Pediatric Sleep Apnea

byJoy Granetz, Ph.D.

Pediatric sleep apnea refers to brief involuntary breathing pauses during sleep in a child. These pauses may last a few seconds or over a minute and can lower oxygen levels in the blood. When this happens, regulatory mechanisms of the brain wake the child up in order to improve air flow. Because of these repeated interruptions in sleep throughout the night, which may be numerous over the course of the night, the child suffers from chronic sleep deprivation and may have trouble waking, feel sleepy during the day, and exhibit suboptimal mental performance throughout the day.

Sleep disordered breathing refers to a spectrum of problems ranging from snoring (without apnea), partial obstruction, and complete cessation of airflow. At the most severe level, chronic obstructive sleep apnea occurs in 1-3% of preschool age children. Although it can occur at all ages, it peaks between the ages of 2 and 6 because of growth related factors of the adenoids and tonsils. A second peak occurs during the teenage years. Family history of sleep apnea is a risk factor. Other risk factors include large tonsils/adenoids, allergies, asthma, reflux, cleft palate repair, obesity, hypotonia, cerebral palsy, hypothyroidism.

More and more research studies are accumulating evidence that suggest that sleep apnea is correlated with cognitive challenges. Children who are chronically sleep deprived from sleep apnea may have behavioral, mood, learning, and attention problems that mimic symptoms of ADHD and related learning and disruptive behavior disorders. Accordingly, before a diagnosis of an attention or learning disorder is made, it is important to rule out medical explanations, such as a sleep related disorder, for the symptoms.

Potential Indicators of sleep apnea include:

  • Snoring
  • Failure to grow
  • Enlarged tonsils and adenoids
  • Mouth breathing
  • Behavioral problems at school

Common presenting symptoms of sleep apnea include loud, continuous snoring, pausing while breathing during sleep (choking, gasping, snorting), chest retraction during sleep, restlessness during sleep, sweating during sleep, and odd sleep positions. Excessive daytime sleepiness is often a result of chronic sleep disruption. Children suffering from sleep apnea often have great difficulty waking in the morning. During the day, parents often observe mouth breathing, chronic nasal congestion, nasal speech, difficulty swallowing, headaches (especially in the morning), ear infections, and poor appetite. Behavioral problems, such as mood changes, aggression, impatience, and ADHD-like symptoms are often reported. Bedwetting is sometimes associated with sleep apnea due to hormone disruptions. Growth failure or ‘failure to thrive’ is seen in severe cases. Sleep terrors or sleep walking sometimes result from fragmented sleep patterns.

Enlarged tonsils can cause sleep apnea in children. In fact, it is estimated that 90% of pediatric sleep apnea is caused by enlarged tonsils. Tonsillectomy and/or adenoidectomy are the typical treatments for sleep apnea in children. Studies suggest that with treatment, most related symptoms, including learning and behavioral problems, often completely resolve.

If you are concerned that your child may be suffering from sleep apnea, talk to your pediatrician about your concerns. You may be referred to a Pediatric ENT or Otolaryngologist. A pediatric sleep study, or polysomnography, may be required for a definitive diagnosis. It is important to rule out this disorder, as research suggests that untreated obstructive sleep apnea may be associated with serious medical complications over time.