Pediatric ENT – Snoring & Sleep Apnea

Overview of Sleep Disordered Breathing

Child SleepingSleep-disordered breathing (SDB) is a general term for breathing difficulties that occur during sleep. SDB can range from frequent, mild snoring to obstructive sleep apnea (OSA), a condition involving repeated episodes of partial or complete blockage of the airway during sleep. Blockage of the airways during sleep disrupts the natural pattern of sleep. Such interruptions can result in a decrease in heart rate, rise in blood pressure, and arousal into a lighter stage of sleep. Oxygen levels in the blood can also drop. Approximately 10% of children snore regularly, and about 2-4 % of the pediatric population has OSA. Recent research indicates that even mild SDB or snoring may cause many of the same problems as OSA in children.

Symptoms of Obstructive Sleep Apnea

Snoring that is loud and present on most nights is the most obvious symptom of sleep-disordered breathing in children. The snoring may be loud and irregular. Gasping and snorting noises may also be present. Because of the lack of good-quality, restful sleep, a child with SDB may be irritable or have difficulty concentrating in school. Some children seem sleepy during the day while others may seem overly busy or exhibit hyperactivity. Bed-wetting is also frequently seen in children with sleep apnea.

Enlarged tonsils and adenoids are a common cause of airway narrowing that causes or contributes to SDB. Overweight children are at increased risk for SDB and OSA because of airway narrowing from fat depositis. Children with abnormalities involving the lower jaw or tongue or neuromuscular deficits have a higher risk of developing sleep disordered breathing.

Potential Consequences of Untreated Pediatric Sleep Disordered Breathing

  • Social: Loud snoring can become a significant social problem if a child shares a room with siblings or at sleepovers and summer camp.
  • Behavior and learning: Children with SDB may become moody, inattentive, and disruptive both at home and at school. Sleep-disordered breathing can also be a contributing factor to attention deficit disorders in some children.
  • Enuresis (bed wetting): SDB can cause increased nighttime urine production, which may lead to bedwetting.
  • Growth: Children with SDB may not produce enough growth hormone, resulting in abnormally slow growth and development.
  • Obesity: SBD may cause the body to have increased resistance to insulin or daytime fatigue with resultant decrease in physical activity. These factors can contribute to obesity.
  • Cardiovascular: OSA can be associated with an increased risk of high blood pressure or other heart and lung problems.

Diagnosis of Sleep Apnea

Sleep disordered breathing should be considered in a child who has frequent loud snoring, gasping or snorting while sleeping. Sleep may be unusually restless or the child may have unexplained bed wetting in conjunction with snoring. Behavioral symptoms can include changes in mood, misbehavior, and poor school performance. Not every child with academic or behavioral issues will have SDB, but if a child snores loudly on a regular basis and is experiencing mood, behavior, or school performance problems, sleep disordered breathing should be considered.
These symptoms should be discussed with the child’s pediatrician or an otolaryngologist (ear, nose and throat specialist). In most cases, the diagnosis of sleep-disordered breathing is made by history and physical examination.
In certain cases, the physician may recommend further testing. A sleep study, or polysomnography, is a test for the diagnosis of sleep apnea. This study is performed while the child is sleeping in a sleep laboratory or hospital. Several measurements are taken through the night including brain waves, oxygen levels, airflow, muscle movement and breathing.

Treatment for Sleep Disordered Breathing

Because enlarged tonsils and adenoids are the most common cause for SDB in children, tonsillectomy and adenoidectomy (removal of the tonsils and adenoids, T&A) are typically first-line therapy. Many children with sleep apnea show both short and long- term improvement in their sleep and behavior after T&A. Most children do not require overnight admission in the hospital and go home a few hours after surgery. Acetaminophen and ibuprofen are typically used to control pain.
Other treatment options include weight loss, the use of Continuous Positive Airway Pressure (CPAP) or additional surgical procedures may sometimes be required. These are used less often in children and may be used if sleep apnea persists after T&A.