Children And Sleep Apnea

Sleep Apnea
Sleep apnea is a condition characterized by brief periods of breathing cessation during sleep. There are three main types. Obstructive sleep apnea occurs when the air passages are blocked, such as when the soft tissues in the throat collapse and close off the airway. In central sleep apnea, the brain fails to send the appropriate signals to the respiratory muscles to start breathing. Mixed sleep apnea is a combination of the two conditions.

According to the National Heart, Lung, and Blood Institute, sleep apnea affects about 18 million Americans. Risk factors include loud snoring, excess weight, high blood pressure, and structural abnormalities in the upper airways. The condition often runs in families. In a single night, a person with the condition may stop breathing as many as 20 to 30 times an hour.

A person with sleep apnea may be unaware of the episodes of breathing cessation. However, the condition causes brief arousal from sleep and interferes with quality sleep. That can lead to daytime sleepiness, irritability, mood problems, and problems with concentration and judgement. Sleep-deprived people may have difficulty with productivity and are at higher risk for accidents.

Obstructive Sleep Apnea in Children
Sleep apnea is most common in adults, but can occur in children. The American Sleep Apnea Association estimates up to three percent of schoolchildren have obstructive sleep apnea (OSA). In children, it's most commonly caused by enlarged tonsils and adenoids. However, tonsil size isn't necessarily an absolute indication of risk. Some children with OSA have small tonsils and adenoids, while others with enlarged tonsils have no symptoms of breathing problems. Other risk factors for OSA in children include: family history of sleep apnea, craniofacial abnormalities, cerebral palsy, muscular dystrophy, Down Syndrome, or morbid obesity. Potential signs of risk for sleep apnea in a child include loud snoring, chronic nasal congestion, high arched palate (caused by a difficulty in breathing through the nose), large tonsils, abnormally developed jaw, or an unusually large tongue.

As in adults, sleep apnea can interfere with quality sleep in children. But instead of getting sleepy, children often become inattentive and hyperactive. They may have difficulty in school and are sometimes misdiagnosed with attention deficit/hyperactivity disorder. In a review of several studies, researchers found 84 percent of children with OSA had excessive daytime sleepiness, 76 percent had behavioral disturbances, 42 percent were hyperactive, and 16 percent experienced decreased school performance.

There are several treatments that can be used for children with OSA. If tonsils or adenoids are very large, a doctor may recommend a tonsillectomy and/or adenoidectomy. Overweight children may benefit from weight loss. A trial of nasal steriods may be warranted to reduce inflammation in the airways. Some physicians advise avoiding environmental tobacco smoke and other indoor irritants and allergens. Another therapy is continuous positive airway pressure (CPAP). A special mask is worn over the nose during sleep. Constant pressurized air is blown into the mask and then into the airways, preventing the airways from collapsing during sleep. CPAP is not a cure for sleep apnea and must be used every night to prevent the symptoms from recurring. CPAP can't be used by everyone. Some children have difficulty adjusting to using the mask during sleep.

For general information on sleep apnea in children:
American Academy of Pediatrics, public website,
American Lung Association, contact your local chapter, or visit their website at
American Sleep Apnea Association, 1424 “K” Street, NW, Suite 302, Washington, DC 20005,
National Center on Sleep Disorders Research,
National Sleep Foundation, 1522 “K” Street, NW, Suite 500, Washington, DC 20005,