Sleep Apnea: Interfering with your child's rest?
By Richard M. Kravitz, M.D. and Dennis Clements, MD, PhD
parents, we consider nothing more important than the health and
well-being of our children. We make sure they eat well, get their
checkups, are immunized to prevent serious illnesses, and see a
doctor when they are sick. Yet many parents are unaware that problems
may occur at a time they least expect--while their children are
sleep apnea (OSA), condition in which the airway becomes partially
or completely blocked during sleep, occurs in 1 to 3 percent of
otherwise healthy children. While long recognized in adults, OSA
has only recently been recognized as a significant problem for children.
Children frequently have symptoms that are different from those
experienced by adults, and as a result, a potentially serious problem
may go unrecognized and untreated.
is most commonly seen in children ages 2 to 7, but it can affect
infants and adolescents as well. The most common cause of OSA in
children is enlarged adenoids and tonsils, though we are seeing
an increasing number of cases caused by childhood obesity.
with OSA frequently snore and may have difficulty breathing while
asleep. They may have pauses in their breathing (called apneas),
which can be followed by a sudden gasping for air. Their sleep can
be restless, with tossing and turning, and they may sleep in unusual
or contorted positions in an attempt to open up their blocked airway.
If left untreated, children are at risk for many physical as well
as behavioral problems. These can include: daytime sleepiness (after
snoring, the most common symptom seen in adults); excessive napping;
changes in behavior; hyperactivity (especially troublesome in school);
trouble concentrating in school with a decline in school performance;
poor growth; the reappearance of bedwetting; and high blood pressure
and other cardiac-related problems.
observing your child when he or she sleeps is an important way of
identifying a potential problem, the presence of some or all of
the above listed symptoms is usually not enough to be certain that
OSA is occurring. For example, snoring, a relatively common problem
seen in 10 percent of otherwise healthy children, does not always
mean OSA. Also, when sleep apnea is present, its severity does not
always correlate with the number and degree of symptoms present--some
children with mild snoring have severe OSA, while others with heavy
snoring do not have OSA at all. Currently, the only way to definitively
determine whether or not OSA is present is by physiologic monitoring
of the child while asleep with a sleep study (also known as polysomnography).
a child for OSA requires spending the night in a sleep lab, a room
that is set up like a bedroom. A parent is encouraged to spend the
night with their child as to make them feel comfortable and to add
information as to how closely the night of observed sleep mirrors
what is normally seen at home. The child is observed throughout
the night by a sleep technician who further comments on the witnessed
sleep. During the sleep study, we monitor the childs brainwaves,
respirations, heartbeats, and oxygen and carbon dioxide levels looking
for evidence of any airway obstruction. Using computerized equipment,
technicians will record the child's breathing patterns for evaluation
by a doctor with expertise in sleep medicine.
the sleep study confirms the presence of OSA, several treatment
options are available, depending on the underlying cause. For example,
if enlarged tonsils and/or adenoids are felt to be the problem,
the child may be referred to an Ear, Nose, and Throat specialist
to remove this excess tissue (this is the most common treatment
used in children under 10 years old). If the child is overweight
and this is thought to be the cause of the sleep apnea, weight loss
can frequently solve the problem. Finally, the sleep specialist
may recommend continuous positive airway pressure (CPAP). CPAP is
a device that blows air into the childs nose and/or mouth
and helps stent open the collapsing airway. CPAP is well tolerated
in children and highly effective at treating OSA not responsive
to other treatments.
your child snores, has trouble sleeping at night, is tired or hyperactive
during the day, or has trouble concentrating while in school, he
or she might have OSA. Tell your doctor of your concerns. Referral
to a sleep specialist might be the ticket to a good nights
M. Kravitz, MD, is the director of Duke's Pediatric Sleep Laboratory
and an assistant professor of pediatrics in the division of pulmonary
medicine. Dennis Clements, MD, PhD, is interim chair of the Department
of Pediatrics at Duke University Medical Center. For more information,