Pediatric obstructive sleep apnea

Overview

Pediatric obstructive sleep apnea is a condition in which a child's breathing is partly or completely blocked during sleep. Breathing can briefly stop and start again many times a night. The condition happens when the upper airway narrows or is blocked during sleep.

Obstructive sleep apnea can look different in children than it does in adults. Adults usually have daytime sleepiness. Children are more likely to have behavior issues, such as acting hyper or not paying attention. Risk factors also differ. In adults, the key risk factors are obesity and age. Although obesity can play a role in children, the main risk factor in children is having tonsils and adenoids that are larger than usual. The adenoids are two small pads of tissue in the back of the nose. The tonsils are two oval-shaped pads in the back of the mouth.

It's important for healthcare professionals to find and treat pediatric obstructive sleep apnea as soon as possible. Early treatment helps prevent other health conditions called complications. These can affect children's growth, learning, behavior and heart health. The first treatment may be surgery to remove enlarged tonsils and adenoids. But some children may get better using medical devices or taking medicines.

Symptoms

During sleep, symptoms of pediatric obstructive sleep apnea can include:

• Snoring.
• Pauses in breathing.
• Restless sleep.
• Snorting, gasping, coughing or choking.
• Mouth breathing.
• Nighttime sweating.
• Bed-wetting that starts after a long period of dry overnights.

Infants and young children with obstructive sleep apnea don't always snore. They might just have disturbed sleep.

During the day, children with sleep apnea might:

• Get headaches in the morning.
• Breathe through the mouth or have trouble breathing through the nose.
• Have trouble learning and paying attention.
• Do poorly in school.
• Have behavior issues such as acting hyper, impulsive or aggressive.
• Have poor weight gain.
• Talk about feeling sleepy, or fall asleep during school or during short car or bus rides.

When to see a doctor

See your child's healthcare professional if your child has any symptoms of obstructive sleep apnea, including frequent snoring.

Causes

Pediatric obstructive sleep apnea is caused by muscles in the back of the throat relaxing and blocking the upper airway. In children, this leads to pauses in breathing that last about twice as long as the typical breath.

When breathing stops, this triggers the brain to wake up so that the airway can open again. This makes it hard to get enough rest.

Various conditions can raise the risk of the upper airway becoming blocked during sleep. Commonly, enlarged tonsils in the back of the mouth and enlarged adenoids in the back of the nose can cause a blockage. Other possible causes include being born with a birth defect related to the shape of the face or head and certain health conditions.

Risk factors

The main risk factor for pediatric obstructive sleep apnea is enlarged tonsils and adenoids, especially in younger children. Obesity also is an important a risk factor, mainly among teenagers.

Other risk factors for pediatric sleep apnea include having:

• A genetic condition such as Down syndrome or Prader-Willi syndrome.
• Birth defects in the skull or face.
• A group of conditions called cerebral palsy that affect movement and posture.
• A group of inherited blood disorders known as sickle cell disease.
• Conditions called neuromuscular disorders that affect the function of muscles due to problems with the nerves and muscles in the body.
• A history of low birth weight.
• A family history of obstructive sleep apnea.

Complications

Without treatment, pediatric obstructive sleep apnea can lead to other health conditions called complications. Rarely, pediatric obstructive sleep apnea can cause infants and young children not to grow as much as those who don't have the condition. Children who don't receive treatment also may have a higher risk of later complications such as:

• High blood pressure.
• High cholesterol.
• A higher than typical blood sugar level that raises the risk of diabetes.
• Other heart and blood vessel conditions.

Very rarely, children with certain genetic conditions can have serious symptoms of pediatric obstructive sleep apnea. These symptoms can lead to death. But in most children, treatment can help manage complications.