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Obstructive Sleep Apnea

Sleep disordered breathing (SDB) or obstructive sleep apnea (OSA), is a relatively common problem in children. It can be seen in children of all ages, from infants to adolescents, but peaks between two to six years of age and again in adolescence. Boys and girls are equally affected. SDB or OSA in children has slightly different causes, consequences and treatments than that of adults with OSA.

What is OSA or SDB?

When breathing is obstructed, the brain thinks that the body is being "choked." The child's heart rate slows, the sympathetic nervous system is stimulated, blood pressure rises, the brain is aroused and sleep is disrupted. In most cases, a child's system can tolerate the changes in blood pressure and heart rate. Their brain, however, does not tolerate the repeated interruptions of sleep.

What are consequences of untreated OSA?

Sleep disruption can lead to symptoms of excessive sleepiness during the day (falling asleep in school). In some children, the disrupted sleep will cause symptoms of hyperactivity, irritability, moodiness and behavior difficulties.

Other problems caused by obstructive sleep apnea can include:

  • Failure to grow or gain weight (growth hormone is secreted at night)
  • High blood pressure
  • Bedwetting from increased nighttime urine production
  • ADD/ADHD (research says OSA can contribute to these disorders)

Who is at risk for OSA?

All children are at risk to develop obstructive sleep apnea. Children at increased risk include those who suffer from:

  • Large tonsils and adenoids
  • Obesity
  • Down's syndrome
  • Cranio-facial abnormalities
  • Neuromuscular weaknesses

What are the symptoms of OSA?

Similar to adults, children with obstructive sleep apnea will often develop symptoms of loud snoring, difficulty breathing (their chest seems to "suck in" while trying to breathe), and intermittent snorts and gasps. Apnea is the period of time (usually counted in seconds) between the snore and the gasp or snort.

Other symptoms are:

  • Restless sleep
  • Frequent partial or total awakenings
  • Odd sleep positions (neck extended and head cocked backwards or sleeping in a sitting position)
  • Profuse night sweating
  • Daytime mouth breathing
  • Noisy swallowing

How is OSA diagnosed?

Initially, a parent or sibling will notice the snoring and possibly apnea. The child with suspected SDB or OSA should be referred to an ENT (otolaryngologist) for further evaluation and treatment. 

This evaluation will include:

  • Extended history and physical exam
  • Sleep tape or sleep study 

A sleep tape is made by making a short audio or video tape recording of your child while sleeping. It is most helpful if you are able to capture an observed snoring and difficulty breathing episode or two, rather than taping many hours of sleep. This tape will be reviewed for a diagnosis of OSA.

A second diagnostic tool is the sleep study. These are conducted in the hospital during an overnight stay. Monitors are used while your child sleeps to look at heart rate, breathing rate, oxygen level and carbon dioxide level as well as recording other data to help us determine the presence and degree of obstructive sleep apnea.

How is pediatric OSA treated?

Treatment of sleep disorders can include:

  • Surgery to remove the tonsil or adenoid tissue that may be obstructing the airway of children with sleep apnea.
  • Medications or specialized breathing equipment to help the child obtain a more restful night's sleep.



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