What is child sleep apnea?

Sleep apnea occurs when the muscles relax after you fall asleep. As a result, soft tissue in the back of the throat collapses and blocks the airway. This leads to either a reduction or pause in breathing.

Adults breathe about 12-16 breaths per minute. Children tend to have a faster breathing pattern that varies based on age and size. Children also have smaller lungs, so they have less oxygen in reserve. For these reasons, even a brief pause in breathing can cause a child to have low levels of oxygen in the blood. Children tend to take frequent, shallow breaths rather than slow, deep breaths. This also can cause a child with sleep apnea to have too much carbon dioxide in the blood.

Adults with sleep apnea often have fragmented sleep. They tend to wake up briefly after their breathing stops. Children with sleep apnea often do not wake up in response to pauses in breathing. They have a higher arousal threshold than adults. As a result, their sleep pattern tends to be fairly normal. If your child is experiencing difficulties with sleep maintenance, further evaluation is warranted.

Excessive daytime sleepiness is more common in adults with sleep apnea than in children with sleep apnea. Older children and teens are more likely than younger children to have this problem. Rather, inattention and/or hyperactivity may be seen in younger children with sleep apnea.

Many children with sleep apnea have a history of snoring. Snoring may be loud and may include obvious pauses in breathing and gasps for breath. Sometimes the snoring involves a continuous, partial obstruction without any obvious pauses or arousals. The child’s body may move in response to the pauses in breathing, and the child may appear to have restless sleep.

Younger children have a very flexible rib cage. As a result, the breathing problems can produce unusual movements of a child’s chest and abdomen. The rib cage may appear to move inward as the child inhales. Parents often notice that the child seems to be working hard to breathe. For healthy children over three years of age, this type of breathing is not normal.

In extreme cases, a child with untreated sleep apnea may develop a “funnel chest” over time. The ongoing breathing problems cause the sternum, or breastbone, to sink in. This produces a depression in the chest wall.

Children with sleep apnea may frequently shift positions during sleep and sometimes sleep in unusual positions. They may sleep sitting up or with the neck overextended to improve breathing. They also may sweat a lot during sleep and may have headaches in the morning. Bedwetting or sleep terrors also may occur.

Children with sleep apnea tend to breathe normally when they are awake. But it is common for them to breathe through the mouth. They may have frequent infections of the upper respiratory tract. Some children with sleep apnea have such large tonsils that they have a hard time swallowing.

Symptoms of sleep apnea tend to appear in the first few years of life but can occur at any age. Sleep apnea often remains undiagnosed for several years. In early childhood, sleep apnea can slow a child’s growth rate. Following treatment for sleep apnea, children tend to show gains in both height and weight. Untreated sleep apnea also can lead to high blood pressure.

Cognitive and behavioral problems are common in children with sleep apnea. These problems may include:

Aggressive behavior
Attention-deficit/hyperactivity disorder
Delays in development
Poor school performance
Mood changes and poor choices

What are symptoms of child sleep apnea?

If your child has sleep apnea they may:

Snore, have labored breathing or stop breathing during sleep
Have a rib cage that moves inward as the child inhales
Have body movements and arousals from sleep
Sweat during sleep
Sleep with the neck overextended or in an unusual position
Have excessive daytime sleepiness
Be hyperactive or exhibit aggressive behavior
Have a slow rate of growth
Have morning headaches
Develop bedwetting

What are risk factors for child sleep apnea?

Sleep apnea occurs in about 3-5 percent of otherwise healthy children and adolescents. The disorder is frequently identified between the ages of 3 and 6 years when the tonsils and adenoids are large compared to the throat. Sleep apnea appears to occur at the same rate in boys and girls. This disorder is common in children who are obese and is more likely to occur in a child who has a family member with sleep apnea.

Children with an abnormal facial structure are at risk for sleep apnea. It is common in children with Down syndrome. It also may occur in children with neuromuscular diseases. Children with cerebral palsy or sickle cell disease may be more likely to develop sleep apnea. An operation that corrects a cleft palate also can produce sleep apnea. These patients should have regular screening for sleep apnea despite symptoms being present or absent.

How to diagnose child sleep apnea?

Sleep apnea is a serious disorder that needs to be treated. Sleep doctors are trained experts in diagnosing and treating sleep apnea. Use the sleep center directory to find an accredited sleep center and a sleep doctor near you. Some centers specialize in helping children.

It is also important to know if there is something else that is causing your child’s sleep problems. A sleep doctor can look for other conditions that may imitate the symptoms of sleep apnea or make them worse. These include:

Another sleep disorder
A medical condition
Medication use
A mental health disorder
Substance abuse

Describe the problems you have observed and when you first noticed them. Let the doctor know if your child recently gained a lot of weight. Provide the doctor with your child’s complete medical history.

A sleep doctor will review your child’s history and symptoms. If needed, the doctor will schedule your child for an overnight sleep study. This kind of study is called polysomnography. It is the best way to evaluate your child’s sleep. It charts your child’s brain waves, heartbeat, and breathing during sleep. It also records arm and leg movements. The sleep study will reveal if your child has sleep apnea. It also will show the severity of the problem. The study requires your child to spend the night at the sleep center. A parent or guardian also will need to stay at the sleep center with the child. In rare cases, a doctor may use another test to evaluate your child’s upper airway. Examples include endoscopy and magnetic resonance imaging.

With the results of this study the doctor will be able to develop an individual treatment plan for your child.

How to treat child sleep apnea?

Adenotonsillectomy is the most common treatment for sleep apnea in children. This surgery involves the removal of the adenoids and tonsils. It reduces the obstruction and increases the size of the upper airway. As a result, the child is able to breathe normally. Some children may continue to have sleep apnea even after adenotonsillectomy.

CPAP is another treatment option for children. It may be used if surgery is not an option or if sleep apnea persists after surgery. CPAP delivers a steady stream of air through a mask worn over the nose or face. The air gently blows into the back of the throat. This keeps the airway open so your child can breathe during sleep.

Overweight or obese children will benefit from weight loss. This can reduce the frequency and severity of sleep apnea. Usually, weight loss is combined with another treatment option.

Some children may benefit from wearing an oral appliance during sleep. An oral appliance is about the size of a sports mouthguard. It moves the jaw forward to keep the airway open. The effectiveness of this treatment in children is still being studied.