Obstructive Sleep Apnea
This disorder is both frequent and serious. Numerous health problems are associated with obstructive sleep apnea syndrome (OSAS) in childhood. It is estimated that 2-3% of children have OSAS and the most common cause is enlarged tonsils and adenoids. When obesity is also present the risk for associated health problems is increased further.
The most common cause of OSAS is airway blockage. The windpipe is restricted or collapses when your child breathes in during inspiration. Enlarged tonsils and adenoids are often the cause and this obstruction occurs during sleep when there is a decrease in body tone and general awareness. Symptoms can be mild or severe. Usual symptoms include restless sleep, snoring, noisy breathing apnea, paradoxical chest movements, labored breathing and chest retractions and sweating. Some children complain of frequent waking and nightmares.
If the obstruction is nasal then mouth breathing is often seen. This allows your child to compensate for being unable to breathe through the nose. Other children will hyper extend their neck and assume a nose up sniffing position. This often decreases the snoring noises. Daytime symptoms can include quality of life issues including mouth breathing, hyperactivity, moodiness, sleepiness, and headaches and learning problems. Moderate obstruction can lead to neurobehavioral, cardiovascular and metabolic consequences. Severe cases can lead to pulmonary hypertension, systemic hypertension, failure to thrive and developmental delay.
OSAS is more commonly seen in children who are overweight and in children with small jaws, muscles weakness, craniofacial syndromes or Down syndrome.
A comprehensive history and physical examination by your pediatrician is the first step to obtain this diagnosis. Your child may also need to see a lung specialist (pulmonologist) or an ear, nose and throat (ENT) physician. Further diagnostic evaluations may be needed including an overnight sleep study (polysomnography) and an evaluation of the upper airways either through direct visualization or through X-rays and other imaging studies.
OSAS treatment depends on the cause. When enlarged tonsils or adenoids are the cause then removal is necessary. This involves an adenoidectomy and/or a tonsillectomy. If other structural or weight issues are present then these issues need to be addressed. When surgery is not helpful then treatment with continuous positive airway pressure (CPAP) is often the option of choice.
If your child has surgery and continues to have symptoms then close follow-up and continued treatment is necessary.