Obstructive sleep apnia (apnea, apena) in children

Sleep apnea (apnia) is not a frequent problem in children but an estimated 1-2% of children below the age of six seems suffer from apena.

There seems to be a roughly equal distribution between girls and boys. In the US alone, it is estimated that over 300,000 children are affected by OSA (obstructive sleep apnea).

Children sleep apnea (apnia) 

The early brain activity in a child relies to a large extent of fully funcional sleep but it is not uncommon that there are disturbances or disruptions in the sleep pattern, sometimes to the extent where it will be a sleep disorder and one of the more severe conditions in this respect is OSA. If this is left untreated the condition can affect the psychological as well as the physical health of the child. There may be mood problems or it may escalate into problems with cognition, abstract thinking and the general health.

The reason sleep apnea appears in children is often due to enlargened adenoids and tonsils. In some cases where the child has enlargened tonsils, they can have SA and still show no symptoms. In other cases, symptoms can show with much lower enlargement of the tonsils. The risk groups are children with other conditions such as Downs syndrome, cerebral palsy or muscular dystrophy.

The symptoms in children can be a history of snoring, restless sleep and the use of strange sleeping positions. It has been noted a hereditary connection i.e. that there is often snoring or SA in the family line. It is quite common that the affected child during wake hours, uses mouth for breathing. The guidelines published by the ATS (American Thoractic Society) suggests using polysomnography as a diagnostic tool for children where SA is suspected. The apneas (breathing disruptions) are not always evident without further examination. The polysomnography is an overnight technician supervised sleep study. The overnight text monitors eye movements, respiration, muscle tension, brainwaves, blood oxygen and includes also an audio recording for analyzing snoring and sudden gasping for air.

There are other possibilites evaluated recently, such as the abbreviated polysomnography which has the popular description of a nap study. There is also research going on with the monitoring of the oxygen level in the blood stream (oximetry).

When the evaluation of sleep history reveals a possible problem with OSA, or any other sleep disorder, the child should be evaluated for nasal obstruction, obesity, mouth breathing due to possible growth deformations. If any other risk factors are present - such as a hereditary factor, allergy or asthma, the evaluation becomes even more important. The evaluation should also investigate the size of the tonsils and the pharynx and any cardiovascular complications such as pulmonary hypotension should be observed thoroughly.

Treatment of sleep apnia in children

The most common treatment is either adenoidectomy and/or tonsillectomy which cures most cases of child OSA. It is recommended that both adenoids and tonsils are removed. This is a fairly simple surgical operation but it can still cause complications and it is not recommended that children with only snoring as a symptom should undergo the surgery. Possible side effects / complications of the surgery are respiratory failures or edemas (airway or pulmonary). When successful, it can still take 1-2 months after the surgery to resove the SA completely.

In some, not so frequent cases, of child OSA, emergecy care may be needed. In these cases it is important to notice that some sedatives actually will make the sleep apena worse and may need to be avoided. If using nasopharyngeal tubes for the bypassing of any obstruction it is also very important to have a very close watch on the patient as these tubes have a tencency to get clogged from the mucoid present.

CPAP machines for children

There is currently no CPAP (cepap) machine approved for use with children but it is nevertheless often used as it can be very efficient. The main concern when using CPAP is to make sure the mask size is well chosen to fit the child. It is recommended that sleep studies are carried out 1-2 times per year as the CPAP requirements will vary with the actual growth of the airways which tend to develop rapidly in young children.

BPAP (bilevel positive airway pressure) has also proven to be effective as a treatment for obstructive sleep apnia in children, even down to infant ages.

It is also important that overweight children lose some weight. If any cranial abnormalities are present, surgery may be required. Patients with the so called Pierre Robin sequence may benefit from adhesion (lip tounge). Tracteostomy however is seldom used anymore.

Tracheostomy used to be the only treatment available before the mid 1980's. The tracheostomy means cutting a small hole surgically in the neck and inserting a tube that can be opened and shut with a valve. The valve would only be opened during night (or you could not speak). Night-time, the valve is left open and thereby the airstream manages to bypass all obstructions. It is still used, but only in very severe and usually emergency cases.

After tonsillectomy and adenoidectomy, most children will have a large reduction of the condition but there is no guarantee that the sleep apnia (sleep apnea) will not re-emerge later in life.