Overview

Pediatric obstructive sleep apnea is a sleep disorder in which your child's breathing is partially or completely blocked repeatedly during sleep. The condition is due to narrowing or blockage of the upper airway during sleep.

There are differences between pediatric obstructive sleep apnea and adult sleep apnea. While adults usually have daytime sleepiness, children are more likely to have behavioral problems. The underlying cause in adults is often obesity, while in children the most common underlying condition is enlargement of the adenoids and tonsils.

Early diagnosis and treatment are important to prevent complications that can affect children's growth, cognitive development and behavior.

Symptoms

During sleep, signs and symptoms of pediatric sleep apnea might include:

• Snoring
• Pauses in breathing
• Restless sleep
• Snorting, coughing or choking
• Mouth breathing
• Nighttime sweating
• Bed-wetting
• Sleep terrors

Infants and young children with obstructive sleep apnea don't always snore. They might just have disturbed sleep.

During the day, children with sleep apnea might:

• Perform poorly in school
• Have difficulty paying attention
• Have learning problems
• Have behavioral problems
• Have poor weight gain
• Be hyperactive

When to see a doctor

Make an appointment with your child's doctor if your child consistently wakes up in the morning feeling tired and has behavioral problems.

Causes

Obesity is a common factor underlying obstructive sleep apnea in adults. But in children the most common condition leading to obstructive sleep apnea is enlarged tonsils and adenoids. However, obesity also plays a role in children. Other underlying factors can be craniofacial anomalies and neuromuscular disorders.

Risk factors

Besides obesity, other risk factors for pediatric sleep apnea include having:

• Down syndrome
• Abnormalities in the skull or face
• Cerebral palsy
• Sickle cell disease
• Neuromuscular disease
• History of low birth weight
• Family history of obstructive sleep apnea

Complications

Pediatric obstructive sleep apnea can have serious complications, including:

• Failure to grow
• Heart problems
• Death

Diagnosis

To diagnose pediatric sleep apnea, the doctor will review your child's symptoms and medical history and conduct a physical exam. Your child may have an examination of the neck, mouth and tongue, and adenoids. Your doctor might order several tests to diagnose the condition.

Tests might include:

• Polysomnogram. Doctors evaluate your child's condition during an overnight sleep study. This test uses sensors applied to the body to record brain wave activity, breathing patterns, snoring, oxygen levels, heart rate and muscle activity while your child sleeps.
• Oximetry. If doctors strongly suspect obstructive sleep apnea, and a full polysomnogram isn't needed or available, an overnight recording of oxygen levels might help make the diagnosis. Oximetry can be done at home. However, it sometimes fails to give the diagnosis, in which case your child will still need to have a polysomnogram.
• Electrocardiogram. In an electrocardiogram, sensor patches with wires attached (electrodes) measure the electrical impulses given off by your child's heart. Doctors may use this test to determine if your child has an underlying heart condition.

Treatment

Your doctor will work with you to find the most appropriate treatment for your child's sleep apnea. Treatment might include:

• Medications. Topical nasal steroids, such as fluticasone (Dymista) and budesonide (Rhinocort, Pulmicort Flexhaler, others), might ease sleep apnea symptoms for some children with mild obstructive sleep apnea. For kids with allergies, montelukast (Singulair) might help relieve symptoms when used alone, or with nasal steroids.
• Removal of the tonsils and adenoids. For moderate to severe sleep apnea, your doctor might refer your child to a pediatric ear, nose and throat specialist to discuss removing the tonsils and adenoids. An adenotonsillectomy (ad-uh-no-ton-sil-EK-tuh-me) might improve obstructive sleep apnea by opening the airway. Other forms of upper airway surgery might be recommended, based on the child's condition.

• Positive airway pressure therapy. In continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP), small machines gently blow air through a tube and mask attached to your child's nose, or nose and mouth. The machine sends air pressure into the back of your child's throat to keep your child's airway open. Doctors often treat pediatric obstructive sleep apnea with positive airway pressure therapy when medications or removal of adenoids and tonsils is not effective.

  Proper fitting of the mask and refitting as the child grows can help the child tolerate the mask over the face.

• Oral appliances. Oral appliances, such as dental devices or mouthpieces, may be recommended. Some devices help to expand the palate and nasal passages, or move your child's bottom jaw and tongue forward to keep your child's upper airway open. Only some children benefit from such devices.

Lifestyle and home remedies

• Avoid airway irritants and allergens. All children, but especially those with pediatric obstructive sleep apnea, should be kept away from exposure to tobacco smoke or other indoor allergens or pollutants, as they can cause airway irritation and congestion.
• Weight loss. Doctors may recommend that your child lose weight if he or she is obese. Your doctor can provide you and your child with diet and nutrition information, or refer your child to other specialists with expertise in managing obesity.

Preparing for an appointment

You'll likely start by seeing your child's primary care provider. Or, you might be referred immediately to an ear, nose and throat specialist or a sleep medicine specialist.

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

What you can do

Make a list of:

• Your child's symptoms, including any that seem unrelated to the reason for your appointment
• All medications, vitamins or other supplements your child takes, including the doses
• Questions to ask your doctor

For pediatric obstructive sleep apnea, some basic questions to ask your doctor include:

• What tests are needed?
• Is this condition likely temporary or chronic?
• What's the best course of action?
• What are the alternatives to the primary approach you're suggesting?
• Should I take my child to a specialist?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

• Does your child snore?
• What else have you observed about your child's sleep?
• Does your child have problems paying attention?
• Does your child have learning difficulties?
• Do you have a family history of obstructive sleep apnea?