Obstructive sleep apnea

Obstruction of the airway during sleep may be much more subtle in the child. Although the term sleep apnea may still be used, true apnea commonly does not occur. Instead, the obstruction will lead to a disruption of sleep or “arousal.” Snoring is a sign that disruption is occurring. Reoccurrence of these events throughout the night prohibits the child from obtaining a restful sleep. However, young children may not manifest this with obvious signs of fatigue. Rather, symptoms such as irritability, poor attention span, lack of concentration, and even poor physical growth will be seen. In some cases, the normal secretion of growth hormone which occurs during sleep may be disturbed. Over a prolonged period of time alteration of the growth of the midface leading to orthodontic concerns and even cardiac and pulmonary side effects may occur.

Recent reports in the pediatric literature have stressed that because signs of this process are perhaps less obvious in children, any child with snoring deserves evaluation. This evaluation will include a thorough examination of the upper airway and a detailed history of the child’s social and intellectual development. A polysomnogram may then be used to confirm the diagnosis and establish the real severity of the problem.

Treatment

Treatment may include non-surgical options such as continuous positive airway pressure (CPAP), in which a mask is worn while sleeping, and the airway is kept open by a constant pressure of air. This may be difficult for the pediatric patient to tolerate.

Surgical treatment is aimed at eliminating the obstruction. Most commonly the tonsils and adenoids are addressed first. It is important to note that these structures should be evaluated based on their size relative to the individual patients airway. In addition the interior of the nose should be examined. Inflammation of normal structures known as turbinates can contribute to the obstruction. Tonsillectomy with adenoidectomy is very effective in relieving snoring and improving the airway. Reduction of the turbinates can be accomplished by a non surgical method called radiofrequency which uses a small electrode. After each procedure it is important to document whether or not the sleep issues have been completely resolved. In some cases, further treatment may include surgery to shorten the palate or orthodontic procedures to widen and open the airway further.

References

Since a child’s growth, development and overall health is important you may wish more information regarding these issues:

Clinical Practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 4:704-712, 2002.

Chervin RD, Archbold KH, Dillon JE, Panahi P, Pituch KJ, Dahl RE, Guilleminault C. Inattention, hyperactivity, and symptoms of sleep-disordered breathing. Pediatrics 3:449-56, 2002.

Owens JA. The practice of pediatric sleep medicine: results of a community survey. Pediatrics 3:E51,2001.

Guilleminault C and Khramtsov A. Upper airway resistance syndrome in children: a clinical review. Seminars in Pediatric Neurology 4:207-215, 2001.

Chervin RD, Dillon JE, Bassetti C, Ganoczy DA, Pituch KJ. Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep 12:1185-92, 1997.

Nieminen P, Lopponen T, Tolonen U, Lanning P, Knip M, Lopponen H. Growth and biochemical markers of growth in children with snoring and obstructive sleep apnea. Pediatrics 109:e55, 2002