August 2020 | Reviewed by: Anne M. Morse, DO and Jon Saito, MD
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