Pediatric Sleep Apnea: What All Parents Should Know
Sleep apnea is typically viewed as a concern for adults. But surprisingly, many children also suffer from sleep apnea, and if left untreated, the effects can range from behavioral challenges to life-altering developmental issues. Unfortunately, pediatric sleep apnea is both difficult to spot and could also be on the rise. Here’s what every parent should know.
What Is Sleep Apnea & How Does It Present in Children?
Sleep apnea is a disorder where regular breathing is interrupted during sleep. Children can suffer from the following two types of sleep apnea.
Obstructive Sleep Apnea
The most common type, where an anatomical blockage is present at the back of the nose or throat. This can be due to enlarged tonsils, adenoids or tongue and other jaw, nose or throat problems. During sleep, the airway muscles relax and eventually become obstructed by the sleeper’s anatomy. Heavy snoring can be a strong indication of obstructive sleep apnea.
Central Sleep Apnea
The less common type, where the brainstem fails to send the necessary signals to the muscles that control breathing during sleep. Central sleep apnea is often tied to other medical conditions, and although it can be accompanied by snoring, it is typically less pronounced than snoring from obstructive sleep apnea.
While it is commonly estimated that 1 to 4% of children have sleep apnea, the American Osteopathic Association believes that up to 15% of children suffer from sleep apnea, and 90% of cases go undiagnosed.
What Are the Symptoms of Pediatric Sleep Apnea?6,7
• Loud snoring and heavy breathing
• Coughing, choking, snorts, pauses and gasps
• Mouth breathing
• Restless sleeping and sleep terrors
• Sleep walking
• Abnormal sleeping positions
• Bedwetting
What Are Some of the Potential Consequences?8,9,10
• Difficulty paying attention
• Behavioral problems and moodiness
• Difficulty waking up in the morning
• Sleepiness and falling asleep during the day
• Hormonal and metabolic problems
• Stunted physical growth
• Stunted mental development
Why Is Pediatric Sleep Apnea Difficult to Detect?
Many of the symptoms of sleep apnea both during sleep and while awake can also be completely normal for children. Take snoring—the primary indicator of obstructive sleep apnea—for example. 10% of children between the ages of one and nine snore, and the difference between harmless snoring and snoring that can be related to morbidities with “adverse consequences” is not known. It is simply estimated that 2-3% of pediatric snoring is a warning sign.11
The difficulty to detect pediatric sleep apnea may have severe consequences for children. Studies indicate that up to 25% of attention deficit hyperactivity disorder (ADHD) cases are actually related to fragmented sleep from obstructive sleep apnea.12
The learning and behavioral problems for these children could be solved with better sleep, not ADHD medication. Even more troubling, there are indications that pediatric sleep apnea could permanently harm the development of the executive functions of the brain.13
Pediatric Sleep Apnea May Be Rising in Prevalence
Childhood obesity has a very strong correlation with pediatric sleep apnea. Researchers believe that up to 60% of obese children suffer from the disorder.14 Unfortunately, childhood obesity may be on the rise. According to US News, obesity in 2-5 year-old children jumped from 9% to 14% from 1999 to 2016.15 As of 2019 according to the CDC, 2-5 year-olds have remained steady at 13.9% but 6-11 year-olds are as high as 18.6%.16
If You Are Worried That Your Child Has Sleep Apnea, What Should You Do?
Speak to your child’s pediatrician about your concerns. They may refer you to a sleep specialist for a sleep study (polysomnagram), where they will monitor your child while they sleep for a range of sleep apnea indicators.
For Parents, You Should Know There Are Great Options for Treatment
Once diagnosed, doctors can effectively treat the causes of sleep apnea for many patients, and there are also medical devices that can ensure a safe night’s sleep as well. For moderate cases of sleep apnea, doctors may simply recommend waiting to see if the symptoms subside naturally.
Otherwise, they may recommend intervention to alleviate an anatomical cause of the disorder. That could range from weight loss to surgical interventions. Tonsillectomies and adenoidectomies are the most common surgical options for sleep apnea. Although any surgery is stressful, these are among the most routine procedures for children in general and typically take 30 minutes or less to perform.17, 18, 19
Continuous positive airway pressure (CPAP) therapy could also be recommended. In CPAP therapy, a fitted mask is connected to a machine that delivers air, ensuring the user’s airways remain open while sleeping. There are numerous options to fine-tune the fit and feel of CPAP facemasks to make them as comfortable as possible. Millions of Americans use CPAP machines every day, and they can provide a safe and restorative night’s rest for children with sleep apnea.
1 https://www.healthline.com/health/sleep-apnea-in-children
2 https://kidshealth.org/en/parents/apnea.html
3 https://www.mayoclinic.org/diseases-conditions/central-sleep-apnea/symptoms-causes/syc-20352109
4 https://www.sleepapnea.org/treat/childrens-sleep-apnea/
5 https://medicalxpress.com/news/2019-02-percent-children-apnea-undiagnosed.html
6 https://kidshealth.org/en/parents/apnea.html
7 https://www.healthline.com/health/sleep-apnea-in-children#symptoms
8 https://kidshealth.org/en/parents/apnea.html
9 https://www.healthline.com/health/sleep-apnea-in-children#symptoms
10 https://www.sleepapnea.org/treat/childrens-sleep-apnea/
11 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645258/
12 https://www.sleepapnea.org/treat/childrens-sleep-apnea/
13 https://www.sleepapnea.org/treat/childrens-sleep-apnea/
14https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3432382/#:~:text=Obesity%20in%20childhood%20and%20adolescence,to%2060%25%20of%20obese%20children.
15 https://www.usnews.com/news/healthiest-communities/articles/2018-02-26/study-childhood-obesity-on-the-rise#:~:text=In%20a%20study%20published%20Monday, seeing%20the%20most%20drastic%20increase.&text=Contrary%20to%20prior%20beliefs%20that,found%20obesity%20is%20still%20widespread.
16https://www.cdc.gov/obesity/data/childhood.html#:~:text=Obesity%20prevalence%20was%2013.9%25%20among,more%20common%20among%20certain %20populations.
17 https://my.clevelandclinic.org/health/treatments/15447-adenoidectomy-adenoid-removal#:~:text=An%20adenoidectomy%20is%20a%20surgery,of%20the %20surgery%20are%20provided.
18 https://kidshealth.org/en/parents/tonsil.html
19https://kidshealth.org/en/parents/adenoids.html#:~:text=An%20adenoidectomy%20(ad%2Deh%2D,provider%20may%20recommend%20an%20adenoidectomy.