Many people snore from time to time, even children, however, whereas in the adult population snoring may be nothing more than a social nuisance, in a child it is always a red flag and should be evaluated by an ENT or sleep expert. When a child regularly snores at night, other than with the occasional cold or seasonal allergies, parents should pay attention. Snoring is a sign of sleep loss and interruption of deep sleep and this takes a toll on your child’s physical health, growth, his/her ability to concentrate in school and can even show up as behavioral issues. If your child snores on a regular basis, an assessment by a medical expert in the field is necessary to identify the true pathology and get your child the rest they need.
What is pediatric obstructive sleep apnea?
Pediatric sleep apnea affects as many as 8% of all children. The idea that children will eventually grow out of this is common, however it is not correct. If anything, a child’s airway over time will get worse leading to worsening of the sleep apnea and perhaps only becoming more obvious as they become adults where serious health issues may become present. The interruption of sleep during childhood has its own issues as far as the child’s development physically, mentally, and emotionally. There are effective solutions for this problem so identification of the issue and implementation of treatment is important.
Obstructive sleep apnea occurs when the posture of deep sleep relaxes certain areas of the upper respiratory tract. This can happen as a result of the tongue, soft palate, tonsils, or adenoids.
Anatomic issues inside the nasal passages such as a deviated septum or enlarged turbinates can also play a role in both snoring and sleep apnea.
Unfortunately, the signs and symptoms of pediatric sleep apnea are all too commonly ignored and can mean a child is incorrectly diagnosed. Even the term obstructive sleep apnea in children may indicate that a child has to have an apnea (complete stoppage of breathing) to have this diagnosis. Actually, in children, a full stoppage of breathing may never occur and issues such as snoring and restlessness may be the only signs that the child is having difficulties. Other issues that may be present with children with obstructive sleep apnea are:
- Wetting the bed
- Academic struggles
- The diagnosis of ADD or ADHD
- Suffering from mood disorders that lead to psychological diagnosis and the use of medications
- Being lazy or lethargic
Some of these relationships are extremely strong. For example, studies have shown that as high as 40% of all children diagnosed with ADD or ADHD may have a significant obstructive sleep disorder hat either is causing the entire symptomatology or is at least a major contributor.
If, in fact, the underlying sleep disorder is not treated, then treatment for the attention issue is likely to fail- a tired child will simply not be able to pay attention as well as one getting the sleep they need.
Interestingly, unlike adults with obstructive sleep apnea who almost always report daytime
sleepiness, children rarely report being sleepy, but their behavior issues and/or inability to focus/concentrate tell a different story.
Signs and symptoms of obstructive sleep apnea in children
As was mentioned previously, one of the biggest differences between pediatric sleep apnea and the adult version is that adults often stop breathing when their airway is blocked, whereas children may not. They may have partially blocked breathing that does maintain a stream of diminished airflow but still drastically deprives their bodies of necessary oxygen and prevents their ability to sleep soundly. This is because when an individual does struggle to breathe during sleep the brain is actually able to notice this and subsequently cause an arousal, which pulls the patient out of deep restful sleep to a more superficial layer of sleep in order to open the airway back up and facilitate easy breathing. When this is happening over and over again all night, although the patient may seem to be asleep, they are never experiencing the uninterrupted deep levels of sleep that are necessary for normal human function.
Signs and symptoms do include:
- Snoring (although it is important to note that many children with sleep apnea do not snore at all, which means it is important to pay attention to the other potential signs and symptoms)
- Restless sleeping
- Bed covers that are tossed/turned or fall off the bed completely during the night
- Heavy mouth breathing
- Sleepwalking and/or night terrors
- Pausing or having breathing gaps when sleeping
- Difficulty focusing or concentrating in school
- Poor growth
- Poor school performance despite intelligence and curiosity
Any of the above signs are indications for further evaluation and you can contact the office of Dr. Jerome Hester directly to discuss your concerns and schedule an appointment.
Treatment methods for pediatric sleep apnea
The most common causes for sleep apnea in children is enlarged and adenoids (more on other causes below), and while surgery is certainly an option, consideration of all treatments should be thoroughly discussed. Dr. Hester will undertake a complete history and physical examination and then outline all potential treatment options for your child with obstructive sleep apnea.
Least invasive treatment options
Continuous positive airway pressure (CPAP) is a non-invasive treatment option whereby an individual wears a mask each night connected to a positive pressure machine. This allows a column of air to constantly be present in the airway such that the airway cannot collapse. Although this is an extremely effective and safe mechanism of treatment in an adult, it is difficult for most children to tolerate it. In addition, there are some concerns regarding the use of CPAP in a developing child that it, in fact, may cause derangements of growth of the upper and lower jaws. However, if appropriate, this option will be fully discussed at the time of your consultation.
Minimally invasive treatment
For milder cases, radiofrequency, which is the use of heat treatment to tighten and shrink tissues, can be used. It is common to use this treatment inside the nose to reduce structures known as turbinates (see our information regarding turbinate reduction) as well as the back part of the tongue and the soft palate, (the roof of the mouth). This provides a gentle method to tighten and reshape the tissue in order to allow the airway to stay open at night. Radiofrequency may not be able to provide a complete treatment solution in those individuals who do have other significant anatomic abnormalities such as enlargement of the tonsils and adenoids or jaw deficiencies, however, even in those cases, it can certainly augment other treatments in a minimally invasive and safe way.
The position of the upper and lower jaws may also play a role in obstructing the airway, or in fact, can be altered by the obstructed airway. This delicate interaction between cause and effect may necessitate working with an orthodontist. In many cases, the orthodontists will want the soft tissues of the airway to be corrected first, which then allows orthodontic treatment to proceed without having to fight the forces of an obstructed airway. With his decades of experience, Dr. Hester is able to work with your orthodontist or make a referral to determine whether orthodontic treatment would be part of your child’s treatment.
Surgical treatment options
In addition to the above treatments, in many cases, surgery to correct the anatomic issues causing the problem may be the most viable option. Surgeries commonly used to treat pediatric obstructive sleep apnea include the following:
- Removing enlarged tonsils and/or adenoids that are large enough to obstruct the airway. It is important to note that it is not always the absolute size of the tonsil or adenoid that is important, it is the size in its relationship to the size of the airway. Many times this is a mistake made by those individuals not experienced with examining an airway and a tonsil will be written off as “normal size.” Once again, a thorough examination of the airway to determine whether the tonsil itself may, in fact, be part of the obstruction is necessary to outline a successful treatment plan.
- Straightening a deviated septum
- Treatment of structures inside the nasal cavity such as turbinates and the nasal valve, which are soft tissue structures and maybe adding to the obstruction.
- Upper and lower jaw reconstruction. This is usually reserved for more extreme cases or those individuals who have significant upper and/or lower jaw abnormalities that cannot be corrected with orthodontia alone and are typically done at a later age.
Give your child the gift of healthy sleep
Sleep is essential to your child’s whole body health and well being. When sleep is negatively compromised by pediatric sleep apnea, your child’s health and happiness are compromised in the present as well as the future. Sleep apnea is associated with diminished growth, academic struggles, and the exacerbation of other health issues. Over time sleep apnea also places your child at a much higher risk of high blood pressure, weight problems (healthy sleep is essential for normal metabolism), hormone imbalance, heart disease, and diabetes. So remember that a snoring child may be as cute as a button, but the snoring is also telling you that something needs to be addressed. If you have noticed any signs or symptoms of sleep apnea in your child, contact the office of Dr. Jerome Hester and schedule an appointment. Dr. Hester specializes in pediatric sleep apnea and works patiently and diligently to find the best treatment option for your child. Together you can give your child the gift of healthy sleep. It is a priceless gift that lasts a lifetime.