Night is the part of the day when we try to rest. Sleep is that period of our routine during which we rest our energies, in addition to resting the body and repairing itself.
While having poor quality sleep in adulthood affects our physical and mental health very negatively, sleep problems in childhood are more critical. Not being able to sleep well results in problems with cognitive development and impaired growth.
One of the sleep problems that children can suffer from is sleep apnea in children, a disorder which, although relatively rare, can affect the health of our children so badly that we need to be very familiar with it. Below, we’ll dig deeper into what it is, causes, symptoms, and treatment.
What is sleep apnea in children?
Obstructive sleep apnea syndrome (OSAS) in children is a sleep breathing disorder that affects about 2% of children, especially between 2 and 5 years old. This problem is characterized by repeated episodes of airway obstruction when falling asleep and may occur partially (hypopnea) or completely (apnea).
This disorder is usually caused by a narrowing or blockage of the upper airways when falling asleep.
Because the child cannot breathe well while sleeping, his lungs do not receive enough oxygen, causing this gas to decrease in the blood (hypoxemia), and there may also be an increase in retention. CO2 from hypercapnia. This disturbance of pulmonary ventilation can be repeated up to about 400 times per night, prevent the affected person from enjoying deep, restful sleep.
Not sleeping well at night because not being able to breathe well affects the physical and mental health of adults and children, but this problem has different consequences depending on age. While in adults with apnea they usually have daytime sleepiness, in the case of children there are problems with behavior, attention and hyperactivity, which can lead to a misdiagnosis of breast apnea. sleep thinking that behind the behavior problem of the little ones hides a psychological disorder.
The underlying cause in adults is usually obesity, while in children it is usually a problem with the adenoids and tonsils, especially due to their enlargement.
Whatever the cause, it should be noted that it can interfere with the physical and intellectual development of boys and girls, this is why early diagnosis and treatment is so important in order to avoid any complications that can affect children’s cognitive and behavioral development.
The signs and symptoms that may be observed in a child with sleep apnea while sleeping are:
- Breathing pauses
- Restless or restless sleep
- Snoring, coughing or drowning
- Breathe through your mouth
- Night sweats
- Bedwetting: urinating while sleeping
- Night terrors and nightmares
- Wake up soon
- Be excessive when standing up
- Morning headaches
In infants and toddlers, obstructive sleep apnea does not always manifest as snoring. If necessary, they may simply show disturbed sleep and difficulty getting restful sleep.
When awake, children with sleep apnea may experience the following problems related to their sleep disorder.
- Poor academic performance
- Attention problems
- Learning problems
- Behavioral problems
- Little weight gain (critical in very young children)
- Growth retardation
Obstructive sleep apnea in boys and girls can lead to multiple complications in the physical and psychological health of the affected person, among which we can highlight stunted growth, heart problems and death.
Causes and risk factors
Obesity is often a common cause behind obstructive sleep apnea in adults. However, in the case of boys and girls, although this is also a cause, it is usually the most common cause. an enlargement of the tonsils and adenoids or vegetation, masses of tissue located at the back of the nasal cavity.
This sleep problem can also occur due to craniofacial abnormalities and neuromuscular disorders.
In addition to obesity, among the risk factors for sleep apnea in children we have:
- Down Syndrome
- Skull or face abnormalities
- Cerebral palsy
- Neuromuscular disease
- Sickle cell anemia
- Low birth weight
- Family history of this sleep disorder
The diagnosis of pediatric sleep apnea is a bit complicated because it should be done while the affected person is sleeping. The doctor will check the child’s symptoms and medical history and perform a physical exam while awake, including an exam of the neck, mouth, and tongue to check the condition of the tonsil and muscles. adenoids.
However, because in order to detect this problem it is necessary to see how the child is sleeping, the doctor will eventually tell the parents of the person with several tests to diagnose the disease. Among the tests used are:
The doctor assesses the child’s condition during a nighttime sleep study. In this test, sensors placed all over the body are used to record brain wave activity, breathing pattern, oxygen levels, heart rate, muscle activity, and snoring while the child is sleeping.
If pediatricians suspect that the child has obstructive sleep apnea and a complete polysomnogram is not required or available, a recording of oxygen levels during sleep could help confirm the diagnosis. Oximetry can be done at home.
To perform an EKG, you need to place patches with electrodes connected to a machine that it measures the electrical impulses coming from the child’s heart. The pediatric team can use this test to determine if the little one has heart disease that could be the cause of sleep apnea.
There are several treatment options for treating sleep apnea in children. Each case will require special treatment, mainly the following.
The pharmacological route to treat this type of apnea includes topical nasal steroids, such as fluticasone and budesonide, which may relieve the symptoms of this sleep disorder in some children with mild obstructive sleep apnea. For children with allergies, montelukast appears to be used to relieve symptoms, both on its own and with nasal steroids.
2. Removal of tonsils and adenoids
When the child suffers from moderate or severe sleep apnea, one of the treatment options, although drastic, is the removal of the tonsils and adenoids.
This type of procedure is called adeno-tonsillectomy and is only used when an otolaryngologist considers it the best option available to improve the quality of life of the child, thereby opening the airways. .
3. Positive airway pressure therapy
In positive airway therapy several machines are used which blow air through a tube and a mask placed over the nose and / or mouth.
This machine sends a pressure of air in the back of the child’s throat, to keep the airways open. This option is used when medication or removal of adenoids and tonsils has not been effective.
4. Oral devices
Oral appliances, such as braces or filters, are another option. they can help widen the palate and nasal passages. They are also used to move the child’s lower jaw and tongue forward so that the upper airways remain open. It should also be noted that few children benefit from oral devices.
- Pediatric Pulmonology Section, Obstructive Sleep Apnea Syndrome Subcommittee. American Academy of Pediatrics (2002). Clinical practice guide: diagnosis and management of obstructive sleep apnea syndrome in children. Pediatrics, 109 (4), 704-712. https://doi.org/10.1542/peds.109.4.704
- Gislason, T., & Benediktsdóttir, B. (1995). Snoring, episodes of apnea and nocturnal hypoxemia in children aged 6 months to 6 years. An epidemiological study of the lower limit of prevalence. Cofre, 107 (4), 963-966.
- Brietzke, SE, Katz, ES and Roberson, DW (2004). Can history and physical examination reliably diagnose pediatric sleep apnea / obstructive sleep apnea syndrome? A systematic review of the literature. Otorhinolaryngology: Head and Neck Surgery: Official Journal of the American Academy of Otorhinolaryngology-Head and Neck Surgery, 131 (6), 827-832. https://doi.org/10.1016/j.otohns.2004.07.002
- Guilleminault, C., Nino-Murcia, G., Heldt, G., Baldwin, R. and Hutchinson, D. (1986). Alternative treatment to tracheostomy in obstructive sleep apnea syndrome: continuous nasal pressure in young children. Pediatrics, 78 (5), 797-802.
- Massa, F., Gonsalez, S., Laverty, A., Wallis, C. and Lane, R. (2002). The use of continuous nasal pressure to treat obstructive sleep apnea. Archives of Disease in Childhood, 87 (5), 438-443.