests are available but difficult to access in some communities. Many sleep problems in children can be improved with instruction on sleep hygiene and the importance of sleep to health and behavior. Medical causes of sleep problems are rare but often benefit from treatment and therefore warrant attention during any evaluation.
At one time, elementary school children went to bed easily and woke up early, naturally without alarms. Now their sleep is disrupted by TV, computer games, texting, and other digital distractions. Sleep deprivation is often the primary cause now of inattention, school failure, poor peer relations, and obesity. Medical causes of sleep problems are often overlooked in children because of their difficulty in reporting symptoms.
Primary sleep disorders, such as obstructive sleep apnea (OSA) and restless legs syndrome (RLS), in children have been shown to be associated with excessive daytime sleepiness, impaired attentional capacity and memory, behavioral issues, and attention deficit hyperactivity disorder (ADHD).
Pediatric OSA is a sleep disorder in which a child’s breathing is completely or partially blocked, often repeatedly during sleep. This is caused by narrowing or blockage of the upper airway during sleep. These breathing disturbances often result in brief arousals from sleep, which can interfere with obtaining good quality sleep. Therefore, screening for daytime impairments are important in children suspected of having obstructive sleep apnea (OSA).
While bedtime difficulties and frequent night time awakenings are seen during infancy and early childhood, sleep difficulties due to insufficient sleep hygiene or circadian rhythm disorders tend to be more prominent in adolescence. Sleep problems in children and adolescents can complicate other underlying medical conditions, such as obesity and asthma, and psychological problems, such as depression, anxiety, and substance abuse. Once a proper diagnosis is made, we can make recommendations to correct any of these pediatric sleep disorders.
Treatments for Pediatric Sleep Apnea
According to the Korean Journal of Pediatrics, one of the most common treatments for Sleep Apnea in children is the removal of the tonsils and adenoids if they are enlarged. If your pediatrician feels like your child’s Sleep Apnea may be caused by enlarged tonsils or adenoids, you may be referred to an ear, nose, and throat doctor (ENT). Your child may need an adenotonsillectomy to remove both the tonsils and adenoids, and for many children, this resolves the problem.
When the adenoids and tonsils aren’t the cause of Sleep Apnea or the symptoms remain after your child’s adenotonsillectomy, then continuous positive airway pressure (CPAP) therapy may be recommended for your child. CPAP therapy involves wearing a mask that covers the mouth and nose while your child is sleeping.
If being overweight is a factor in your child’s Sleep Apnea, it will be important to work with your doctor on safe weight loss methods for your child, including exercise and dietary changes. If your child’s Sleep Apnea is mild, weight loss may eliminate the problem and your child may not need further treatment.
Other treatments that may be used to address other risk factors in unique cases include:
- Asthma inhalers and medications
- Treatments for gastroesophageal reflux
- Allergy medications for children with environmental or seasonal allergies
- Oral appliances
Sleep Apnea does occur in infants, toddlers, and children, and failing to treat it can have a serious impact on your child’s overall health, behavior, and development. Seek treatment if your child displays any of the symptoms of Sleep Apnea in children, and you can work together with your pediatrician to find the best treatment to ensure your child begins getting healthy sleep.
For more information on the treatment for children with obstructive sleep issues, call the El Paso Sleep Center today for a FREE evaluation. We are your pediatric care physicians and will work with you, your family and your child to find the best solution to pediatric and adolescent sleep issues. Call us today at: 575-647-5337.