Pediatric obstructive sleep apnea

Diagnosis

When a child’s doctor suspects sleep apnea, they may suggest seeing a sleep specialist. The specialist will perform various tests to determine if the child has sleep apnea. These tests may include:

• Sleep history: The doctor will ask about the child’s sleeping patterns and habits.
• Upper airway evaluation: The doctor will examine the child’s head, neck, nose, mouth, and tongue to assess any potential issues.
• Polysomnogram (sleep study): This test is conducted in a sleep laboratory, usually with a parent present. It measures various parameters such as brain activity, heart rate, airflow through the nose and mouth, blood oxygen and carbon dioxide levels, muscle activity, and movements during sleep. It is a non-invasive procedure and does not cause any pain or involve needles. In some cases, a similar study may be done at the bedside if the child is hospitalized.
• Oximetry: This is an overnight recording of oxygen levels, typically done at home. While it cannot provide a definitive diagnosis of obstructive sleep apnea, the results may help the doctor determine if further testing for sleep apnea is necessary.

Treatment

Treatment options for childhood sleep apnea depend on the cause of the obstruction and may include:

• Lifestyle modification: If the child is overweight, weight loss through diet and exercise can be helpful in managing obstructive sleep apnea (OSA).
• Medications: Some children with mild OSA may find relief from symptoms through the use of topical nasal steroids like fluticasone and budesonide. Allergy medications like montelukast may also help relieve symptoms, particularly when used in combination with nasal steroids.
• Tonsil and adenoid removal: For moderate to severe sleep apnea, a pediatric ear, nose, and throat specialist may recommend the removal of the child’s tonsils and adenoids. This procedure, known as adenotonsillectomy, can open up the airway and improve obstructive sleep apnea. Other upper airway surgeries may be suggested based on the child’s specific condition.
• Positive airway pressure therapy: Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP) machines are used to gently blow air through a tube connected to a mask worn over the child’s nose or nose and mouth. This air pressure helps keep the airway open during sleep. Pediatric obstructive sleep apnea often requires positive airway pressure therapy when other treatments are ineffective. It is important to ensure proper mask fitting and adjust the mask as the child grows to ensure comfort.
• Oral appliances: Some children may benefit from oral appliances such as dental devices or mouthpieces. These devices can help expand the palate and nasal passages, as well as move the jaw and tongue forward to maintain an open upper airway. However, not all children will find oral appliances effective for their sleep apnea.