Articles

The Snoring Child

WHAT IS SLEEP APNOEA ?

Paediatric obstructive sleep apnoea (or a “newer term” sleep disordered breathing) in children is a medical condition in which children have breathing problems while they are asleep. Sleep apnoea can affect children’s sleep and behaviour, and if untreated can lead to more serious problems.

When children (and adults) fall asleep, the muscles in the upper airway relax and become floppy. These can be partially or totally blocked by large tonsils and adenoids while the child is asleep.

Snoring in children is common (15-20%) however, obstructive sleep apnoea is less common.

It affects approximately 2-3 children in every 100.

WHAT ARE THE MAIN SYMPTOMS OF SLEEP APNOEA ?

(ZB Paediatric “Sleep Apnoea” Checklist ©)

Sleep apnoea may be difficult to diagnose, thus is it important to look for the following symptoms:

S noring

L aboured breathing during sleep

E xcessive Sweatiness AND/OR Restlessness during sleep

E xcessive day time Sleepiness AND/OR morning Tiredness/Headaches

P auses in breathing AND/OR “Choking”/Gasping/Snorting during sleep

A wakening due to bad dreams (“parasomnias”) AND/OR sleep walking

P ositions (sleeping in unusual positions; eg extended neck, sitting up)

N asal obstruction and mouth breathing

O verweight or Underweight

E nuresis (bedwetting)

A ttention/learning/behavioural problems

Note: Some research has shown that OSA may be a significant contributing factor to Attention Deficit Disorder (ADD) and Attention deficit hyperactivity disorder (ADHD)

October 2012

 WHAT CAUSES SLEEP APNOEA ?

  • Large tonsils and adenoids (these grow most quickly between 2-7 years old)

  • Obesity

  • Allergy causing nasal obstruction

  • Medical conditions associated with weak muscles (eg: Down’s Syndrome)

  • Abnormalities of the jaw bone and tongue.

HOW IS SLEEP APNOEA DIAGNOSED ?

 A sleep study (Polysomnograph) is the gold standard test for diagnosing Obstructive Sleep Apnoea. There are no needles or pain with this test. A number of wires are attached to the skin of the head and body to measure various parameters including pulse rate and oxygen saturation. Children sleep overnight with the parent while these measurements are made.

HOW IS OBSTRUCTIVE SLEEP APNOEA TREATED ?

  • Enlarged tonsils and adenoids are a common cause, thus dissection tonsillectomy and curettage adenoidectomy are performed to treat this problem.

  • Allergic rhinitis/nasal obstruction is treated with medication (+/- surgery).

  • Obese and overweight children are started on exercise and weight management programs.

  • Children with severe sleep apnoea may require CPAP (continuous positive airway pressure). This is rare.

  • Rarely there are children that require specialised surgical procedures.

The American Academy of Paediatric ENT Surgery has shown that treating sleep apnoea in children results in an extreme improvement in their sleep and behaviour.

 PROGNOSIS

Although many children can be cured by surgery, some may still snore and require further treatment.

 

 

 

October 2012