Sleep Apnea in Children

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Sleep apnea is perhaps the most disruptive sleep problem for children and adults alike, since it can interfere with their sleep on a regular basis throughout the night.

What is sleep apnea?

Sleep apnea is a disorder that causes people to stop breathing during their sleep for brief periods of time. In children these restless periods typically last anywhere from a few seconds to as long as 30 seconds. In adults they can be as long as a minute or two. A person’s natural reflexes then kick in and restart breathing.

Obstructive sleep apnea
Most sleep apnea cases are obstructive sleep apnea, which occurs when the soft palate and tongue relax during sleep and fall back into the airway, closing it off. “The actual obstruction usually occurs in the back of the throat, behind the base of the tongue,” says Dr. Ferber. “The walls of the throat are relatively floppy in this region; if they collapse and the tongue falls backward, the airway can be blocked.” (Ferber, 2006, p. 389)This causes blood oxygen levels to drop, which momentarily jolts a person awake, what is referred to as partial arousal, which restores breathing to normal. But since this can happen dozens of times each hour, it interferes significantly with a child’s sleep.

How common is sleep apnea in children?

Though once thought of as a rare condition in children, sleep apnea is now known to afflict between 1% and 4% of children (depending on which expert you ask), though some doctors believe the actual number to be even greater than this. (Petersen, 2013)

Signs and symptoms of sleep apnea in kids

Sleep apnea is often accompanied by heavy snoring (the restricted airway that causes the snoring is also what causes the muscles to contract, creating a temporary lapse in breathing). So if a child snores loudly, you might want to place a tape recorder in their room at night to see if they are experiencing sleep apnea as well. You should be able to decipher the silent pause when breathing is stopped, which is usually followed by gasps of breath or choking sounds once breathing resumes.

Here are some additional guidelines to use when trying to decipher the symptoms of sleep apnea:

Snoring:

Loud, raspy, squeaky, or snorting noises
Typically snoring can be heard from elsewhere; if you have to stand close to a child to hear it, apnea is unlikely
Occurs most nights, not just occasionally
Snoring may be more severe in the second half of the night
Snoring is most pronounced when the child sleeps on their back

Breathing/Apnea:

A child’s breathing seems labored
They sleep with their mouth open
Restless sleep
Their upper chest is pulled inward rather than expanding when a child breathes in
Pauses in breathing followed by snorting

Daytime symptoms of sleep apnea in children:

Tired during the day
Headaches in the morning
High blood pressure or EEG abnormalities

What causes sleep apnea in children?

The most common causes of sleep apnea in kids are enlarged tonsils and adenoids. These tissues at the back of the nasal cavity are often at their largest between the ages of 3 and 5, though a child’s airway is still small. This can restrict the airway and lead to sleep apnea. Sleep apnea typically involves some sort of collapse of the airway, often the soft palate. But it’s hard for patients to know exactly where the airway collapse is occurring, and impossible for doctors to know without the help of a sleep study. Children with Down Syndrome are especially prone to sleep apnea, since they often have distorted facial proportions and tongues that are too large for their mouths.

Very young children can also experience sleep apnea as a result of the fact that the systems in their brain which regulate breathing are immature, and sometimes misfire. Infants can suffer a neurological sleep apnea that occurs because the communication between the brain and the nervous system is still developing. But this condition is usually temporary. It goes away as a child grows, and isn’t related to typical sleep apnea. Asthma and gastrointestinal reflux disease (GERD) also put kids at increased risk for sleep apnea. The condition also tends to worsen during the winter months when colds are more frequent.

In children as in adults, obesity is a primary cause of sleep apnea. The two are so interconnected “that we routinely perform a sleep study on almost every extremely obese youngster who is treated at the hospital where our sleep laboratory is located,” says Dr. Ferber. (2006, p. 396)

Is sleep apnea dangerous? Is it harmful?

Sleep apnea is not dangerous in the traditional sense (children always start breathing again), but it can cause a number of other problems for a child which could be harmful. For one, it tends to disrupt sleep. Children who stop breathing may awake briefly gasping for air when their reflexes kick in, so it can prevent them from getting a solid, relaxed night’s sleep. This lack of quality REM sleep cycles can translate into learning and behavioral problems during the day. One study in the journal Pediatrics asked parents of 11,000 children about their child’s sleeping habits. It was found that children who were observed to have disordered breathing in their sleep had 40% more behavioral problems at 4-years-old and 60% more at age 7. (Levine, 2012)

Sleep apnea makes it harder for a child to function during the day. One child was so impaired he had to repeat 5^th grade. Other studies have found a link between sleep apnea and ADHD symptoms in children. One 2007 study analyzed children with both sleep apnea and attention-deficit/hyperactivity disorder. They found that treating their sleep apnea resulted in a 36% decrease in hyperactivity symptom ratings – a much higher reduction in symptoms than the 24% decrease typically achieved with ADHD medications. (Stickgold, 2015) Sleep apnea is also associated with anywhere from a twofold to a fivefold increase in the risk of major depression, as well as an increase in the risk of other mental health disorders. (ibid)

Furthermore, a number of studies are raising concerns that sleep apnea could deprive a child’s brain of oxygen during sleep. So if such episodes are happening many times a night, over time this could cause neurodevelopment delays or other problems.

For more information on treatments for sleep apnea in children:

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