Obstructive Sleep Apnea in Children

What is childhood sleep apnea?

Childhood sleep apnea is a common condition that causes a pause in your child’s breathing pattern while they sleep. Your child’s breathing changes due to an obstruction or blockage in their airway or because their brain isn’t communicating with their breathing muscles.

When your child’s brain senses changes to their body’s air intake, it’ll signal their lungs to breathe. This may cause your child to wake up frequently in the middle of the night. It’s similar to hearing your phone ring once while you’re sleeping. When you hear it, you wake up but fall back asleep instead of answering it.

While brief, these interruptions affect your child’s sleeping pattern. As a result, your child may be more tired during the daytime.

You may hear your child’s healthcare provider refer to childhood sleep apnea as pediatric sleep apnea.

What are the types of childhood sleep apnea?

There are three types of childhood sleep apnea:

• Obstructive sleep apnea: This is the most common form of childhood sleep apnea. It occurs when your child has a blockage in their airways.
• Central sleep apnea: This is a rare type of sleep apnea. It usually affects newborns. It happens when a baby’s brain has trouble communicating with the muscles that regulate their breathing.
• Mixed/complex sleep apnea (treatment-emergent central sleep apnea): This is a form of central sleep apnea. It occurs when a child who has obstructive sleep apnea receives treatment with a CPAP (continuous positive airway pressure) machine and develops central sleep apnea.

How common is childhood sleep apnea?

Sleep apnea is very common. Around the world, an estimated 1 billion people have sleep apnea. Among children, obstructive sleep apnea occurs in up to 1% to 5% of all ages including babies, infants, toddlers, children, adolescents and teenagers. Childhood obstructive sleep apnea is most common between the ages of 2 and 6 years old.

Is childhood sleep apnea dangerous?

While it’s most common for a child to experience mild symptoms of sleep apnea, untreated childhood sleep apnea could be dangerous and lead to the following complications:

• Growth and development challenges.
• Loss of bladder control (enuresis).
• Cardiopulmonary disease (heart and lung conditions).
• Attention-deficit/hyperactivity disorder (ADHD).

Changes to your child’s sleep pattern may affect your child’s behavior, emotional capacity and academic performance.

What are the signs and symptoms of childhood sleep apnea?

The signs and symptoms of childhood sleep apnea may include the following, which happen during sleep:

• Mouth breathing, loud breathing or snoring.
• Pauses or moments when breathing stops.
• Coughing or choking.
• Tossing and turning (restless sleep).
• Night sweats.
• Sleepwalking or sleep talking.
• Bedwetting.

During the daytime, you may notice the following behaviors, which may be clues that your child has sleep apnea:

• Fatigue.
• Inattentiveness or lack of focus.
• Irritable mood, aggressiveness or other emotional or behavioral problems.
• Morning headaches.

What causes childhood sleep apnea?

An obstruction or blockage in your child’s airways causes obstructive childhood sleep apnea. A miscommunication from your child’s brain to the muscles in your child’s airway causes central sleep apnea. Sometimes the use of a CPAP machine may cause a more complex sleep apnea.

Blockages or obstructions caused by obstructive sleep apnea can be the result of:

• Enlarged tonsils or adenoids. These are glands located in the back of your throat. They can get bigger if your child has an infection or inflammation. A genetic trait can make their glands larger than normal.
• Muscle tone changes. Certain genetic conditions, like Down syndrome or cerebral palsy, can cause muscle tone changes in your child’s head and neck. Your child may have a normal muscle tone during the day but their muscle tone decreases at night, allowing tissue to come closer together and block the airway.
• Bone structure abnormalities. A narrow facial bone structure like a small jaw or an overbite can affect your child’s air intake.
• Tumor. A growth in the airways may cause an obstruction. This is very rare.

What are the risk factors for childhood sleep apnea?

Your child may be more at risk of sleep apnea if they have:

• Allergies.
• Asthma.
• Cleft palateor pharyngeal flap surgery.
• Exposure to tobacco smoke.
• A record of sleep apnea in their biological family history (genetic predisposition).
• Obesity.
• Acid reflux.
• An upper respiratory infection.

How is childhood sleep apnea diagnosed?

A healthcare provider will diagnose childhood sleep apnea after learning more about your child’s symptoms and asking questions about their sleep like if they snore. They’ll also perform a physical examination and take a complete medical history. Your healthcare provider may recommend your child visit a sleep specialist.

A sleep specialist may conduct the following tests to determine if your child has sleep apnea:

• Sleep history: A report of your child’s nightly sleeping patterns.
• Upper airway evaluation: This includes a physical exam and sometimes other procedures like an X-ray or scope to evaluate for blockage in your child’s nose (nasal endoscopy).
• Sleep study (polysomnography): This test monitors your child as they sleep. It measures your child’s brain activity, heart rate, amount of airflow through their mouth and nose, oxygen and carbon dioxide content in their blood, muscle activity, chest and abdominal wall movement, and sleep interruptions.

How is childhood sleep apnea treated?

Childhood sleep apnea treatment varies based on the cause and severity. Their healthcare provider will focus on clearing your child’s airways. Treatment options could include:

• Surgery: Surgery may be necessary to remove enlarged tonsils or adenoids or repair structural abnormalities of your child’s head and neck to create more room in their airway.
• Lifestyle modifications: Regular exercise can naturally open your child’s airways. In addition, changes to your child’s diet can may help them reach or maintain a healthy BMI (body mass index) for their age.
• Medications: Medications can help keep your child’s airways clear or open them up. Your child’s provider may make medication recommendations based on the cause of their sleep apnea. For example, medications for allergies include antihistamines, fluticasone (Flonase®) and montelukast (Singulair®). A nasal decongestant can help if your child has an upper respiratory infection.
• Continuous positive airway pressure (CPAP): CPAP involves wearing a mask over your nose during sleep. The mask attaches to a small, portable machine that blows air through the nasal passages and into your airway. The air pressure keeps your child’s airway open so they can breathe normally during sleep.

If your child develops complex sleep apnea after treatment for obstructive sleep apnea, their healthcare provider may suggest changing the airflow pressures on their CPAP machine or refitting the mask to your child’s face. Most often, CPAP airflow pressures are too high or too low. Almost all symptoms of complex sleep apnea improve with adjusted therapy.

A healthcare provider will evaluate your child’s symptoms before making a recommendation for treatment or at-home management of the condition.

Are there side effects of the treatment?

Talk to your child’s healthcare provider about side effects of the treatment they recommend. Each type of surgery comes with possible risks. The side effects of medications vary by type. Ask your child’s provider if you should watch for side effects during their treatment.

Can childhood sleep apnea be prevented?

Most causes of childhood sleep apnea can’t be prevented.

You can help your child reduce their risk of obstructive sleep apnea by:

• Exercising regularly.
• Avoiding areas where there’s tobacco smoke.
• Managing seasonal allergies.

Your child’s provider can make personalized recommendations to help your child reduce their risk, especially if the condition runs in your biological family history.

What can I expect if my child has sleep apnea?

With treatment, childhood sleep apnea symptoms can go away and won’t have a long-term effect on your child as they grow. Untreated sleep apnea may be dangerous and can affect your child’s growth and development. Some children will have lingering symptoms as they age and may need lifelong management throughout adulthood.

Does childhood sleep apnea go away?

For certain causes, treatment is available to eliminate symptoms of obstructive sleep apnea in children. If your child has mild symptoms of sleep apnea, they may grow out of it. This can happen when tissue in the back of their throat shrinks as they get older, which opens their airways. Surgery to remove tonsils or adenoids effectively treats the condition. Symptoms of obstructive sleep apnea may return if your child develops a new blockage in their airway.

When should I see a healthcare provider?

Visit a healthcare provider if you notice signs or symptoms of sleep apnea, especially if you notice your child waking up often in the middle of the night or they have interruptions to their breathing pattern as they sleep.

Visit the emergency room (ER), or call 911 or your local emergency services number, if:

• Your child has trouble breathing.
• Your child’s skin, lips and nails turn pale, blue or gray.

What questions should I ask my doctor?

• What caused my child’s symptoms?
• Are there side effects of the treatment?
• Does my child need surgery?
• How long will my child need to use a CPAP machine?