What Factors Cause Sleep Apnea to Occur in Children?

Enlarged Tonsils, Obesity Likely to Disrupt Nighttime Breathing

Children can have sleep apnea due to factors relating to their anatomy like enlarged tonsils, obesity, and other disorders
Children can have sleep apnea due to factors relating to their anatomy like enlarged tonsils, obesity, and other disorders. Getty Images

Sleep apnea is a common condition in adults, and it can also occur in children. What factors cause sleep apnea to occur in children? There are various contributions that can lead to a narrowing or instability of the upper airway, which can cause the pauses in breathing characteristic of sleep apnea. As sleep apnea can have serious consequences in children - including impacts on growth, intelligence, and behavior - it is important to identify correctable causes.

When considering the potential predisposing factors for children to develop sleep apnea, these can be subdivided into several major categories:

  • Enlarged tonsils and adenoids

Perhaps the single most common contribution to sleep apnea in children relates to a narrowing of the anatomy of the upper airway. The tissues at the back of the mouth and throat called tonsils and adenoids are likely suspects. Just because enlargement of these tissues is present does not mean a child will have sleep apnea. However, those children with sleep apnea who have enlarged tonsils and adenoids may be significantly helped by removing them. Approximately 10 percent of children do not improve after surgery, and they may have other factors contributing to their condition.

  • Obesity

Obesity among children is increasing, and it may have a greater role in causing sleep apnea as these trends continue. As the amount of fat lining the airway grows, it may lead to crowding and narrowing within the airway.

Alternatively, extra weight outside of the airway may apply pressure and lead to the airway collapse, resulting in apnea events.

  • Craniofacial abnormalities

There are several abnormalities of the head or face (called craniofacial abnormalities) that may lead to an increased risk of developing sleep apnea.

Conditions that decrease the size of the nose, mouth, and throat may lead to a collapse of the airway during sleep. For example, an enlarged tongue (called macroglossia) may contribute. Other conditions include:

  • Midfacial hypoplasia (an underdevelopment of the nose and central face)
  • Retrognathia or micrognathia (a recessed or small jaw)
  • Narrow maxillary arch (the top of the mouth)

Children with Down's syndrome are at particular high risk for developing these problems.

  • Mucopolysaccharidoses

There are a group of rare disorders called mucopolysaccharidoses, or mucolipidoses, that may put children at increased risk of sleep apnea. This occurs because of the tissues in the upper airway accumulating large molecules and swelling in size. There are typically associated developmental abnormalities that are identified at birth or in early childhood, so most parents will be aware that their child has this condition.

  • Neuromuscular factors

Loss of the control of the musculature of the upper airway may also lead to sleep apnea.

A change in muscle tone (called hypotonia if it is low, or hypertonia if it is high) may contribute. Compression of the brainstem (as may occur in Arnold Chiari malformations or in tumors) may lead to sleep apnea. There are some developmental abnormalities, such as Down syndrome, that lead to a high risk for the condition. In general, other problems will be identified beyond the sleep apnea to suggest the risk of more serious conditions.

If you are concerned that your child may have symptoms or signs suggestive of sleep apnea, don't hesitate to speak with your pediatrician. If you feel like your concerns are being dismissed, consider a second opinion from a pediatric sleep specialist. The only way to definitely evaluate sleep apnea in children is an overnight attended sleep study at a testing center; push to get one if you are concerned for your child's breathing during sleep.

Sources:

Arens, R et al. "Pathophysiology of upper airway obstruction: a developmental perspective." Sleep 2004; 27:997.

Bixler, EO et al. "Sleep disordered breathing in children in a general population sample: prevalence and risk factors." Sleep 2009; 32:731.

Rosen, GM et al. "Mechanisms and predisposing factors for sleep disorders breathing in children." UpToDate Online. Accessed November 2, 2009.

Verhulst, SL et al. "Sleep-disordered breathing in overweight and obese children and adolescents: prevalence, characteristics and the role of fat distribution." Arch Dis Child 2007; 92:205.

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