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Children's health
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Sleep Apnea in Children: Signs, Causes and Treatments

 Thu May 02 2024

Reading time : 7 mins

Does your child habitually snore or sleeps with his/her mouth open? Sleep apnea could be the problem. That can be worrisome but fortunately, its treatable!

Sleep apnea, a severe sleep disorder, can profoundly impact a child's health. It occurs when a person’s breathing is interrupted during sleep. Children who have sleep apnea can stop breathing during their sleep. These breathing interruptions typically last 10 to 20 seconds and might occur from five to more than 30 times in an hour. Sometimes, it may go hundreds of times. This means the brain and the rest of the body might not get enough oxygen.

Most children have some degree of sleep apnea, and they go unnoticed by parents. Sleep apnea goes beyond just restless nights. It disrupts their sleep patterns, causing frequent awakenings throughout the night. Quality of sleep is profoundly affected by these apenic episodes thus affecting children’s behaviour and learning abilities. They become irritable, cranky and struggle to concentrate. This can lead to behavioural issues at school and hinder their ability to learn effectively. Treating sleep apnea can help the child overcome these associated symptoms.

What Kinds of Sleep Apnea Are there in Children?

Childhood sleep apnea comes in three different forms.

Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea is the most prevalent type in children. It happens when there is a repetitive narrowing or obstruction of your child's airways. Most common causes of obstructive sleep apnea are enlarged tonsils or adenoids. This causes pauses in breathing followed by shallow breathing. This is accompanied by loud snort or a choking sound.

Central Sleep Apnea

Central Sleep Apnea is an uncommon sleep apnea that usually affects newborns. It occurs when the newborn's brain experiences difficulties coordinating with the respiratory muscles such as in congenital central hypoventilation syndrome or abnormalities affecting the brainstem. Other causes include premature birth, cerebral palsy, history of smoking in the mother during pregnancy.

Mixed or Complex Sleep Apnea (CSO)

Treatment-emergent CSO, sometimes referred to as mixed or complex sleep apnea, is one kind of Central Sleep Apnea. It happens when a child with OSA who has been under primary treatment with a Continuous Positive Airway Pressure (CPAP) machine goes on to develop Central Sleep Apnea. The mechanisms behind this phenomenon and CompSA are not well understood.

Common causes of Sleep Apnea in children?

  • Recurrent tonsillitis

  • Adenoids

  • Obesity or excess weight

  • Congenital airway narrowing.

  • History of sleep apnea in the family

Obesity and excess weight are common risk factors for sleep apnea, but it is not the causative factor. Breathing pauses during sleep are a defining feature of sleep apnea. Several factors, such as respiratory infections and lifestyle choices, can cause these breathing pauses. However, because it narrows the airways, being overweight might worsen sleep apnea. There may be other contributing variables.

What are Sleep Cycles?

It's important to comprehend sleep cycles because they provide you insights into your child's sleeping habits and how to encourage good sleep hygiene as disturbed sleep contributes to various associated symptoms in children with sleep apnea. The phases of sleep are broken down as follows.

There are three non-rapid eye movement stages (NREM) and one rapid eye movement stage (REM) for one complete sleep cycle. Any normal healthy person goes through 4 – 6 cycles per night.

Stage 1: Drowsiness – N1 (stage 1 of NREM)

This is the phase where awareness gives way to sleep. Your youngster can have drooping eyelids, slower movements, and a weary appearance. This short phase serves as a transition to more profound sleep. It is easy to wake someone up from this stage, however uninterrupted sleep may not spend much time in this stage and moves through further cycles.

Stage 2: Light Sleep – N2 (stage 2 of NREM)

Your child's sleep cycle consists mostly of this stage. Their body temperature decreases somewhat, their respiration and pulse rate become slower, and they could have momentary cramping in their muscles. Overall, brain activity is slower. Generally, a normal spends most of their sleep time in light sleep.

Stage 3: Deep Sleep

Another name for this is slow-wave sleep. The deepest sleep characterizes this stage. The body heals wounds, strengthens the immune system, and encourages physical development during this time. They may appear calm and motionless during this phase, and awakening is more difficult. Although brain activity is reduced, evidence suggests that deep sleep contributes to insightful thinking, creativity, and memory. Sleep apnea can disrupt these phases of sleep causing dullness and lack of concentration.

Stage 4: REM (Rapid Eye Movement)

During this phase brain activity picks up. Although the eyes are closed movement is observed and hence the name rapid eye movement sleep. Dreaming happens at this point. They might only sometimes have a REM eye rush. This phase of increased brain activity is critical for the development of cognitive abilities and the control of emotions. They sleep through a large portion of the night in REM sleep. Mainly in the second half of the night.

What Sleep Apnea Symptoms Are There?

These are common signs that could point to sleep apnea.

Loud Snoring

Loud snoring is a common sign of sleep apnea. Although it is not a prevalent symptom, sleep apnea is not the cause of all snores. Breathing pauses can cause the snoring to stop.

Breathing Pauses

If someone notices that your child occasionally stops breathing while they are asleep, it may be a clear sign of sleep apnea. These pauses could be followed by a choking sound when his breathing resumes.

Daytime drowsiness/Sleeping

Kids who have sleep apnea often experience excessive fatigue during the day, even if they get enough sleep. This may find it difficult to stay awake during the day, especially when something important needs to be done.

Lack of Concentration and disturbed Memory

Poor sleep quality from sleep apnea can make the child difficult to concentrate in school with poor, and a decline in cognitive function.

If your child struggles with concentration during the day or if they have memory problems, you should think about sleep apnea as a possible cause.

Other signs that your youngster may exhibit are:

  • Bags under eyes/a dark circle around the eyes

  • Weight loss

  • Pale skin colour

  • Bedwetting

  • Fatigue, tired, and sleepy despite getting 8 hours of sleep every night.

  • Confused and cranky

  • Poor performance at school

A common misconception among parents is that pediatric obstructive sleep apnea (OSA) exclusively affects overweight kids. Although obesity is a common cause any youngster, regardless of size, can have OSA which may be due to recurrent tonsillitis or adenoids. Please don't write off your child's frequent snoring, sleeping with their mouth open, difficulty falling asleep, or extreme fatigue during the day as typical child characteristics.

Early OSA diagnosis is crucial as child's behaviour, learning, and long-term health may be affected by untreated OSA.

How can Sleep Apnea be Diagnosed?

Your child must have a sleep study to be diagnosed with OSA. It can be carried out using Polysomnography (PSG – a sleep study that measures various physiological functions and brain activity during sleep) at home or in a sleep clinic. Your child will wear sensors to track his heart rate, breathing, blood oxygen levels, and brain waves as he sleeps for the duration of the study or sleep apnea test.

Additionally, if your child is consistently exhausted, talk to your doctors about his sleeping patterns. Your doctor can conduct a sleep test at your convenience. The test monitors respiration and sleep, displaying the duration of a user's sleep in each stage as well as the quality of their breathing. It also picks up on pauses, breathing problems, and breath quality. Paediatricians can use the results of the sleep test to assess if a patient may have sleep apnea accurately.

How Do They Treat Sleep Apnea?

The current estimate for sleep apnea in youngsters is between 2 to 5%. If your child has been diagnosed with sleep apnea, talk to the paediatrician about possible causes and your choices for treatment. Indeed, a consultation with a paediatrician may be the secret to improved sleep.

Untreated Obstructive Sleep Apnea (OSA) raises the risk of depression, diabetes, and elevated blood pressure later in life.

As commonly seen in children, if it is tonsillitis or adenoiditis of acute nature, course of antibiotics to overcome the infection are prescribed. Recurrent tonsillitis or adenoiditis is treated surgically through partial/complete tonsillectomy or/and adenoidectomy. Removing tonsils/adenoids should open the airways and eliminate OSA.

Additional possible treatments consist of -

  • Adaptive ventilation devices and Bilevel positive airway pressure

  • Supplemental oxygen

  • Surgical corrections in case of narrow airways

  • Medication (only for Central Sleep Apnea)

Myofunctional Therapy – What is it and how can it benefityour Child?

Myofunctional Therapy - It is the “neuromuscular re-education or re-patterning of the orofacial muscles”. It is advised as a complementary therapy in sleep apnea to strengthen the muscles that support the airways.

It offers numerous other benefits for children. It helps address issues of talking, eating or breathing through facial and tongue exercises and behaviour modification techniques. By improving tongue posture, swallowing patterns, and oral muscle function, myofunctional therapy can help guide the growth of the jaw and dental arches, preventing potential problems such as crowding and misalignment of teeth.

Myofunctional therapy can improve breathing, swallowing, and speaking while promoting proper facial and dental development. This therapy can lead to long-term benefits for oral and overall health.

When will Your Child Feel Better Following Treatment?

The duration of recovery or improvement following sleep apnea treatment depends on the cause and specific treatments used. While some people may see full benefits after three to six months of constant treatment or surgery (tonsillectomy or/and adenoidectomy), others may experience immediate improvement. Your healthcare professional can provide further information about your child’s recovery.

Positive airway pressure devices are effective in treating sleep apnea. These small machines gently pump in air into the respiratory airways through a tube and mask attached to your child’s nose or mouth to avoid collapsing of the airways. While many advanced newer devices can change automatically to match your needs while, older devices may require altering settings (especially if your sleep apnea is light or moderate). Most children can overcome the discomfort of wearing a mask to sleep rather quickly, while some may need time to adjust. When they use a positive airway pressure device to sleep through the night, many children immediately experience improvements.

Final Takeaway,

Sleep apnea is a common disorder that causes breathing disturbances while your child is asleep. As a result, children wake up just long enough to breathe, disrupting their sleep and preventing them from feeling fully rested. Early diagnosis and treatment of sleep apnea are essential as the condition can eventually cause significant or even fatal complications. Treatment options for this condition are numerous, and it is often treatable.

When your children adhere to these treatments and incorporate them into their daily routine without fail, they stand the best chance of achieving full recovery. For medical support and advice, speak with our paediatricians. They can assist your child in resolving these problems so your little one can have a restful night's sleep.