Symptoms of Sleep Apnea in Children

When Does Snoring Mean Obstructive Sleep Apnea

Young girl sleeping could she have sleep apnea
What are the symptoms of sleep apnea in children?. Evan Kafka/Taxi/Getty Images

What are the symptoms of sleep apnea in children? When is snoring in kids normal, and when is it a problem?

Obstructive Sleep Apnea Syndrome (OSAS) in Children

Obstructive sleep apnea syndrome (OSAS) is a common problem in children, affecting 2 to 4% of children at some time. It is increasingly being recognized as a cause of daytime attention and behavior problems.

Sleep Apnea in Children vs Adults

Unlike adults with sleep apnea, who are often overweight and frequently wake up at night, children with OSA are more difficult to recognize and diagnose.

In contrast with adults, most children with sleep apnea are not overweight. That said, being overweight is a risk factor for sleep apnea in kids as with adults, due to an increase in fat around the neck and throat.

Symptoms of Sleep Apnea in Children

Although snoring is a common symptom in children with obstructive sleep apnea, it is important to remember that between 10 and 20 percent of normal children snore (primary snoring) on a regular or intermittent basis.

Some of the signs and symptoms of obstructive sleep apnea in children include:

  • Snoring - Snoring is usually loud, and occurs most nights.
  • Frequent awakenings or restlessness with sleep.  You may notice your child have moments when her breathing stops for a few moments.
  • Failure to thrive (weight loss or poor weight gain) - Sleep apnea can result in a decreased production of growth hormone, which can in turn result in poor weight and height gain.
  • Overweight - While sleep apnea can cause poor growth and development, it can also result in obesity, as daytime sleepiness can cause a decrease in exercise and cause insulin resistance.
  • Mouth breathing.
  • Enlarged tonsils and adenoids.
  • Excess sweating at night.
  • Frequent nightmares.
  • Bedwetting.
  • Excessive daytime sleepiness.
  • Morning headaches.
  • Daytime cognitive and behavior problems, including problems paying attention, aggressive behavior and hyperactivity, which can lead to problems at school.

Behavioral Problems as a Symptom of Sleep Apnea in Kids

The importance of checking for the possibility of sleep apnea in children with problem behaviors can't be stressed enough. Not only because correcting sleep apnea as an easy (relatively that is) way to correct these problems, but because the long term consequences for children are that much more severe than adults, including not only medical issues, but growth and emotional development as well. It's important to talk to your pediatrician about any behavior changes that concern you. Keep in mind that this does not always mean only children who are acting moody or aggressively. It may also include those who were previously on the "feisty" site but are now becoming more compliant and quiet due to daytime fatigue.

Medical Conditions Associated with an Increased Risk of Sleep Apnea

What medical conditions may raise the risk that your child could have sleep apnea?

  • Down's syndrome - Children with Down's syndrome are at high risk for sleep apnea, partly related to decreased muscle tone and also increased tongue size.
  • Neuromuscular and central nervous system abnormalities including cerebral palsy.
  • Craniofacial abnormalities like Pierre Robin syndrome, Treacher Collins syndrome and Crouzon syndrome.
  • Children with craniosynostosis such as Pfeffer's syndrome and more.
  • Obesity.

Diagnosis of Sleep Apnea in Kids

The diagnosis of OSA in children is usually based on the characteristic symptoms and evidence of adenotonsillar hypertrophy (big tonsils and adenoids) and mouth breathing. Children suspected of having OSA should usually be evaluated by a Pediatric ENT specialist for further evaluation.

If necessary, further testing might include polysomnography (a pediatric sleep study).

Treatments for Children With Sleep Apnea

Although most younger children with OSA are not overweight, if a child is overweight, that might contribute to his symptoms. Weight loss is therefore important for overweight children with obstructive sleep apnea.

Other underlying medical conditions, especially allergies, should also be treated. A nasal steroid might help improve nasal obstruction and OSA symptoms in children who also have allergies.

The main treatment for kids with OSA is surgery, with removal of the child's enlarged tonsils and adenoids (tonsillectomy and adenoidectomy or T&A). At the current time, most T & A's in the Untied States are performed for sleep disordered breathing and obstructive sleep apnea.

Most of the time, surgery (T & A) will result in resolution of sleep apnea in kids. If not, further surgery may be needed, or your physician may recommend the use of continuous positive airway pressure (CPAP). or orthodontic procedures such as rapid maxillary expansion.

What You Need To Know as a Parent

  • As in adults, obstructive sleep apnea can cause a lot of complications, including poor growth, headaches, high blood pressure and other heart and lung problems.
  • OSA, and sleep problems in general, are increasingly being recognized as a cause of children's daytime school and behavioral problems. If your child is having problems at school or with his behavior and he snores loudly, you should ask your Pediatrician about OSA.

Bottom Line

If your child has any of the symptoms at all of sleep apnea, talk to your pediatrician. Please note again that, unlike adults, most children who suffer with sleep apnea are not obese. Sleep apnea can have profound consequences for a child in terms of energy level, behavior, and learning. Consequences of sleep apnea in children may even affect their results on intelligence tests.

Sources:

American Academy of Otolaryngology – Head and Neck Surgery. Pediatric Sleep Disordered Breathing/Obstructive Sleep Apnea. Accessed 04/0/16. http://www.entnet.org/content/pediatric-sleep-disordered-breathingobstructive-sleep-apnea

Dehlink, E., and H. Tan. Update on paediatric obstructive sleep apnoea. Journal of Thoracic Disease. 2016. 8(2):224-35.

Marcus, C., Brooks, L., Draper, K. et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012. 130(3):e714-55.

Continue Reading