Pediatric obstructive sleep apnea

Overview

Pediatric obstructive sleep apnea is a condition characterized by brief pauses in a child’s breathing pattern during sleep. These pauses occur due to blockages or obstructions in the airway. While it can affect children of any age, it is most commonly observed in those between 2 and 6 years old. The prevalence of pediatric obstructive sleep apnea ranges from 2% to 5%.
Compared to adult sleep apnea, pediatric obstructive sleep apnea presents with distinct differences. While adults typically experience daytime sleepiness as a common symptom, children are more likely to exhibit behavioral problems. The underlying causes also differ between the two groups. Obesity is often the primary factor in adults, whereas in children, enlarged adenoids and tonsils are frequently responsible. Adenoids are small tissue pads located in the back of the nose, while tonsils are oval-shaped pads situated at the back of the mouth.
Early diagnosis and treatment of pediatric obstructive sleep apnea is crucial in order to prevent complications that can negatively impact a child’s growth, cognitive development, and behavior.

Symptoms

Pediatric sleep apnea symptoms could manifest while the child is sleeping such as:

• Noisy or loud breathing, snoring, or breathing through the mouth while sleeping.
• Temporary pauses in breathing or difficulty breathing during sleep.
• Restless sleep characterized by frequent tossing and turning.
• Excessive sweating during sleep.
• Bedwetting
• Sleeping in unusual positions, such as with the neck hyperextended.
• Difficulty paying attention and lack of focus in school.
• Experiencing extreme sleepiness during the day, including falling asleep regularly in school.
• Poor academic performance.
• Irritability, aggression, or other behavioral problems, including hyperactivity.
• Growth issues, as severe obstructive sleep apnea (OSA) can hinder proper development.
• Morning headaches.

Obstructive sleep apnea in infants and young children is not often accompanied by snoring. They might simply have had a restless night.

During the daytime, children with sleep apnea may exhibit the following symptoms:

• Trouble learning or behavioral issues
• Not doing well in school
• Being extremely active
• Decreased attention span
• Problems gaining weight

If your child consistently displays behavioral issues and wakes up feeling fatigued, schedule a consultation with their doctor.

Causes

Sleep apnea in children is often caused by enlarged tonsils and adenoids that block their airway and hinder breathing during sleep. The relative size of these structures in comparison to the child’s airway is a key factor. When the child is awake, the muscles in the head and neck are more effective at keeping the airway passages open. However, during sleep, muscle tone decreases, allowing the tissues to come closer together and obstruct the airway. Additionally, other factors such as tissues in the nose, neck, and tongue can also contribute to the obstruction.

Various factors can contribute to obstructive sleep apnea (OSA) in children. These include obesity, a narrow facial bone structure, retrognathia (a small jaw), a history of cleft palate or pharyngeal flap surgery, low muscle tone (hypotonia) as seen in neuromuscular diseases, high muscle tone (as in cerebral palsy), and rarely, the presence of a tumor or growth in the airway. Children with syndromes that affect facial structure, such as Down syndrome, are also more prone to developing sleep apnea. Furthermore, children with nasal allergies, asthma, stomach acid reflux, and frequent upper airway infections are at an increased risk of developing OSA.

Risk factors

In addition to obesity, the following conditions increase the risk of pediatric sleep apnea:

• Neuromuscular disease
• Decreased weight at birth
• Obstructive sleep apnea in the family
• Down syndrome
• Congenital facial or skull defects
• Cerebral palsy
• Sickle cell disease