Screening Children for Snoring and Recommended Sleep Apnea Treatments

Pediatricians Are Advised to Identify Snoring and Provide Appropriate Referrals

475147933.jpg
A toddler boy sleeps on his back. Cornelia Schauermann/Cultura/Getty Images

In 2012, the American Academy of Pediatrics updated their recommendations for the screening of snoring and treatment of obstructive sleep apnea in children. These guidelines are meant to inform the care provided by the nation’s pediatricians. In addition, parents may benefit from understanding the statement’s recommendations for evaluation and treatment of sleep-disordered breathing in children. Learn more about these recommendations:

  • All children and adolescents should be screened for snoring.

Quite simply, children and teenagers who chronically snore should be identified. If this is only noted with a cold or temporary nasal congestion, it may be less significant. However, frequent snoring may be a sign of more significant disordered breathing in sleep. It may be associated with pauses in breathing called sleep apnea. As this condition has important impacts on behavior and growth, it must be recognized and treated. The first step is to ask about snoring.

  • Sleep studies should be performed in children and adolescents with snoring and symptoms or signs of sleep apnea.

If chronic snoring is recognized, it should prompt a sleep study called a polysomnogram. Symptoms of sleep apnea such as sleepiness, hyperactivity, bedwetting, sleepwalking, restless or sweaty sleep, and others may be identified. The pediatrician may also see other signs of possible sleep apnea, such as enlarged tonsils, a small jaw, or allergies.

If present, a sleep test is required. This overnight testing occurs in a sleep center. Measurements of breathing, oxygen levels, heart rate, sleep stages, and leg movements occur. Home testing is not approved for children as it may miss the diagnosis. The apnea-hypopnea index (AHI) is abnormal in children when it is greater than 1.

The pediatrician may need to provide a referral to a board-certified sleep specialist for further evaluation.

  • Surgery is recommended as the first-line treatment of children with enlarged tonsils and adenoids.

When children have enlarged tonsils or adenoids, the most effective treatment is the surgical removal of these tissues (a procedure called adenotonsillectomy). This is one of the most common surgeries in children. It is routinely performed by a general surgeon or an ear, nose, and throat (ENT) specialist. Most children recover fully within a few weeks. The risk associated with the procedure is very low and the benefit on breathing outweighs the potential harm in most cases. If tonsillar enlargement is not noted, the surgery is not indicated.

  • After surgery, monitoring should occur and reassessment is recommended.

If tonsillectomy and adenoidectomy is performed, high-risk patients may require additional monitoring. The surgeon will determine if this is needed. Rarely, children may be admitted to the hospital for observation before being sent home for recovery.

After the surgery is completed, children should be reassessed 2 months later with another sleep study to ensure the snoring and sleep apnea has resolved. This is especially important if symptoms or signs of sleep apnea are still present. If it persists on objective testing, further treatment may be indicated.

  • Continuous positive airway pressure (CPAP) is recommended if adenotonsillectomy is not performed or if sleep apnea persists after surgery.

Not everyone is comfortable pursuing surgery for their children. Though it is highly effective and safe, some still wish to avoid any potential complications. As an alternative, the use of CPAP can be employed. This therapy delivers a constant flow of air through a mask that keeps the airway open and improves breathing in sleep. It is very safe, but long-term facial growth should be monitored by a physician.

  • Weight loss is recommended in those children who are overweight or obese.

As in adults, excessive weight can contribute to snoring and sleep apnea in children. Therefore, children who are identified as overweight or obese should be guided through a weight loss program. This may include dietary changes, including the elimination of high-calorie junk food, and increased physical activity. Limiting screen time can also be helpful. Children who are of normal weight will not benefit from weight loss.

  • Nasal steroid sprays for allergies may be an option for children with mild sleep apnea, especially if it persists after surgery.

Finally, some children experience sleep apnea due to seasonal allergies (often called allergic rhinitis). This can contribute to nasal congestion and decreased airflow through the nose. As a result, sleep apnea can occur due to collapse of the upper airway. If symptoms of allergies are observed – including a runny nose, sneezing, itchy or red eyes – treatment targeting these allergies may be helpful. Singulair is frequently recommended in children. In addition, the use of nasal steroid sprays may be indicated. As there may be an impact on overall growth, this should be monitored if the sprays are used beyond 2 months.

If you are concerned about snoring or sleep apnea in your child, speak with your pediatrician about the options for evaluation and treatment. It has a significant role in growth, development, behavior, and function that cannot be overstated. Changes can be made now that may provide your child with lifelong benefits.

Source:

Marcus CL et al. “Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome.” Pediatrics. Originally published online August 27, 2012; DOI: 10.1542/peds.2012-1671. Last accessed: May 30, 2015.

Continue Reading