Obstructive sleep apnea (OSA) is a sleep related breathing disorder. It is one component of a spectrum of sleep disordered breathing.
OSA occurs when the muscles relax after you fall asleep. As a result soft tissue in the back of the throat collapses and blocks the airway. This leads to partial reductions in breathing. These are called "hypopneas." It also can lead to complete pauses in breathing. These are called "apneas." In children these obstructions tend to occur during the stage of rapid eye movement (REM) sleep.
Even brief apneas can cause a child to have low levels of oxygen in the blood. This is called "hypoxemia." It can occur quickly in a child with OSA. Because children have smaller lungs, they have less oxygen in reserve. Children tend to take frequent, shallow breaths rather than slow, deep breaths. This also can cause a child with OSA to have too much carbon dioxide in the blood. This is called "hypercapnia."
Adults with OSA often have fragmented sleep. They tend to wake up briefly after their breathing stops. Children with OSA often do not wake up in response to pauses in breathing. They have a higher "arousal threshold" than adults. As a result their sleep pattern tends to be fairly normal.
Excessive daytime sleepiness is more common in adults with OSA than in children with OSA. Older children and teens are more likely than younger children to have this problem.
Most children with OSA have a history of snoring. It tends to be loud and may include obvious pauses in breathing and gasps for breath. Sometimes the snoring involves a continuous, partial obstruction without any obvious pauses or arousals. The child's body may move in response to the pauses in breathing.
Younger children have a very flexible rib cage. As a result the breathing problems can produce unusual movements of a child's chest and abdomen. The rib cage may appear to move inward as the child inhales. This is called "paradoxical movement." Parents often notice that the child seems to be working hard to breathe. For healthy children over three years of age, this type of breathing is not normal.
In extreme cases a child with untreated OSA may develop a "funnel chest" over time. The ongoing breathing problems cause the sternum, or "breastbone," to sink in. This produces a depression in the chest wall.
Children with OSA may sleep in unusual positions. They may sleep sitting up or with the neck overextended. They also may sweat a lot during sleep and may have headaches in the morning. Bedwetting or sleep terrors also may occur.
Children with OSA tend to breathe normally when they are awake. But it is common for them to breathe through the mouth. They may have frequent infections of the upper respiratory tract. Some children with OSA have such large tonsils that they have a hard time swallowing. This is called "dysphagia."
Symptoms of OSA tend to appear in the first few years of life. But OSA often remains undiagnosed until many years later. In early childhood OSA can slow a child's growth rate. Following treatment for OSA children tend to show gains in both height and weight. Untreated OSA also can lead to high blood pressure.
Cognitive and behavioral problems are common in children with OSA. These problems may include:
Aggressive behavior
Attention-deficit/hyperactivity disorder (ADHD)
Delays in development
Poor school performance
Who gets it?
OSA occurs in about two percent of young children. It can develop in children at any age, but it is most common in preschoolers. OSA often occurs between the ages of 3 and 6 years when the tonsils and adenoids are large compared to the throat. OSA appears to occur at the same rate in young boys and girls. How often it occurs in infants and teens is unknown. OSA also is common in children who are obese.
Children with an abnormal facial structure are at risk for OSA. It is common in children with Down syndrome. It also may occur in children with neuromuscular diseases. Children with cerebral palsy or sickle cell disease may be more likely to develop OSA. An operation that corrects a cleft palate also can produce OSA.
OSA is more likely to occur in a child who has a family member with OSA.
How do I know if I have it?
Does your child snore, have labored breathing or stop breathing during sleep?
Have you observed any of these problems in your child?
A rib cage that moves inward as the child inhales
Body movements and arousals from sleep
Sweating during sleep
Sleeping with the neck overextended
Excessive daytime sleepiness
Hyperactivity or aggressive behavior
A slow rate of growth
Morning headaches
If your answer to these questions is yes, then your child might have obstructive sleep apnea.
Do I need to see a sleep specialist?
Yes. This is a serious disorder that needs to be treated by a sleep specialist. These doctors have training and expertise in this area. Schedule an appointment at an accredited sleep disorders center . Some centers specialize in helping children. A sleep specialist will review your child's history and symptoms. If needed, the doctor will schedule your child for an overnight sleep study. This kind of study is called a polysomnogram. It is the best way to evaluate your child's sleep. With the results of this study the doctor will be able to develop an individual treatment plan for your child.
It is also important to know if there is something else that is causing your child's sleep problems. A sleep specialist can look for other conditions that may imitate the symptoms of OSA or make them worse. These include:
Another sleep disorder
A medical condition
Medication use
A mental health disorder
Substance abuse
What will the doctor need to know? Describe the problems you have observed and when you first noticed them. Let the doctor know if your child recently gained a lot of weight. Provide the doctor with your child's complete medical history.
Will I need to take any tests?
If your doctor thinks that your child has a problem with breathing during sleep, then your child may need an overnight sleep study . This study is called a polysomnogram. It charts your child's brain waves, heartbeat, and breathing during sleep. It also records arm and leg movements. The sleep study will reveal if your child has OSA. It also will show the severity of the problem. The study requires your child to spend the night at the sleep center. A parent or guardian also will need to stay at the sleep center with the child. In rare cases a doctor may use another test to evaluate your child's upper airway. Examples include endoscopy and magnetic resonance imaging.
How is it treated?
Adenotonsillectomy is the most common treatment for OSA in children. This surgery involves the removal of the adenoids and tonsils. It reduces the obstruction and increases the size of the upper airway. As a result the child is able to breathe normally. Some children may continue to have OSA even after adenotonsillectomy.
Continuous positive airway pressure (CPAP) is another treatment option for children. It may be used if surgery is not an option or if OSA persists after surgery. CPAP delivers a steady stream of air through a mask worn over the nose or face. The air gently blows into the back of the throat. This keeps the airway open so your child is able to breathe during sleep.
Overweight or obese children will benefit from weight loss. This can reduce the frequency and severity of OSA. Usually weight loss is combined with another treatment option.
Some children may benefit from wearing an oral appliance during sleep. An oral appliance is about the size of a sports mouth guard. It moves the jaw forward to keep the airway open. The effectiveness of this treatment in children is still being studied. A sleep specialist at an accredited sleep disorders center can determine which treatment option is best for your child.