Sleep apnea in children: symptoms, causes and treatment

The night is the part of the day in which we try to rest. Sleep is that period of our routine in which we replenish energy, in addition to making the body rest and repair itself.

If in adulthood having a poor quality of sleep affects our physical and mental health very negatively, more critical are sleep problems during childhood. Not being able to sleep well results in impaired growth and cognitive development problems.

One of the sleep problems that little ones can suffer is sleep apnea in children, a disorder that, although relatively rare, can affect the health of our children so seriously that we should know it very well. Next we are going to delve into what it is, its causes, symptoms and treatment.

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What is sleep apnea in children?

Obstructive sleep apnea syndrome (OSAS) in children is a sleep-disordered breathing disorder that affects about 2% of infants, especially between the ages of 2 and 5. This problem is characterized by repeated episodes of airway obstruction while sleeping, which can occur partially (hypopnea) or totally (apnea).

This disorder is usually due to a narrowing or blockage in the upper airways while sleeping.

Because the little one cannot breathe well while sleeping, his lungs do not receive enough oxygen which causes him to there is a reduction in this gas in the blood (hypoxemia), and there may also be an increase in CO2 retention (hypercapnia). This interruption of pulmonary ventilation can be repeated up to 400 times each night, preventing the affected person from enjoying deep restorative sleep.

Not sleeping well at night because of not being able to breathe well affects the physical and mental health of adults and children, but this problem has different consequences according to age. While in adults with apnea they usually present daytime sleepiness, in the case of children, behavioral problems, attention and hyperactivity are manifested, which which can make sleep apnea not properly diagnosed, thinking that behind the child's behavioral problem there is some disorder psychological.

The basic cause in adults is usually obesity, while in children it is usually a problem in the adenoids and tonsils, especially due to their enlargement.

Whatever causes it, it should be noted that can impair the physical and intellectual development of boys and girls, which is why early diagnosis and treatment are so important in order to avoid any complications that affect the cognitive and behavioral development of children.

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Symptoms

The signs and symptoms that may be observed in the child with sleep apnea while sleeping are:

• Snoring
• Pauses in breathing
• Restless or restless sleep
• Snorting, coughing, or choking
• Mouth breathing
• Nocturnal hyper sweating
• Bedwetting: urinating while sleeping
• Night terrors and nightmares
• Wake up soon
• Excessive thirst when waking up
• Morning headaches

In infants and children who are still very young, obstructive sleep apnea does not always manifest itself in the form of snoring. In their case, it may happen that they simply manifest a sleep disturbance and difficulties in having a restful sleep.

While awake, children with sleep apnea may manifest the following problems related to their sleep disorder.

• Poor school performance
• Attention problems
• Learning problems
• Behavior problems
• Little weight gain (critical in very young children)
• Hyperactivity
• Stunted growth

Obstructive sleep apnea in boys and girls can involve multiple complications in the physical and psychological health of the affected person, among which we can highlight stunted growth, heart problems, and death.

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Causes and risk factors

Obesity is often a common cause behind obstructive sleep apnea in adults. However, in the case of boys and girls, although this is also a cause, the most common is usually an enlarged tonsils and adenoids or vegetations, masses of tissue located in the back of the nasal cavity.

This sleep problem can also appear due to craniofacial abnormalities and neuromuscular disorders.

In addition to obesity, among the risk factors for sleep apnea in children we have:

• Down's Syndrome
• Abnormalities in the skull or face
• Cerebral palsy
• Neuromuscular disease
• Sickle cell disease
• Low birth weight
• Family history of this sleep disorder

Diagnosis

The diagnosis of pediatric sleep apnea is somewhat complicated, since it is necessary to carry it out while the affected person sleeps. The doctor will review your child's symptoms and medical history, and perform a physical exam while he or she is awake, including examination of the neck, mouth and tongue to check the status of the tonsil and adenoids.

But, since to detect this problem it is necessary to see how the child sleeps, the doctor will possibly order the parents of the affected person several tests to diagnose the condition. Among the tests used we find:

1. Polysomnography

The doctor evaluates the child's condition during a nighttime sleep study. This test uses sensors placed over the entire body to record brain wave activity, breathing pattern, oxygen levels, heart rate, muscle activity, and snoring while the child sleeps.

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2. Oximetry

In case pediatricians suspect that the child suffers from obstructive apnea, and a complete polysomnography is not required or available, a record of oxygen levels while you sleep may offer help to confirm the diagnosis. Oximetry can be done at home.

3. Electrocardiogram

To perform an electrocardiogram, you need to place patches with electrodes connected to a machine that measures electrical impulses coming from the child's heart. The pediatric team can use this test to determine if the little one has heart disease that could be behind the sleep apnea.

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Treatment

The therapeutic options for treating sleep apnea in children are diverse. Each case will require a particular treatment, being mainly the following.

1. Medicines

The pharmacological route to treat this type of apnea includes topical nasal steroids, such as fluticasone and budesonide, which can relieve the symptoms of this sleep disorder in some children with obstructive apnea slight sleep. In children with allergies, montelukast appears to relieve symptoms, both used alone and with nasal steroids.

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2. Removal of the tonsils and adenoids

When the child suffers from moderate or severe sleep apnea, one of the therapeutic options, although drastic, consists of the removal of the tonsils and adenoids.

This type of intervention is called adenotonsillectomy and it is only used when an otolaryngologist considers that it is the best option available to improve the quality of life of the child, thus opening the ways respiratory

3. Positive airway pressure therapy

In positive airway pressure therapy several machines are used that blow air through a tube and a mask placed over the nose and / or mouth.

This machine sends air pressure down the back of the child's throat to keep his airway open. This option is resorted to when medications or the removal of the adenoids and tonsils have not been effective.

4. Oral Devices

Another option is oral devices, such as dental braces or mouthpieces, which can help expand the palate and nasal passages. They also serve to move the child's lower jaw and tongue forward so that the upper airway remains open. It should also be said that few children benefit from oral devices.