Obstructive sleep apnea is a very serious medical condition, affecting an estimated 25 million adults in the United States, according to the American Academy of Sleep Medicine. However, the possibility of children developing sleep apnea is often overlooked. Individuals of any age can develop sleep apnea, and the consequences for children differ somewhat from those seen in adults. Learning about the symptoms of obstructive sleep apnea can ensure that your child gets an accurate diagnosis and appropriate treatment options.
What Is Obstructive Sleep Apnea?
Obstructive sleep apnea is a serious medical condition that can affect childhood development. Between 1 and 10% of children suffer from obstructive sleep apnea (Chan et al., 2004), but many go undiagnosed. Children with sleep apnea have an obstruction or blockage to the upper airway when they sleep. During sleep, our muscles relax, including the muscles at the back of the throat. Excessive relaxation of these important muscles can cause the airway to collapse.
This temporary cessation of breathing cuts off the oxygen supply to the brain and rest of the body. As a result, children gasp for breath and briefly wake up (though they may not be aware of this) before returning to sleep. As a result, the sleep cycle is severely disrupted by sleep apnea. Although the condition is not fatal, it has serious consequences for several aspects of development, making it essential that parents recognize the signs and symptoms of obstructive sleep apnea in children.
Signs and Symptoms of Obstructive Sleep Apnea in Children
For parents, early detection of sleep apnea symptoms can help your children get a prompt diagnosis and treatment. Some of the signs of sleep apnea include:
Snoring. Between 3 and 12% of children snore (Chan et al., 2004). Snoring is not a definitive sign of sleep apnea, but it can increase your child’s risk. In particular, it is important to listen to snores that result in snorts or gasps. Pauses in breathing while snoring can also be a sign of sleep apnea.
Heavy breathing while sleeping.
Very restless sleep. Children who move around a lot while they sleep may have sleep apnea. However, other sleep disorders can also cause restless sleep.
Sleeping in unusual positions. Most children sleep in odd positions on occasion. However, if you notice your child frequently sleeping in unusual positions, it may be a sign that the body is positioning itself in an attempt to get better airflow.
Bedwetting. A sudden change in urinary continence can be a sign of sleep apnea, particularly if child has not experienced previous problems with wetting the bed. However, this is not a definitive symptom of sleep apnea, as bedwetting can be triggered many several causes.
Daytime sleepiness. If your child seems tired or complains of feeling tired during the day, he or she may not be getting enough sleep. Chronic daytime sleepiness can be a sign of sleep apnea or other sleep disorders.
Certain children are particularly at risk for obstructive sleep apnea. Being overweight or obese is a large risk factor for the condition. This is because excess body weight can cause changes to the soft tissue of the mouth, making it more likely that the airway will collapse during sleep. Defects in the mouth, jaw, or throat can also contribute to risk for sleep apnea. In particular, children with enlarged tonsils or a large tongue are at higher risk for the condition.
Finally, there appears to be a genetic component to the development of sleep apnea. Having a family member with the condition increases your child’s risk. Medical conditions such as Down syndrome or cerebral palsy also make it more likely that your child will develop sleep apnea.
Long-Term Consequences of Untreated Sleep Apnea in Children
Sleep apnea has several long-term consequences that can be problematic for later childhood development and may persist into adulthood.
Sleep Apnea and Failure to Thrive
Very young children and even infants can develop obstructive sleep apnea. In infants and toddlers, sleep apnea can result in failure to thrive. Failure to thrive is a condition in which a baby or small child does not put on enough body weight. In addition to losing weight or failing to gain weight, a child may also have other developmental delays. For instance, children may fall behind on developmental milestones such as babbling, talking, crawling, or walking on time.
Relatedly, children with obstructive sleep apnea may be small in stature. Human growth hormone is an important hormone for childhood growth and development. This hormone is released during sleep and seems to peak at the onset of deep sleep (Takahashi et al., 1968). For kids with sleep apnea, the sleep cycle may be so disrupted that they do not enter or maintain deep sleep. This leads to a lower level of human growth hormone, causing children to be small in stature.
Fortunately, proper diagnosis and treatment of sleep apnea can reverse this failure to thrive. In one scientific report, 87% of infants who underwent adenotonsillectomy (tonsil removal) to treat obstructive sleep apnea showed significant weight gain following the surgery (Freezer et al., 1995). This makes early diagnosis critically important in infants and young children.
Sleep apnea is associated with heavy mouth breathing. This can lead to an elongated facial structure that emerges during the developmental years. With this elongated facial structure, the jaw tends to sit further back, a condition known as retrognathia. This causes the airway to become even smaller, exacerbating the sleep apnea. Additionally, mouth breathing may lead to dental problems and gum disease.
Attention Deficit Hyperactivity Disorder (ADHD)
One of the most prominent long-term consequences of pediatric sleep apnea is the development of attention deficit hyperactivity disorder, or ADHD. In fact, up to 95% of obstructive sleep apnea patients have some level of attentional problems (Youseff et al., 2011). This has led to a high rate of misdiagnosis of ADHD, as some children labeled as having ADHD may actually be experiencing attentional issues related to a sleep disorder.
When adults and children become sleep deprived, they manifest very different symptoms. While adults tend to feel sluggish and tired, children may have the opposite reaction, showing behavioral issues. Sleep deprived children often become “keyed up,” moody, and defiant. They may also have difficulty focusing, sitting still at school or at home, and behaving appropriately with their peers. These symptoms have a high degree of overlap with symptoms of ADHD, leading to frequent misdiagnosis of ADHD and sleep apnea. The good news is that many children who are treated for sleep apnea have a reversal in their attentional difficulties and behavioral issues. In some cases, they no longer meet criteria for ADHD.
How to Get An Accurate Diagnosis and Treatment Plan for Childhood Sleep Apnea
Fortunately, sleep apnea is a treatable condition. The first step is to get an accurate diagnosis of sleep apnea. Although it is sometimes possible to make a diagnosis through clinical features alone, the gold standard for diagnosis of sleep apnea is polysomnography, commonly known as a sleep study. During polysomnography, sleep doctors will monitor brain waves, eye movements, heart and respiration patterns, blood oxygen levels, movements during sleep, and snoring. This can help your Seattle sleep specialist make an accurate diagnosis of sleep apnea.
Following diagnosis of sleep apnea, there are several potential treatment options. First, your sleep doctor can determine if there is a physiological reason for your child’s sleep problems. For instance, enlarged tonsils are a common cause of this condition. As a result, tonsillectomy may be an appropriate treatment for some children. Weight loss may also be recommended if your child’s body weight may be contributing to the sleep problem.
If enlarged tonsils or adenoids are not contributing to the sleep apnea, your Seattle sleep doctor may recommend the use of a continuous positive airway pressure (CPAP) machine. CPAP therapy involves the use of a mask to deliver oxygen throughout the night. It is the best way to ensure that your child gets enough oxygen to fuel the brain and body during sleep.
Some children eventually grow out of sleep apnea, while others do not. Thus, if your child is diagnosed with obstructive sleep apnea, it is important to comply with treatment recommendations and to return for follow-up visits as needed. This can help your sleep doctor make personalized recommendations to ensure your child’s continued health and appropriate development.
If you think your child has sleep apnea, please schedule an appopintment with Sound Sleep Health in Seattle. Call us at (425) 279-7151 today.