When we sleep, our muscles relax. This includes the muscles in the back of the throat that help keep the airway open. In obstructive sleep apnea, these muscles can relax too much and collapse the airway, making it hard to breathe.
In children, sleep disordered breathing (SDB) is characterized by sleep patterns which can include: snoring, restless sleeping, waking at night, obstructive events (apnea), enuresis (involuntary urination), and behavioral changes during the day (hyperactivity, lethargy, increased daytime fatigue) as well as difficulty in arousal and in falling asleep.
Obstructive Sleep-Disordered Breathing (SDB) affects up to 11% of children and forms a continuum of severity ranging from primary snoring to obstructive sleep apnea. Prevalence is increased in certain pediatric populations such as children with special needs, children with psychiatric or medical diagnoses and children with autism or pervasive developmental disorders. Recent research has demonstrated 75% of children with ADHD also have a sleep disorder.
Overall, sleep affects every aspect of a child's development, particularly higher cognitive functions. Research suggests that the long term effects of untreated sleep apnea in children include cognitive, behavioral, and psychosocial problems as well as growth delays and impacts on cardiovascular health. Consequences of untreated obstructive sleep apnea include failure to thrive, enuresis (bed-wetting), attention-deficit disorder, behavior problems, poor academic performance, and cardiopulmonary disease.
The most common etiology of obstructive sleep apnea is adenotonsillar hypertrophy (enlarged adenoids and/or tonsils).
Behavior and cognitive deficits can recur in children with SDB. Poor academic performance in the teenage years is associated with snoring. Greater than 80% of children who have documented and treated SDB will benefit from long term increases in cognitive ability, behavioral stabilization and positive changes in temperament.
Signs of obstructive sleep apnea in children include:
● mouth breathing awake or asleep, in the absence of snoring
● snoring, often with pauses, snorts, or gasps
● heavy breathing while sleeping
● very restless sleep and sleeping in unusual positions (i.e., chin tipped upward away from the neck)
● bedwetting
● daytime sleepiness or behavior problems
● sleepwalking or night terrors
● difficulty with arousal in waking
● behavioral and attention problems (hyperactivity)
**If you suspect your child may have a sleep disorder, you should see a doctor who specializes in sleep disorders immediately.**
References
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James Chan, M.D. Cleveland Clinic Foundation, Cleveland, Ohio Jennifer C. Edman, M.D. Fairview Hospital, Cleveland, Ohio PETER J. KOLTAI, M.D. Cleveland Clinic Foundation, Cleveland, Ohio.Am Fam Physician. 2004 Mar 1;69(5):1147-1155.
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Walter LM, C Horne RS. Obstructive sleep-disordered breathing in children: Impact on the developing brain. Pediatr RespirolCrit Care Med 2018;2:58-64
** Credit: Little Sprout Therapy & Metro Myo
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