Obstructive Sleep Apnea
Brief pauses in breathing during sleep are normal. But when breathing stops often or for longer periods, it's called sleep apnea.
When someone has sleep apnea, oxygen levels in the body may fall and sleep can be disrupted. You might think that only older people have sleep apnea, but kids and teens can develop it, too.
About Sleep Apnea
Sleep apnea happens when a person stops breathing during sleep ("apnea" comes from a Greek word meaning "without wind"). It is usually caused by something obstructing, or blocking, the upper airway. This is known as obstructive sleep apnea (OSA).
OSA is a common, serious condition that can make kids miss out on healthy, restful sleep. If left untreated, obstructive sleep apnea can lead to learning, behavior, growth, and heart problems. In very rare cases, it can even be life threatening.
Less commonly, sleep apnea can happen when someone doesn't get enough oxygen during sleep because the brain doesn't send signals to the muscles that control breathing. This is called central sleep apnea. Head injuries and other conditions that affect the brain increase the risk of developing this type of apnea, which mostly affects older adults.
When we sleep, our muscles relax. This includes the muscles in the back of the throat that help keep the airway open. In obstructive sleep apnea, these muscles can relax too much and collapse the airway, making it hard to breathe.
This is especially true if someone has enlarged tonsils or adenoids (germ-fighting tissues at the back of the nasal cavity), which can block the airway during sleep. In fact, enlarged tonsils and adenoids are the most common cause of OSA in kids.
Risk factors for the development of OSA include:
- a family history of obstructive sleep apnea
- being overweight
- certain medical conditions, such as Down syndrome or cerebral palsy
- defects in the structures of the mouth, jaw, or throat that can narrow the airway
- a large neck (17 inches or more in circumference for men; 16 inches for women)
- a large tongue, which can fall back and block the airway during sleep
When breathing stops, oxygen levels in the body drop. This usually triggers the brain to briefly wake us up so that the airway reopens. Most of the time, this process happens quickly and we go right back to sleep without knowing we woke up. But with sleep apnea, this pattern repeats itself all night. So people who have it don't reach a deeper, more restful level of sleep.
Symptoms of OSA in kids include:
- snoring, often associated with pauses, snorts, or gasps
- heavy breathing while sleeping
- very restless sleep and sleeping in unusual positions
- bedwetting (especially if a child previously stayed dry at night)
- daytime sleepiness or behavioral problems
Because OSA makes it hard to get a good night's sleep, kids might have a hard time waking in the morning, be tired throughout the day, and have attention or other behavior problems. As a result, sleep apnea can hurt school performance. Teachers and others may think a child has attention deficit hyperactivity disorder (ADHD) or learning difficulties.
If your child snores regularly, is a restless sleeper, is very sleepy during the day, or has other signs of sleep apnea, talk to your doctor. Your doctor might refer you to a sleep specialist or recommend a sleep study.
A sleep study (also called a polysomnogram) lets doctors check for OSA and record a variety of body functions while a child sleeps. Sleep studies also can help doctors diagnose central sleep apnea and other sleep disorders.
In the study, sensors are placed at a few spots on the child's body with a mild adhesive or tape. The sensors are wired to a computer to provide information while the child sleeps. Sleep studies are painless and risk-free, but patients usually need to spend the night in a hospital or sleep center.
During a sleep study, doctors monitor:
- eye movements
- heart rate
- breathing pattern
- brain waves
- blood oxygen level
- snoring and other noises
- body movements and sleep positions
Treating Sleep Apnea
If enlarged tonsils or adenoids are thought to be causing the apnea, the doctor will refer your child to an ear, nose, and throat doctor (ENT). The ENT might decide that an operation called an adenotonsillectomy is needed to remove the tonsils and adenoids. This often is an effective treatment for OSA.
If tonsils and adenoids are not the cause of OSA or if symptoms of OSA remain after adenotonsillectomy, a doctor may recommend continuous positive airway pressure (CPAP) therapy. In CPAP therapy, a person wears a mask that covers the nose and mouth during sleep. The mask is connected to a machine that continuously pumps air into it to open the airways.
When excess weight is a factor in OSA, it's important to work with a doctor on diet changes, exercise, and other safe weight-loss methods. In mild cases of OSA, doctors may monitor a child for a period of time to see if symptoms improve before deciding on treatment.