Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is fairly common in children when there is a partial or complete blockage of the airway during sleep. The result is a disruption to the respiratory system and interruption of the child’s sleep. OSA is found in children at all ages, especially 2-6 years. Approximately 2% of the population is found to suffer from OSA with a fairly equal male/female ratio.

Unlike in adults, OSA in children can be caused by a wider range of factors, most common cause is a blockage of the upper respiratory airway caused by an enlargement of the tonsils located at the base of the tongue and the adenoids situated posterior to the nasal cavity. This occurs when the neck muscles are relaxed during sleep. OSA can also be caused by a buildup of fat around the neck in overweight children or by abnormal physical characteristics such as unusual facial features, chin, and neck causing a narrowing of the upper respiratory system. Malfunctions of muscles and nervous system, genetics and hormones are other possible causes of OSA.

Children who have OSA usually snore heavily and find it very difficult to breathe when they are sleeping the pattern of breathing during sleep is abnormal. However, these symptoms do not occur when the children are awake.

• Shaky breathing, obstructed breathing or stoppage of breathing for a period of time, snoring
• Restless sleep, sweating while sleeping, frequently waking up at night
• Uncontrollable urination when sleeping, breathing through the mouth
• Bad performances in school, being grumpy, poor attention, hyperactive behavior, lower E.Q.
• Being sleepy during the daytime
• High blood pressure

• Having enlarged tonsil stones and/or enlarged adenoids. The severity of one or both of these factors can influence the severity of the OSAS. The larger the two factors, the greater the blockage of the airway.
• Being overweight.
• Having an abnormal respiratory system caused by a small molar leading to an unusually narrowed airway.
• Having a brain disorder, such as cerebral palsy which causes a malfunction of the respiratory muscles.
• Having muscular weakness caused by heredity characteristics such as Down syndrome.

Considered as the most efficient and effective method for diagnosing OSA, Polysomnography (Sleep Study) monitors the patient’s sleeping throughout the night. With this method, the children are required to stay in the hospital overnight with parents and technician/nurses observing their breathing. During 6–8 hours of sleeping, the Polysomnography records every signal through electrodes placed on the body.  This method is completely pain-free and the results indicate whether or not the child has a blockage in the respiratory system and can also be used to assess the severity of OSA.

Breathing stops while sleeping leads to a decrease of oxygen in the bloodstream. Failure to cope with this condition in its early stages will impact the function of the brain, memorization, and concentration. The development of the brain and performance at school suffer as a result.  In serious cases, OSA can result in the overworking of the heart and even heart failure which can be fatal.

Treatment

• Treat any infectious disease and allergies, use nasal spray, and stop taking medicines that exacerbate the condition, including sleeping pills and decongestants.
• In some mild cases, having the child sleep on his/her side can help slightly.
• Surgical removal of the tonsils and adenoids is the most recognized method and the most successful with 75-100% cases cured in this way.
• Obese children are recommended to lose weight.
• Reconstructive surgery is required to correct unusual facial features.
• A Continuous Positive Airway-Pressure (CPAP) device is the last resort for extreme cases. It helps keep the upper airway open by providing a constant flow of air delivered through a face mask worn while sleeping.

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