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Sleep Apnea
Sleep Apnea
How to Identify Sleep Apnea in Children
Sleep apnea in children is gaining more attention in the medical community. Although it is still often under diagnosed, it is estimated that up to 12 percent of kids snore and obstructive sleep apnea syndrome (OSAS) affects from one to ten percent of children. While both children and adults can have sleep apnea, it is important to realize that sleep disordered breathing in children can often differ from that of adults in terms of cause, symptoms, diagnosis and treatment. Since symptoms of sleep apnea in children are generally more subtle than those in adults with less distinctive and loud snoring, the recognition and diagnosis of sleep apnea in children requires the awareness of a different set of OSAS characteristics.
As with adults, sleep apnea in children is broken down into three groups: Obstructive sleep apnea; central sleep apnea; and mixed sleep apnea. Just as with adults, the most common form of sleep apnea in children is obstructive sleep apnea. That however, is where many of the similarities end.
Symptoms of Sleep Apnea in Children
As noted, symptoms of sleep apnea in children are different from adults. Although loud snoring can occur, you are more likely to observe louder breathing as well as mouth breathing. Instances of restless sleep including night sweats are frequent. Excessive daytime sleepiness is widespread since restful sleep is disrupted. One study which looked at 50 children with obstructive sleep apnea syndrome found that in 86% of cases, stage 3 NREM sleep was non-existent. It’s no wonder they are tired the next day. Other signs and symptoms of sleep apnea in children include learning deficits and personality changes like hyperactivity and anti-social behavior. Also, frequent nightmares, sleep walking and bed-wetting or enuresis have also been reported.
Clinically, children with sleep apnea display some unique symptoms. Since sleep is so important to normal growth and development, they often display a failure to thrive. Unlike adults with sleep apnea, children with OSAS can often be underweight. When the tonsils and adenoids are enlarged and obstructing the airways, recurring infections to the upper respiratory tract are common. Hypertension and acute cardiac symptoms may also be present.
Causes of Sleep Apnea in Children
Enlarged tonsils and adenoids are the most common cause of sleep apnea in children. While some overweight children can develop OSAS due to excess tissue in their airways just like adults, most OSAS symptoms in children can be associated with enlarged tonsils and adenoids obstructing their airways. As children grow and develop, many times the size of their tonsils and adenoids can be disproportionally large compared to the size of their airways, thereby obstructing or partially blocking their breathing passages. Although a medical exam can usually identify if the tonsils and/or adenoids are enlarged and causing an obstruction, a night time polysomnography test conducted at a sleep apnea clinic is still the most definitive method of diagnosing sleep apnea in children as well as adults. Since children with sleep apnea often have only partial obstructions of their airways, their polysomnography test results will often show fewer true apnea events but their respiratory disturbance index (RDI) scores will usually still be high due to a large number of hypopnea and other less severe respiratory disturbances such as restless leg movements.
Treatment for Sleep Apnea in Children
Unlike with adults, sleep apnea surgery is the first treatment option for sleep apnea in children. While continuous positive airway pressure or sleep apnea cpap machines can be utilized with kids, there are more possible complications and it is often not well tolerated in children. Fortunately, surgery is an extremely effective option. Surgery to remove the tonsils and adenoids called an adenotonsillectomy is the most common surgery preformed on young children. Contrary to common belief, about 75% of the surgeries to remove the tonsils and adenoids in children are performed to open obstructed airways not treat sore throats. More importantly, numerous studies have been published demonstrating the effectiveness of adenotonsillectomy as a sleep apnea treatment for children.
Not treating sleep apnea in children can have many negative consequences including poor cognitive and physical development, cardiac and pulmonary failure and overall poor health. Very young children are at even greater risk. Since their bodies have not yet fully grown and developed, OSAS can have a lasting effect on your child’s health and life. Since most young children can’t understand or express their feelings well, they cannot understand or explain the hardships they are going through, so it’s up to you to recognize their symptoms.
It’s important to understand and recognize the signs and symptoms of sleep apnea in children. Early detection and treatment should be a priority if you suspect that your child has this sleep disorder. See your healthcare provider and have your child examined and tested. Fortunately, sleep apnea in children can be treated and cured.
What do you do when your husband has been diagnosed with sleep apnea and won’t use the machine?
My husband has sleep apnea and will not use the machine. He also has diabetes. He goes to work, comes home sleeps for about two hours, goes to bed at 12:00 AM and gets up about 4:30 for work. On the weekends he will sleep if you let him about 14 hours a day. He would do this during the week but he has to go to work. I just don’t know what to do. I’m very concerned.
Unfortunately, there’s not much you can do… You can show him all the information about sleep apnea and its deleterious effects on health, how improved sleep can actually improve diabetes, etc etc, but until he decides to do what he needs to do, he’ll probably just hear it as “nagging” and ignore you even more industriously.
If it gets to be that bad, you could lay down an ultimatum: That if he doesn’t start taking better care of himself, you’ll leave because you can’t stand to watch him take such risks with his health. I would certainly not recommend that, unless the marriage is already irretrievably broken and you would actually be okay with it if he said, “All right, bye then.”
My sympathies are with you; it’s very frustrating to watch someone you care about neglect themselves. Unfortunately, your options are rather limited. I hope someone else has a more productive answer for you. Good luck.
Sleep Apnea and CPAP
