Restless Leg Syndrome (RLS) | Sleep Apnea | Insomnia | Pediatric Sleep Apnea

What is Pediatric Sleep Apnea?

Sleep apnea, as most people think of it, is a family of sleep disorders that are more properly grouped under the heading "sleep disordered breathing."

What are the symptoms of pediatric sleep disorder breathing?

On occassion children may demonstrate adult symptoms such as:

1. Snoring
2. Tiredness
3. Dry mouth in the morning
4. Restless sleep
5. Sweaty sleep

In children, however, manifestations of sleep deprivation due to any cause, including sleep disordered breathing, is quite different from adults and includes:

1. Inattention
2. Hyperactivity
3. Impulsivity
4. Social difficulties
5. Disruptive behavior
6. Bad grades

With treatment to eliminate sleep apnea, these outcomes can be reversed and your child can resume his or her healthy and productive developmental years. Treatment of sleep apnea also prevents the strain placed on the heart and lungs by recurrent drops in oxygen and repeated awakenings during the night, which can result in hypertension and heart disease.

What types of sleep disordered breathing are seen in children?

The types of sleep disordered breathing most often found in children are:

1. Obstructive sleep apnea
2. Central sleep apnea
3. Upper airway resistance syndrome
4. Simple snoring
5. Apnea of infancy
6. Obstructive hypoventilation

The frequency of each disorder is dependent on the age of the child.

How is obstructive sleep apnea diagnosed?

The only way to reliably distinguish simple snoring from obstructive sleep apnea is to undergo an overnight sleep study in a sleep laboratory. (The size of the tonsils does not distinguish the two.) A sleep study involves a series of “stick on” sensors that detect what stage of sleep your child is in, how well your child is breathing, and how hard your child is working to breathe. Based on the information collected from the sleep study it can be determined if your child has sleep disordered breathing and how severe it is.

What should I expect when my child sees a sleep doctor?

You should expect a thorough history and comprehensive physical examination to be performed by a physician specially trained in pediatric sleep medicine at an accredited sleep medicine fellowship program. This evaluation should not only focus on sleep disordered breathing but all sleep related disorders. The visit may involve an in-depth evaluation of your child’s upper airway using a small flexible fiber optic endoscope. This is a small tube (about the size of a piece of spaghetti) with a camera and light on the end of it. Specific concerns should be explained and all of your questions should be answered to your satisfaction. If sleep disordered breathing is in question, a follow-up appointment for an overnight sleep study will be arranged. The facility should be “kid friendly” and provide arrangements for one family member to sleep in the same room as your child.

The newborn and infant:

During fetal development (before birth) your child’s brain slowly matures to a point that it can orchestrate control of breathing. However, it is sometimes the case that the brain does not mature fast enough and control of breathing is not ideal. The result is apnea of infancy. This manifests as pauses in breathing that can be accompanied by drops in blood oxygen levels. This process may go on for several years following birth in some children. If you notice your infant or young child experiencing prolonged pauses in breathing, consultation with a sleep specialist can clarify if there is anything to be concerned about. If apnea of infancy is discovered, additional workup may be required and supplemental oxygen or medications may be prescribed while the child is periodically monitored to ensure that nature takes its course and the problem corrects itself with maturation of the brain.

Also during fetal development the jaw sometimes starts off undersized relative to the tongue. When this is the case, pauses in breathing associated with noisy breathing may occur. This suggests that the tongue may be blocking off the airway while the child is asleep. In this circumstance a sleep specialist should be consulted. The severity of obstructive sleep apnea can be monitored and treated if necessary. Ultimately the final outcome for these children is generally positive as jaw growth catches up with the rest of the body during the first year of life and resolution of obstructive sleep apnea is achieved.

The toddler and preschooler:

During these years the rate of growth of the tonsils and adenoids can overwhelm the child’s relatively small upper airway with resulting obstruction during sleep. Occasionally this manifests as pauses in breathing (or obstructive sleep apnea of childhood), but more commonly the increased airway resistance results in obstructive hypoventilation without the occurrence of discrete apneas. The increased work of breathing results in poor quality sleep and a poorly rested child. The only way this can be diagnosed is with a special type of sensor known as an esophageal pressure monitor, which measures the work of breathing required to overcome upper airway resistance. Treatment is often achieved by removal of the tonsils and adenoids.

School kids and adolescents:

While tonsil and adenoid enlargement may still play a role in sleep disordered breathing in this age group, these children are becoming young adults and can demonstrate obstructive sleep apnea, as seen in adults. In this setting surgical removal of tonsils and adenoids may not resolve the obstructive sleep apnea and continuous positive airway pressure (CPAP) may be recommended. This involves the use of a nose mask to deliver air pressure to the upper airway to “stent” it open and prevent its collapse.