Pediatric Sleep Apnea

By Charu Sabharwal, MD, DABSM

Comprehensive Sleep Care Center

. https://comprehensivesleepcare.com/

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Pediatric Sleep Apnea

Pediatric obstructive sleep apnea (OSA) affects girls and boys equally and usually begins in the first few years of life, though it may go undiagnosed until later. Here are some signs that may indicate if your child may have a sleep apnea problem

Snoring and breathing difficulty during sleep (infants, however, may not snore at all, but may still have apneas.)

Paradoxical breathing Due to their more pliant rib cages, children with OSA may show paradoxical breathing, an inward rib cage motion during inspiration.

Profuse sweating

Bedwetting

Unusual sleep positions (for example, seated or with neck hyperextended)

Excessive daytime sleepiness (typical in older children or adolescents, but not younger children)

Cognitive and behavioral problems

Developmental delay

Poor school performance

Attention deficit hyperactivity disorder (ADHD)

Aggressive behavior

Slow rate of growth in early childhood OSA can cause growth failure, especially when associated with a genetic or craniofacial disorder.

Morning headaches

Mouth breathing because pediatric OSA is often due to enlarged adenoids and tonsils, a child may also breathe through his or her mouth, have frequent upper respiratory tract infections, or have difficulty swallowing.

Risks

Large tonsils and adenoids

Obesity

Craniofacial abnormalities such as a small chin or other underdeveloped facial structures

Down's syndrome

Neuromuscular diseases

Cerebral palsy

Gastroesophageal reflux disease (may cause swelling of the upper airway leading to blockages)

Storage disorders like the mucopolysaccharidoses

Sickle cell disease

Pharyngeal flap operations to improve speech quality in children with cleft palates

Family members with sleep apnea

Diagnosis

Since diagnosis and management of pediatric OSA differs from that of adult OSA, it's important to obtain an accurate clinical and sleep laboratory assessment including a polysomnogram.

Treatment Options

Adenotonsilectomy (removal of the tonsils and adenoids)

Positive pressure breathing (also referred to as continuous positive airway pressure [CPAP]). This may be used if adenotonsilectomy doesn't help. The level of air pressure depends on each patient's needs.

Losing weight. If excessive weight contributes to a child's OSA, then losing weight may be part of their treatment plan.

Oral appliance. The appliance moves the bottom jaw and tongue forward to keep the upper airway open.

Septoplasty (turbinate reduction). Septoplasty straightens a deviated septum (bony partition between the nostrils) and turbinate reduction trims or removes one or more of the curved bones along the wall of the nasal passage.

Jaw surgery (orthognathic surgery). In this surgery, the upper jaw, lower jaw and/or chin may be moved forward.

Surgery is usually a good option for older adolescents whose jaw structure worsens blockage of the upper airway and who haven't been helped by other treatments.