Obstructive sleep apnea (OSA) means that someone's upper airway becomes temporarily blocked, resulting in snoring or mouth breathing. These episodes result in a drop in the oxygen levels and an increase in the carbon dioxide levels in the bloodstream, and a decrease in the quality of restful sleeping. When left untreated, sleep apnea can result in multiple medical and psychological complications in both adults and children.
How Often Does Sleep Apnea Occur in Children?
Sleep apnea in children often goes undiagnosed, especially since 20% of normal children will occasionally snore, and only 3% of young children actually have OSA. Preschool age children are the most likely age group to develop OSA, as this is the age at which adenoid and tonsillar hypertrophy is most commonly seen - an important risk factor for OSA. Sleep apnea is more common in boys, overweight children and African American children.
What Happens during Sleep Apnea?
Sleep apnea often occurs as a result of structural abnormalities causing narrowing of the upper airway. Neurologic factors, such as lack of muscle tone in the muscles of the upper airway, may also play a role in the development of OSA in children. During sleep, the muscles are more relaxed in the upper airway, and if there is enlarged or swollen tissue in this area (such as enlarged tonsils, adenoids or swollen nasal passages caused by allergic rhinitis ), breathing is impaired. The lack of air moving through the airways and into the lungs results in less oxygen and more carbon dioxide in the bloodstream. This leads to the body trying to compensate by "waking up" (arousals) just enough to increase airway muscle tone and respiratory effort, which leads to decreased quality sleep.
Which Children Are At Risk for Sleep Apnea?
Enlargement of the tonsils and adenoids is the most common risk factor for OSA in children. Other structural abnormalities that increase the risk for OSA include jaw abnormalities ( micrognathia or retrognathia ), congenital facial abnormalities, and having a large tongue ( macroglossia ). Obesity, nasal allergies, neuromuscular diseases , the use of medications with sedative effects, sickle cell anemia , and a family history of OSA are all risk factors for the development of sleep apnea in children.
Allergic rhinitis and non-allergic rhinitis , resulting in nasal congestion , is another important risk factor for sleep apnea in children. It also appears that the inflammatory chemicals released by the body as a result of allergic rhinitis are also an important factor for the development of sleep apnea. Treatment of allergic rhinitis, by reducing nasal congestion as well as the inflammatory chemicals produced as a result of allergic reactions, has been shown to significantly decrease the signs and symptoms of sleep apnea.
What Are the Symptoms of Sleep Apnea?
Nearly all children with OSA will snore loudly, although sleep apnea only occurs in approximately 10 to 30% of children who snore (so snoring doesn't necessarily mean a child has sleep apnea). Other symptoms include pauses in breathing (apneas), snorting, gasping, or struggling during breathing. It is also common for children with sleep apnea to sweat during the night, "toss and turn" and seem "restless" while sleeping. Children may attempt to overcome the airway obstruction by sleeping with their necks hyper-extended, sleep sitting upright or using multiple pillows.
Sleep apnea can affect the psychological health of children. Unlike adults with OSA, who experience daytime fatigue and sleepiness, children experience hyperactivity, aggressive behavior and may be irritable. Children with OSA may have trouble getting up in the morning, complain of frequent morning headaches, and often perform poorly in school. Medical complications of untreated sleep apnea may include poor growth, high blood pressure, pulmonary hypertension , and heart failure .
How Is Sleep Apnea Diagnosed in Children?
The diagnosis of sleep apnea in children is best made with an overnight polysomnogram (sleep study) performed in a sleep laboratory. Less accurate ways to diagnose sleep apnea in children include home videotaping of the child sleeping, measuring oxygen concentration in the blood overnight, a "nap polysomnogram" (a sleep study performed for only 2 hours), and a home sleep study.
When surgical treatment is ineffective, treatment with a continuous positive-airway pressure (CPAP) device can be useful for treatment of children with OSA. For obese children (and adults) with OSA, weight loss can be extremely helpful and often curative. When allergic rhinitis is a factor for children with sleep apnea, treatment with corticosteroid nasal sprays , and/or montelukast (Singulair) , can help reduce the symptoms of OSA.
Alkhalil M, Lockey R. Pediatric Obstructive Sleep Apnea Syndrome (OSAS) for the Allergist: Update on the Assessment and Management. Ann Allergy Asthma Immunol. 2011;107:104-109.
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