Description

Pediatric obstructive sleep apnea is a condition in which the breathing of the child is, in part or completely blocked during sleep. Breathing can be briefly stopping and starting again many times in the night. The condition occurs when the upper airway narrows or is blocked during sleep.

Obstructive sleep apnea may look different in children than in adults. Adults tend to have sleepiness during the day. Children are more likely to have behavioral problems, such as acting hyper or not paying attention. The risk factors also differ. In adults, the major risk factors are obesity and age. Although obesity may play a role in children, the main risk factor in children is to have the tonsils and adenoids that are larger than usual. The adenoids are two small pads of tissue at the back of the nose. The tonsils are two oval-shaped pads in the back of the mouth.

It is important for health professionals to detect and treat pediatric obstructive sleep apnea as soon as possible. Early treatment helps prevent other health problems called complications. These can affect children's growth, learning, behavior, and heart health. The first treatment may be surgery to remove the enlarged tonsils and adenoids. But some children may improve the use of medical devices or drugs.

Symptoms

During sleep, the symptoms of pediatric obstructive sleep apnea may include:

  • Snoring.
  • Pauses in breathing.
  • Restless sleep.
  • Snorting, wheezing, cough or choking.
  • Breathing through the mouth.
  • The night sweating.
  • Bed-wetting that starts after a long period of dry nights accommodation.

Infants and children with obstructive sleep apnea don't always snore. Is it possible to have sleep disorders.

During the day, children with sleep apnea may:

  • Have headaches in the morning.
  • Breathing through the mouth or difficulty breathing through the nose.
  • Problems of learning and attention.
  • To do poorly in school.
  • Have behavior problems, such as acting hyperactive, impulsive, or aggressive.
  • Have poor weight gain.
  • Talk about the feeling of drowsiness or falling asleep during school or during short car or bus.

When to see a doctor

See your health care professional if your child has any of the symptoms of obstructive sleep apnea, including frequent snoring.

Causes

Pediatric obstructive sleep apnea is caused by the muscles in the back of the throat relaxing and blocking the upper airway. In children, this leads to pauses in breathing that last about twice as long as the typical breath.

When breathing stops, this triggers the brain to wake up so that the airway can be opened again. This makes it difficult to get enough rest.

Several conditions can increase the risk of obstruction of the upper airway during sleep. Commonly, enlargement of the tonsils in the back of the mouth and of the adenoids in the back of the nose can cause a blockage. Other possible causes include being born with birth defects related to the shape of the face or the head, and certain health conditions.

Risk factors

The main risk factor for pediatric obstructive sleep apnea is enlarged tonsils and adenoids, especially in small children. Obesity is also a major risk factor, mainly among the teenagers.

Other risk factors for pediatric sleep apnea include:

  • A genetic condition such as Down's syndrome or Prader-Willi syndrome.
  • Birth defects in the skull or face.
  • A group of conditions called cerebral palsy, which affects movement and posture.
  • A group of inherited blood disorders known as sickle cell disease.
  • Conditions called neuromuscular disorders that affect the function of the muscles due to problems with the nerves and muscles in the body.
  • A history of low birth weight.
  • A family history of obstructive sleep apnea.

Complications

Without treatment, pediatric obstructive sleep apnea can lead to other health problems called complications. Rarely, pediatric obstructive sleep apnea can cause babies and small children who do not grow as much as those who do not have the disease. Children who do not receive treatment may also have an increased risk of later complications, such as:

  • The high blood pressure.
  • High cholesterol.
  • A higher than typical level of sugar in blood that increases the risk of diabetes.
  • Other heart and blood vessel conditions.

Very rarely, children with certain genetic conditions can have severe symptoms of pediatric obstructive sleep apnea. These symptoms can lead to death. But in the majority of children, the treatment can help to manage complications.

Diagnosis

The diagnosis involves the steps that a healthcare provider needs to find out if your child has pediatric obstructive sleep apnea. A health care professional to review your child's symptoms and health history and a physical examination. Your child's healthcare provider will likely look at his son in the head, the neck, the nose, the mouth and tongue.

Other tests may be needed. The main evidence of sleep apnea in children is called polysomnography. This implies a dream during the night of the test. The sensors are placed in the body of his son. The sensors record brain waves, breathing patterns, snoring, oxygen levels, heart rate, and muscle activity while your child sleeps. This test can be performed in a sleep center.

Treatment

Your child's healthcare provider will work with you to find the right treatment for your child's pediatric obstructive sleep apnea. Most often, the first treatment for the disease is surgery to remove the enlarged tonsils and adenoids. This is called an adenotonsillectomy (ad-uh-no-ton-sil-EK-tuh-me). But some children get better with medicines or medical devices.

The right treatment plan for your child depends on your child sleep apnea symptoms and risk factors. For the majority of children, including the treatment of adenotonsillectomy, but your child's health care provider may recommend other treatments, if this surgery is not suitable for your child. Other treatments may also be necessary if surgery is not fully treat his son of obstructive sleep apnea.

Some children get better without sleep apnea treatments. It is possible that some children with mild-to-moderate obstructive sleep apnea to get rid of the condition. A health professional may recommend watching a child up to six months to see if symptoms improve. This is called watchful waiting. If the child also has allergies or other conditions that irritate the respiratory tract, the watchful waiting may include the treatment of the people.

Drugs

Topical nasal steroids may relieve symptoms of sleep apnea in children with mild obstructive sleep apnea. These medications include fluticasone (Flovent HFA, Xhance, others) and budesonide (Rhinocort, Pulmicort Flexhaler, other). For children with allergies, montelukast (Singulair) can help relieve the symptoms when used alone or with nasal steroids.

Therapies

Your child's healthcare provider may recommend the use of devices such as:

  • The therapy is positive pressure in the airways.Small machines blow air through a tube with the so-called treatments of continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP). The tube is connected to a mask that goes around the child's nose or the nose and mouth during sleep. The machine delivers air pressure in the back of your child's throat to keep your child's airway open. Often, the therapy of positive pressure in the airway is a treatment option if the drugs or the removal of the adenoids and the tonsils does not work. An adequate fit of the mask and mount as your child grows can make the mask more comfortable to wear.
  • Oral appliances. These devices range in the mouth. Include dental devices and nozzles. Oral appliances help to extend the roof of the mouth and the nostrils. You can also move your child out of the lower jaw and tongue forward to keep the upper airway open. Only some children benefit from these devices.

The therapy is positive pressure in the airways. Small machines blow air through a tube with the so-called treatments of continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP). The tube is connected to a mask that goes around the child's nose or the nose and mouth during sleep. The machine delivers air pressure in the back of your child's throat to keep your child's airway open. Often, the therapy of positive pressure in the airway is a treatment option if the drugs or the removal of the adenoids and the tonsils does not work.

An adequate fit of the mask and mount as your child grows can make the mask more comfortable to wear.

Surgery or other procedures

Adenotonsillectomy to remove the tonsils and adenoids can improve obstructive sleep apnea by opening the airway. It is often a treatment option for children with moderate-to-severe obstructive sleep apnea. Your child's primary health care professional may refer you to a pediatric ear, nose and throat specialist to talk about the surgery. Other forms of the upper airway surgery may be recommended based on the condition of your child.

Lifestyle and home remedies

You can take the following steps at home to help your child with pediatric obstructive sleep apnea:

  • Stay away from the airways to irritants and allergens. Allergens are things that cause allergies. Keep your child away from tobacco smoke and other indoor allergens or pollutants. This step is important for all children, but especially those with obstructive sleep apnea. Irritants and allergens can irritate the airways and cause congestion.
  • The loss of weight. If your child is obese, ask your child's healthcare provider about a weight loss plan. The health care provider may give you and your child information about healthy changes in diet and physical activity. You may also be referred to specialists in the management of obesity because it is a complex disease. Weight loss surgery is a treatment option for some teens who have obstructive sleep apnea and severe obesity.
  • Watchful waiting. Some children can overcome their obstructive sleep apnea, while their health professionals follow-up of their health. This is especially true for children with mild disease and no other risk factors.

Preparing for your appointment

It is likely to start by seeing your child's regular health care provider. Or you may be referred immediately to an ear, nose and throat specialist or a specialist in sleep medicine.

Here's some information to help you prepare for your appointment.

What you can do

Make a list of:

  • Your child's symptoms, including those that do not seem to be related to the reason for your appointment.
  • All the medications, vitamins, or other supplements that your child takes, including the dose.
  • Questions to ask your health care professional.

For pediatric obstructive sleep apnea, some basic questions to ask your child's health care professional include:

  • What tests are needed?
  • Is this condition likely to be short-term or long-term?
  • What is the best course of action?
  • Apart from the main, the treatment you are suggesting, there are other treatment options?
  • Should I take my child to a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Feel free to ask questions.

What to expect from your doctor

Your child's healthcare provider will likely ask questions such as:

  • Does your child snore?
  • What else have you noticed about your child's sleep?
  • Does your child have trouble paying attention?
  • Your child has difficulty with learning?
  • Do you have a family history of obstructive sleep apnea?
Symptoms and treatment of Pediatric obstructive sleep apnea