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Pediatric Obstructive Sleep Apnea
Sleep disordered breathing
(SDB) is a common problem for adults leading to hypertension, heart attack,
stroke, and early death. Other consequences are bedroom disharmony, excessive
daytime sleepiness, weight gain, poor performance at work, failing personal
relationships, and increased risk for accidents, including motor vehicle
accidents.
Sleep disordered breathing in children, from infancy through
puberty, is in some ways a similar condition but has different causes,
consequences, and treatments. A child with SDB does not necessarily have this
condition as an adult.
Pediatric obstructive sleep apnea
The
premiere symptom of sleep disordered breathing is snoring that is loud, present
every night regardless of sleep position, and is ultimately interrupted by
complete obstruction of breathing with gasping and snorting noises.
Approximately 10 percent of children are reported to snore. Ten percent of these
children (one percent of the total pediatric population) have obstructive sleep
apnea.
When an individual, young or old, obstructs breathing during sleep, the body perceives this as a choking phenomenon. The heart rate slows, the sympathetic nervous system is stimulated, blood pressure rises, the brain is aroused, and sleep is disrupted. In most cases a child's vascular system can tolerate the changes in blood pressure and heart rate. However, a child's brain does not tolerate the repeated interruptions to sleep, leading to a child that is sleep deprived, cranky, and ill behaved.
Consequences of untreated pediatric
sleep disordered breathing
- Snoring: A problem if a child
shares a room with a sibling and during sleepovers.
- Sleep deprivation: The child may
become moody, inattentive, and disruptive both at home and at school.
Classroom and athletic performance may decrease along with overall
happiness. The child will lack energy, often preferring to sit in front
of the television rather than participate in school and other
activities. This may contribute to obesity.
- Abnormal urine production: SDB also
causes increased nighttime urine production, and in children, this may
lead to bedwetting.
- Growth: Growth hormone is secreted
at night. Those with SDB may suffer interruptions in hormone secretion,
resulting in slow growth or development.
- Attention deficit disorder (ADD) / attention
deficit hyperactivity disorder (ADHD): There are research
findings that identify sleep disordered breathing as a contributing
factor to attention deficit
disorders.
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Diagnosis of sleep disordered
breathing
The first diagnosis of sleep disordered breathing in
children is made by the parent’s observation of snoring. Other observations may
include obstructions to breathing, gasping, snorting, and thrashing in bed as
well as unexplained bedwetting. Social symptoms are difficult to diagnose but
include alteration in mood, misbehavior, and poor school performance. (Note:
Every child who has sub par academic and social skills may not have SDB, but if
a child is a serious snorer and is experiencing mood, behavior, and performance
problems, sleep disordered breathing should be considered.)
A child with
suspected SDB should be evaluated by an otolaryngologist – head and neck
surgeon. If the symptoms are significant and the tonsils are enlarged, the child
is strongly recommended for T&A, or tonsillectomy and adenoidectomy (removal
of the tonsils and adenoids). Conversely, if the symptoms are mild, academic
performance remains excellent, the tonsils are small, and puberty is eminent
(tonsils and adenoids shrink at puberty), it may be recommended that SDB be
treated only if matters worsen. The majority of cases fall somewhere in between,
and physicians must evaluate each child on a case-by-case basis.
There
are other pediatric sleep disorder diagnoses. Sudden infant death syndrome
(SIDS) and apparent life threatening episode (ALTE) are considered forms of
sleep disordered breathing. Children with these conditions warrant thorough
evaluation by a pediatric sleep specialist. Children with craniofacial
abnormalities, primarily abnormalities of the jaw bones, tongue, and associated
structures, often have sleep disordered breathing. This must be managed and the
deformities treated as the child grows.
The sleep test is the standard
diagnostic test for sleep disordered breathing. This test can be performed in a
sleep laboratory or at home. Sleep tests can produce inaccurate results,
especially in children. Borderline or normal sleep test results may still result
in a diagnosis of SDB based on parental observation and clinical
evaluation.
Treatment for sleep disordered
breathing
Enlarged tonsils are the most common cause for SDB,
thus tonsillectomy/adenoidectomy is the most effective treatment for pediatric
sleep disordered breathing. T&A achieves a 90 percent success rate for
childhood SDB. Of the nearly 400,000 T&As performed in the U.S. each year,
75 percent are performed to treat sleep disordered breathing.
Not every
child with snoring should undergo T&A. The procedure does have risks and
possible complications. Aside from the mental anguish experienced by the parent
and child, potential problems include: anesthesia risks, bleeding, and
infection.
© 2004 AAO-HNS/AAO-HNSF
Please read our disclaimer. Any information provided on this Web site should not be considered medical advice or a substitute for a consultation with Dr. Hector N. Hernandez or other healthcare professional. If you have a medical problem, contact us for diagnosis and treatment. |
