Guide to Obstructive Sleep Apnea in Children

Obstructive sleep apnoea is a condition marked by brief pauses in breathing patterns during sleep. Its most common causes are tonsillitis and adenoiditis, which obstruct the airway and make it difficult to breathe while sleeping. The most common age group impacted by this condition is 3-6 years. 

What is obstructive sleep apnoea (OSA)?

Sleep apnoea is a sleeping disorder arising from complete or partial airway blockage when they sleep. Once identified, it’s important to get proper treatment, as this condition can hinder the growth and development of your child.

A child with sleep apnoea wakes up for a short time and then goes back to sleep repeatedly throughout the night without even knowing. This happens due to the brain identifying variations in the oxygen or carbon dioxide in the body and signals the lungs to breathe deeply.

It’s similar to briefly hearing your phone ring in the middle of the night before you go back to sleep. It creates just enough of a racket to disrupt your sleeping pattern without you being able to do anything. This occurs repeatedly throughout the night, which translates to poor sleep quality and inadequate rest.

It is quite nerve-racking to think of this happening to your child throughout the night while they are totally unaware of it. While your children may not put up a fuss, their daytime routine can be severely impacted.

In essence, sleep apnoea may be thought of as a sleeping disorder arising from complete or partial airway blockage. Once identified, it’s important to get proper treatment, as this condition can hinder the growth and development of your child.

Causes of sleep apnoea

There are many possible causes of sleep apnoea in children, the most common being tonsillitis and adenoiditis. It is easier to breathe during the day, but when the muscles relax at night, the airway narrows or closes as the child breathes in. This hampers their breathing for a short time throughout the night. While all the tissues come together, the tissues in the nose, tongue, and neck also play their part causing this issue.

There are several other causes that can cause obstructive sleep apnoea in children. These include small jaw (retrognathia), narrow facial bone, obesity, an airway tumour or growth, as well as a high and low muscle tone.

It can also be due to a history of cleft palate or pharyngeal surgery. Children with a different facial structure, like those with down syndrome, experience a greater incidence of sleep apnoea. Some other factors that are involved in children having obstructive sleep apnoea include asthma, stomach acid reflux, nasal allergies, and constant infections in the upper airway.

Symptoms of obstructive sleep apnoea

Children with OSA will often excessively sweat while sleeping, wet their beds, and sleep in abnormal positions. They will toss and turn, snore, breathe through their mouth while asleep, pause frequently while breathing or breathe noisily.

Apart from this, not getting enough rest will make them sleepy throughout the day. It results in mood swings, poor performance in school, lack of focus, morning headaches, and development problems.

Consult their paediatrician for a more accurate diagnosis, as these symptoms can also be tied to other health conditions.

How is obstructive sleep apnoea diagnosed?

When you visit your doctor, they will physically examine your child and might even conduct a sleep test. This can be a challenge when dealing with younger children. For a more accurate diagnosis, you will need to fill them in with further details. Communicate your child’s symptoms, sleeping habits/patterns, and medical history. A mobile bedside study might also be suggested if the child is not well and is in the hospital.

After confirmation, your paediatrician will recommend you to a sleep specialist who, along with all the things discussed above, might conduct several other tests.

Sleep history

You will need to observe your child while they’re sleeping throughout the night and report your observations to the doctor.

Upper airway evaluation

It can be done through an instrument or an X-ray.

A sleep study (also called a polysomnogram)

This test monitors your child’s heart rate, brain activity, amount of airflow through the mouth and nose, sleep interruptions, the amount of oxygen and carbon dioxide in the blood, muscle activity, as well as chest and abdominal wall movement. 

It is conducted in an equipped bedroom which acts as a sleep laboratory and is specially designed for this purpose. A child is accompanied by his parents throughout the process, as well as a technician who keeps everything in check and helps if the child removes the sensors due to anxiety. The study is a simple process that is painless and doesn’t involve any sort of needles.

How is obstructive sleep apnoea (OSA) treated?

It can be treated with the following approaches to ensure that the airflow is not hindered during sleep.

Continuous positive airway pressure (CPAP)

It is done by wearing a face mask overnight, which aids in keeping the airways open. The positive airflow from the facemask helps in keeping airways unblocked. CPAP is the primary therapy used for obstructive sleep apnoea.

Some people might not benefit from CPAP and require an alternative approach, typically an oral appliance.

Bilevel positive airway pressure (BPAP)

These machines, also known as BIPAP machines, are recommended if CPAP is not effective for a patient. The BPAP machines push air into your lungs and have 2 air pressure settings; inhaled and exhaled air pressure. Alternate pressure is used while inhaling and exhaling. 

Sleeping on your side

Certain positions might help with obstructive sleep apnoea, but sleeping on your back certainly makes it worse. The most effective position for OSA is sleeping on your side. It can be difficult to develop this habit at the start. However, positional therapy can help overcome this issue.

Tracheostomy

It is a surgical procedure only used in cases of severe sleep apnoea that do not respond to other forms of treatment.

It involves the doctor creating an incision (cut) into your child’s windpipe to make a hole. This hold will act as an alternative airway for breathing. A tracheostomy tube made from metal or plastic will be inserted in this hole and held in place with surgical tape or sutures.

This ensures it does not move around and cause potential damage to that patient. When necessary, the tube also allows a connection to an oxygen tank which lets the lungs get a direct supply of oxygen.

During this procedure, the doctor will take care not to disturb the other structures in the throat, such as the oesophagus, voice box or larynx.

Patients undergoing this procedure recover within 2 weeks but may be needed to stay in the hospital for 3-5 days.

How much sleep do children need?

It is different for every child, but the American Academy of Paediatrics suggests:

Infants

12- 16 hours of sleep every night.

1-2 Years Old

11-14 hours of sleep every night.

3-5 Years Old

10-13 hours of sleep every night.

6-12 Years Old

9-12 hours every night.

Teenagers)

8-10 hours every night.

Vicky Dawson of the Children’s Sleep Charity explains that children cannot function well if they don’t get enough quality sleep. Without it, a child may fall behind on their chores and become lethargic. Quality of sleep has an impact on every part of waking life. Children who sleep well are more involved in the day-to-day tasks and enjoy family time.

Teachers can also identify sleep deprived children based on their performance in assignments and attention during school. Many parents fail to realise how sleep deprived their children can get and how it can dramatically worsen their performance at school. Such children perform poorly academically and suffer from mood swings.

It is recommended to follow the general sleeping guidelines to ensure good health and quality of life. However, it is important to note that some children will function fine with fewer hours of sleep. The main idea is to ensure that everyone gets enough sleep to meet their individual needs.

Given the critical role sleep plays in a child’s life, it is important for all health sectors, parents, and schools to work together as a team to figure out a solution to the sleep deprivation problem.

Sleep and Busy Children

Inculcating healthy sleeping habits can be a lifetime reward for children. Children with active brains find it difficult to dose off early, and they get restless if they are forced to sleep. It’s not a simple case of lying in bed and falling asleep. It requires consistent effort and practice to develop a healthy sleeping habit in a child. However, practice makes perfect. Once your child develops the habit, it will become easier.

Sleep and Brain Recovery

According to research, sleep is a necessary part of rest and recovery. It recharges the body and the mind, which is why waking up after a good quality sleep session makes a person feel active and alert.

Other studies show the brain uses the time during sleep to recharge and develop new neurons that might have been used up throughout the day.

Additional research and investigation into sleep are further revealing the importance of good quality sleep as part of a healthy lifestyle. It benefits not just the body, but also the mind. We’re learning more and more about the importance of sleep every day.

When Should We See a Doctor?

Consult your doctor if you identify any of the sleep apnoea symptoms. It is also advisable to inform your doctor if your child lacks focus, and displays agitation, mood swings, and reduced restraint. These might be factors that indicate they’re suffering from sleep apnoea.