Is your child sleeping with their head tilted back, squeaking when inhaling, or gasping or making choking noises during sleep? Is she or he experiencing daytime hyperactivity or difficulty concentrating at school? Are their grades slipping? Do they seem moody or restless?
If any of these signs sound familiar, it’s possible your child has undiagnosed obstructive sleep apnea (OSA). Pediatric sleep apnea can look different than sleep apnea in adults because children are not just “little adults.” During the developmental stages, their bodies are different than ours. Therefore, so are some of the signs and symptoms of pediatric obstructive sleep apnea.
What Is Childhood Sleep Apnea?
What is obstructive sleep apnea in the child, and how is it different from sleep apnea in an adult? In most ways, the condition is exactly the same. During sleep, a physical airway blockage in the back of the throat, such as excess fatty tissue or overly large tonsils or adenoids, keeps air from moving in and out of the child’s lungs smoothly. This blockage leads to the child’s blood oxygen levels sinking too low while they’re asleep.
Abnormal breathing events, called apneas or hypopneas, then occur. These are cessations or reductions of breathing that often trigger awakenings that disrupt the normal sleep cycle, leading to fragmented, poor quality sleep. As in adults, these nighttime pauses in respiration can look like choking, snorts or gasps.
Some kids with apnea also snore during sleep, much like adults. (However, it’s important to note that many children with apnea don’t snore at all, and not all kids who snore have apnea.)
Obstructive sleep apnea in kids is less prevalent than it is in adults, and it’s often misdiagnosed. For example, often children may receive a diagnosis of ADD or ADHD without doctors looking into the underlying sleep deprivation that may be causing the attention-related behaviors.
ADD medication may be prescribed to treat those symptoms when the real cause of the child’s aggression, hyperactivity, or trouble paying attention at school could be exhaustion due to long-term, insufficient or fragmented sleep. (According to some studies, up to 25% of school-age children with ADHD may indeed have sleep apnea.)
How many children actually do have pediatric sleep apnea? The American Sleep Apnea Association estimates that up to 4% of children between the ages of 2 and 8 have this sleep disorder (sometimes referred to as sleep disordered breathing, or SDB).
Does your child have apnea? Only a sleep physician can tell for sure by conducting a pediatric polysomnography (overnight sleep study).
However, you can get started by looking for clues Take note of your child’s signs, symptoms, and risk factors, and if you notice anything that indicates the possibility of childhood sleep apnea, share these details with your pediatrician.
Why Should You Worry about Pediatric Sleep Apnea?
All humans need sleep, children especially. Getting adequate, high-quality sleep allows the body to release growth hormone and to manage processes related to appetite and digestion, mood regulation, cardiovascular health, and memory and cognitive development. Simply put, without enough sleep, our bodies can’t grow properly, heal themselves or consolidate memories. Insufficient sleep also has a negative effect on the immune system, leaving adults and kids alike more vulnerable to infection.
Left undiagnosed or untreated, sleep apnea in children can have additional harmful effects on a child’s health and well-being. Last year, a study from the University of Chicago found that children ages 7 to 11 with sleep apnea showed “significant decreases significant decreases in gray matter” in various parts of the brain. According to a write-up by the American Sleep Association, this is cause for concern because gray matter is the part of the brain “responsible for memory, emotions, perception, speech, movement, self-control, and decision-making.”
This type of sleep-related neuron damage and loss needs to be studied further by scientists to fully understand the ramifications of what chronic sleep fragmentation does to a developing child’s brain. Some researchers theorize that a loss of gray matter may lead to developmental delays, while others see a possible link between overall less gray matter and lower intelligence. However, at this time researchers aren’t certain enough to make definitive conclusions.
However, evidence does exist showing that persistent sleep deprivation in kids, caused by apnea, sleep disordered breathing, and other sleep disorders, can cause issues like daytime fatigue, attention deficit and hyperactivity symptoms (see below), problems focusing in school, learning problems, and mood dysregulation.
One study showed that behavioral problems may be as much as six times more common in children with ongoing sleep apnea. Kids with apnea may also be disruptive in class and could be three times as likely to receive lower grades.
Sleep apnea can also lead to social problems—for example, a child with apnea is more likely to wet the bed during the night or sleepwalk, and may be additionally embarrassed by snoring, mouth breathing or gasping. These behaviors may lead to shame and embarrassment and could prevent otherwise healthy children from taking opportunities to attend sleepovers or sleepaway camp.
Signs and Symptoms of Sleep Apnea in Children
Does your child have apnea? What are some indications that a child could have sleep apnea or sleep disordered breathing? Symptoms can include both physical and cognitive/behavioral indicators.
Physical indicators of apnea:
- Apneas/hypopneas (pauses in breathing during sleep)
- High inspiratory squeaking noises (wheezing or squealing sounds when inhaling during sleep)
- Mouth breathing during sleep
- Tossing and turning
- Night sweats
- Tilted-back head when sleeping; posturing of the head to open the airway
- Growth problems (e.g., stunted growth)
Cognitive and behavioral indicators of apnea:
- ADD/ADHD symptoms. Paradoxically, young children with sleep apnea may not demonstrate excessive daytime sleepiness the way adults do, with spontaneous naps, yawning and fatigue. Rather, they may show signs of attention-deficit/hyperactivity disorder, known for hallmark behaviors like aggression, mood swings (anger, anxiety, depression), inability to sit still, hyperactivity, problems focusing or paying attention in school, short attention span, or a learning disability. Kids may also have trouble regulating their emotions and planning and organizing tasks.
Of course, the only accurate indicator of obstructive sleep apnea in a child is a pediatric sleep study. A board-certified sleep physician can watch your child sleep in a lab, using sensors and equipment to gauge where your child falls on the apnea hypopnea index (AHI). This index measures how many apnea events per hour your child is experiencing.
More than 1 apnea or 1.5 apneas plus hypopneas per hour is considered abnormal, and past a certain threshold, sleep physicians will recommend children get treatment (tonsillectomy, CPAP treatment, myofunctional therapy, or an oral appliance, in most cases).
Risk Factors for Sleep Apnea in Children
How do you know if your child is at risk for sleep apnea? Though apnea can happen to any child, there are some known risk factors:
- Enlarged tonsils and/or adenoids that can block the airway. Some children also notice difficulty breathing in the daytime. However, when tissues in the mouth and throat relax during sleep, they’re more likely to fall back and block the throat.
- High arched or an elongated soft palate can contribute to increased work of breathing leading to a collapse of the upper airway.
- Childhood obesity (in older kids, ages 12 and up). As with adults, carrying excess weight can be a contributor to airway restriction and snoring in children. Obesity can lead to excess fatty tissue in the throat. With kids younger than 12, however, excess weight is not likely to be the cause.
- Seasonal allergies. Though allergies are unlikely to be the sole cause of apnea, upper respiratory congestion and inflammatory responses can make existing symptoms worse.
We will be discussing in more detail about the various treatment options for sleep apnea or sleep related breathing disorders in children in our next posts.
If you believe your child is suffering from sleep apnea, feel free to reach out to our staff at Premier Sleep Associates in Bellevue, Washington at (425) 698-1732.
Or simply click the button below to request an appointment today!
American Sleep Apnea Association
American Sleep Association
American Academy of Sleep Medicine