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Does your child have sleep apnea? How to tell and what to do

Does your child snore? Or sound like they're gasping for air at night? Here's what you need to know about sleep apnea in kids.

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Pediatric sleep apnea is relatively common, affecting from 1 to 4% of kids. Like adults, children with obstructive sleep apnea experience breathing interruptions while sleeping because the muscles in their airways collapse, leading to daytime sleepiness or potential behavioral issues. In the long term, if left untreated, sleep apnea in kids can cause serious health complications like stunted growth or heart issues.  

The good news is that symptoms are pretty mild for most children, and they often outgrow it. Here's what you need to know if you suspect your child might have sleep apnea.

What causes sleep apnea in children? 

There are two main types of sleep apnea in kids -- obstructive sleep apnea and central sleep apnea. With obstructive sleep apnea, the muscles in the airway collapse in on themselves, blocking your child's ability to breathe. Central sleep apnea is when the brain isn't sending the correct signals to the airway muscles.  

We will talk primarily about obstructive sleep apnea, as it is more common than central sleep apnea. There are several causes of sleep apnea in children, like narrow facial bone structures, cleft palate or a high or low muscle tone. 

However, two main factors largely contribute to OSA in children.

Obesity

According to a cross-sectional study of children aged seven to 18, obesity is a significant contributor to sleep apnea. About 44% of children categorized as overweight had OSA compared to 9.1% prevalence in the "normal-weight group." 

Like in adults, obesity is one of the leading risk factors for sleep apnea. It happens because fat deposits collect in the upper respiratory tract, limiting muscle activity. 

Enlarged tonsils and adenoids

Sleep apnea can arise in children because of enlarged tonsils or adenoids. The tonsils are found in the back of the throat and the adenoids in the nasal cavity. If either is enlarged, it can narrow the child's airways, making it difficult for them to breathe while sleeping. The severity of the breathing interruption will depend on the side of the tonsils or adenoids. This doesn't happen to all children, and it's not exactly clear why it happens to some and not others. Exposure to viruses, bacteria or other infections can enlarge tonsils or adenoids. 

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Common signs and symptoms of sleep apnea in kids

Your child likely won't be able to tell you what's happening. Generally speaking, they'll fall asleep after any breathing interruptions without knowing they woke up. If your child complains of being tired during the day or their behavior has changed, it's worth noting what happens when they sleep.

Snoring isn't always necessary to diagnose a child with sleep apnea, though it is the most common indicator. However, there are several other signs.

The signs of sleep apnea in kids include:

  • Snoring and gasping for breath at night
  • Mouth breathing or heavy breathing
  • Nighttime sweating
  • Wetting the bed
  • Sleepwalking or night terrors
  • Restless sleep
  • Trouble waking or staying awake
  • Behavioral issues

What happens if pediatric sleep apnea isn't treated?

Just because your child snores it doesn't mean they have sleep apnea. If you suspect they could have it, it's worth looking into. The effects of untreated sleep apnea can be severe -- high blood pressure, the risk of a stroke and heart issues all increase with sleep apnea

There are differences between sleep apnea in adults and children -- most of which are highlighted in the side effects of the disorder. Children with sleep apnea will likely exhibit behavioral problems due to their fractured sleep patterns. They may have trouble waking up in the morning, paying attention in school or being hyperactive. If the sleep apnea is left untreated, your child may experience behavioral and learning difficulties.

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Treatments for pediatric sleep apnea

After a physical exam and detailed sleep history, a sleep study is best to diagnose pediatric sleep apnea. In a pediatric sleep study, your child's sleep will be monitored in a lab setting where a doctor can note any abnormalities of sleep apnea symptoms. 

Once diagnosed, your child's sleep apnea treatment will typically fall within these three categories. However, special cases may require unique treatment options. 

Surgery

One of the most significant contributing factors to childhood sleep apnea is the enlargement of the tonsils or the adenoids. Your ears, nose and throat doctor may recommend removing one or both to effectively cure obstructive sleep apnea -- surgery results in the elimination of sleep apnea symptoms 70 to 90% of the time

After surgery, you should expect a sore throat. Children with sleep apnea who get their tonsils and adenoids out have a higher chance of lower oxygen levels for the first two to three nights after surgery.

Continuous positive airway pressure machine

Your child's doctor may also recommend using a CPAP machine to treat their sleep apnea. CPAP machines constantly blow air into your child's airway, ensuring it doesn't close during the night. While they effectively treat sleep apnea, they do require that your child wear the mask when they sleep. 

Sleeping with a CPAP machine will be an adjustment. We recommend that you slowly introduce the machine. Try it at nap time at first and then for more extended periods each night. This will help them ease into the change and better adapt. 

If your child cannot tolerate a CPAP machine, your doctor may recommend an oral appliance to treat their sleep apnea, which pushes the tongue and jaw forward, expanding their airway through the night. Oral appliances are less effective but are easier for most children to adapt to. This option is generally limited to those who had surgery to remove their tonsils and adenoids, and the sleep apnea persists. 

Diet change

In addition to other treatment options for sleep apnea, lifestyle changes will be recommended for children who are considered overweight. Research has shown that weight loss successfully treats sleep apnea among children. Talk to your doctor about a nutritional and exercise plan that promotes a healthy way to lose weight.

Remember that adequate sleep is a crucial part of weight management. Kids who aren't getting enough sleep have a higher likelihood of gaining weight. A CPAP machine can help give them more restorative sleep to help with weight loss

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When should your child see a doctor?

The big, lingering question you have is probably: what should I do first if I think my child has sleep apnea? 

In general, you shouldn't try to self-diagnose your child's sleep apnea. If your child consistently presents any of the symptoms associated with sleep apnea -- snoring, gasping for air or restless sleeping -- you should consult a doctor. It's never too soon to start the conversation. 

Tips to prepare for your appointment:

  • Make sure you bring all the questions you want to be answered. Don't shy away from talking through everything on your mind. 
  • Be ready to explore treatment options you're comfortable with. Express your concerns and hesitations.
  • If you're seeking additional support, you can connect with your local A.W.A.K.E group, an education and support group run by the American Sleep Apnea Association. 

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.