Sleep Disordered Breathing
Sleep-disordered breathing (SDB) is a general term for breathing difficulties occurring during sleep. SDB includes a wide spectrum of breathing abnormalities, ranging from frequent loud snoring to Obstructive Sleep Apnea (OSA), a condition involving repeated episodes of partial or complete blockage of the airway during sleep. When a sleeping child’s breathing is disrupted, the body perceives this as if the child is choking. The heart rate slows, blood pressure rises, the brain is aroused, and sleep is disrupted. Oxygen levels in the blood can also drop.
Approximately 10 percent of children snore regularly and about 2-4 % of the pediatric population has OSA. Recent studies indicate that mild SDB or snoring may cause many of the same problems as OSA in children.
Symptoms and Effects of SDB
The most obvious symptom of sleep-disordered breathing is loud snoring that is present on most nights. The snoring can be interrupted when a complete blockage of breathing occurs, causing gasping or snorting noises as the child struggles to get a breath. The child may also move about frequently in bed and hyper-extend the neck in an effort to open the airway.
Due to this poor-quality sleep, a child with sleep-disordered breathing may be irritable, experience morning headaches, be sleepy during the day, or have difficulty concentrating in school. In children, this fatigue often leads to restlessness and unexpected behavioral changes that may mimic ADHD. Bed-wetting is also frequently seen in children with sleep apnea.
A common physical cause of airway narrowing contributing to SDB is enlarged tonsils and adenoids. Overweight children are at increased risk for SDB because fat deposits around the neck and throat can also narrow the airway. Children with abnormalities involving the lower jaw or tongue or neuromuscular deficits such or cerebral palsy have a higher risk of developing sleep-disordered breathing.
Sleep apnea has both immediate and long-term effects. The immediate effects are more noticeable to the patient and their family and include all the symptoms of sleep deprivation as described above. The long-term effects, however, can be even more serious. Untreated pediatric SDB can have significant consequences including social problems, behavior and learning problems, enuresis (bed-wetting), stunted growth and development, obesity, and cardiovascular problems. It is believed that many of these long-term effects can be prevented by effective treatment of OSA.
Diagnosis and Treatment of SDB
Sleep-disordered breathing should be considered if frequent loud snoring, gasping, snorting, and thrashing in bed or unexplained bed-wetting is observed. Behavioral symptoms can include changes in mood, misbehavior, and poor school performance. Of course, not every child with academic or behavioral issues will have SDB, but if a child snores loudly on a regular basis and is experiencing mood, behavior, or school performance problems, SDB should be considered.
If you notice that your child has any of those symptoms, have them checked by one of our otolaryngologists, Dr. Bryan or Dr. Mettman. Generally, the diagnosis of sleep-disordered breathing is made based on history (parental observations) and the physical examination. In other cases, such as in children suspected of having severe OSA due to craniofacial syndromes, morbid obesity, or neuromuscular disorders or for children less than 3 years of age, additional testing such as a sleep test may be recommended.
Enlarged tonsils and adenoids are a common cause for pediatric SDB. Surgical removal of the enlarged tonsils and adenoids (tonsillectomy and adenoidectomy) is generally considered the first-line treatment for pediatric sleep-disordered breathing. Of the over 500,000 pediatric T&A procedures performed in the U.S. each year, the majority are currently being done to treat sleep-disordered breathing. Many children with sleep apnea show both short and long- term improvement in their sleep and behavior after T&A.
Not every child with snoring should undergo a T&A, as any surgery does have risks. If the symptoms are mild or intermittent, academic performance and behavior is not an issue or the child is near puberty (tonsils and adenoids often shrink at puberty), it may be recommended that a child with SDB be watched conservatively and treated surgically only if symptoms worsen.