Obstructive Sleep Apnea

What is Obstructive Sleep Apnea?

Obstructive sleep apnea (OSA) occurs when a child is unable to move air while asleep but continues to attempt to breathe. The difficulty of breathing usually occurs because of a blockage (obstruction) in the airway.

During episodes of blockage, the child may look as if he/she is trying to breathe (the chest is moving up and down), but no air is being exchanged within the lungs. Often these episodes conclude with a period of gasping and awakening to compensate for lack of breathing. Periods of blockage occur regularly throughout the night and result in a poor, interrupted sleep pattern. Obstructive sleep apnea is defined as the cessation of air movement for a period of twenty seconds, occurring more than once per hours over a given night's sleep.

Sometimes, the inability to circulate air and oxygen in and out of the lungs results in lowered blood oxygen levels (desaturations). If this pattern continues, the lungs and heart may suffer permanent damage.

Obstructive sleep apnea is most commonly found in children between three to six years of age. It occurs more commonly in children with Down syndrome and other congenital conditions affecting the upper airway (i.e., conditions causing large tongue, small jaw, etc.).

What Causes Obstructive Sleep Apnea?

In children, the most common cause of obstructive sleep apnea is enlarged tonsils and/or adenoids. The exact cause for the enlargement is unknown, but may follow a viral respiratory infection. This enlargement may lead to blockage of the back of the nose and throat.

There are many muscles in the head and neck that help to keep the airway open. When a person (child or adult) falls asleep, muscle tone tends to decrease, thus, allowing tissues to fold closer together. If the airway is partially closed (by enlarged tonsils and/or adenoids) while awake, falling asleep may result in a completely closed passage.

Obesity may cause obstructive sleep apnea. While a common cause in adults, obesity is a far less common reason for obstructive sleep apnea in children.

A rare cause of obstructive sleep apnea in children is a tumor or growth in the airway. Certain syndromes or birth defects, such as Down syndrome and Pierre-Robin syndrome, can also cause obstructive sleep apnea.

What are the Symptoms of Obstructive Sleep Apnea?

The following are the most common symptoms that may indicate the presence of obstructive sleep apnea. However, each child may experience symptoms differently. Symptoms may include:

  • Loud snoring or noisy breathing during sleep
  • Periods of not breathing—although the chest wall is moving, no air is moving through the nose and mouth into the lungs. The duration of these periods is variable and measured in seconds.
  • Mouth breathing—the passage to the nose may be completely blocked by enlarged tonsils and adenoids.
  • Restlessness during sleep (with or without periods of being awake)
  • Excessive daytime sleepiness or irritability (because the quality of sleep is poor, the child may be sleepy or irritable in the daytime)
  • Nightmares
  • Hyperactivity during the day
  • Bed wetting
  • Difficulty swallowing food of tough consistency

The symptoms of obstructive sleep apnea may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis. He may arrange an appointment at the Children's Healthcare of Atlanta Sleep Center.

How is Obstructive Sleep Apnea Diagnosed?

Your child's physician should be consulted if noisy breathing during sleep or snoring becomes noticeable. Your child may be referred to an ear, nose, and throat (ENT) physician (otolaryngologist) for further evaluation.

In addition to a complete medical history and physical examination, diagnostic procedures for obstructive sleep apnea may include:

  • Sleep history—report from parents or caretaker
  • Evaluation of the upper airway
  • Sleep study (Also called polysomnography)—the best test available for diagnosing obstructive sleep apnea. The test requires a high level of collaboration on the part of the child and may not be possible in younger and/or uncooperative children. Two types of tests are available. In the first type, the child will sleep in a specialized sleep laboratory. In the second type, the child has on similar monitors but sleeps in his/her own bed. During the sleep study a variety of testing occurs to evaluate the following:
  • Brain activity
  • Electrical activity of the heart
  • Oxygen content in the blood
  • Chest and abdominal wall movement
  • Muscle activity
  • Amount of air flowing through the nose and mouth

During the sleep study, episodes of apnea and hypopnea will be recorded:

  • Apnea - complete airway obstruction.
  • Hypopnea - the partial airway obstruction combined with a significant decrease in the oxygen content of the blood.

Based on the laboratory test, sleep apnea is generally considered significant in children if more than 10 apnea episodes occur per night, or one or more occur per hour. Some experts define the problem as significant if a combination of one or more episodes of apnea and/or hypopnea occur per hour of sleep.

Symptoms of obstructive sleep apnea may resemble other conditions or medical problems. Consult your child's physician for more information.

Treatment for Obstructive Sleep Apnea:

Specific treatment for obstructive sleep apnea will be determined by your child's physician based on:

  • Your child's age, overall health, and medical history
  • Cause of the condition
  • Your child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

The treatment for obstructive sleep apnea is based on the cause. Since enlarged tonsils and adenoids are the most common cause of airway blockage in children, the treatment is surgery and removal of the tonsils (tonsillectomy) and/or adenoids (adenoidectomy). Your child's otolaryngologist will discuss the treatment options, risks and benefits with you. This surgery requires general anesthesia. Depending on the health of the child, surgery may be performed on an outpatient basis.

If the cause of the disorder is obesity, less invasive treatments may be appropriate, including weight loss and wearing a special mask while sleeping to keep the airway open. This mask delivers continuous positive airway pressure (CPAP). The device itself is often clumsy, and it may be difficult to convince a child to wear such a mask. Surgery may be necessary but is frequently not effective in this setting.