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Obstructive Sleep Apnea

What is obstructive sleep apnea?

Obstructive sleep apnea occurs when a child stops breathing during sleep. The cessation of breathing usually occurs because there is a blockage (obstruction) in the airway. It affects many children. Childhood obstructive sleep apnea is most commonly found in children between 2 and 6 years of age, but can occur at any age.

What causes obstructive sleep apnea?

In children, the most common cause of obstructive sleep apnea is enlarged tonsils and adenoids. During sleep there is a considerable decrease in muscle tone, which affects the airway and breathing. Many of these children have little difficulty breathing when awake; however, with decreased muscle tone during sleep, the airway becomes smaller, and the tonsils and adenoids block the airway, making the flow of air more difficult and the work of breathing harder.

It is like breathing through a small, flimsy straw with the straw occasionally collapsing and blocking airflow. Many of the short pauses (lasting only a few seconds) cause a brief arousal that increases muscle tone, opens the airway, and allows the child to resume breathing.

Although the actual number of minutes of arousal during the night may be small, the repeated disruptions (a comparable image would be someone poking you 15 to 30 times a night) can result in a poor night’s sleep, which can lead to significant daytime problems in children. The child is usually unaware of waking up, and the parent often describes very restless sleep but usually does not describe the child’s waking up completely.

Who is at Risk?

Sleep apnea is more common in children who are overweight; however, some children with enlarged tonsils and/or adenoids may even be underweight. Other children who are at high risk for sleep apnea include those with a small jaw, craniofacial syndromes, muscle weakness or Down syndrome.

What are the symptoms of obstructive sleep apnea?

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

In addition, the symptoms of obstructive sleep apnea may resemble other conditions or medical problems. Be sure to always consult your child's physician.

How is obstructive sleep apnea diagnosed?

Your child's physician should be consulted if you are concerned about your child’s breathing during the night. Your child may be referred to a specialist, such as a sleep specialist, an ear, nose and throat (ENT) physician (otolaryngologist), or a pulmonary doctor for further evaluation.

In addition to a complete medical history and physical examination, diagnostic procedures for obstructive sleep apnea may include an overnight sleep study (also called polysomnography) and an evaluation of the upper airway by visualization and/or X-rays.

What is a sleep study?

Your doctor will discuss the usefulness of a sleep study in the evaluation of obstructive sleep apnea. The Sleep Laboratory provides complete description of a sleep study and a tour of the sleep lab at The Children’s Hospital of Philadelphia.

How is obstructive sleep apnea treated?

The treatment for obstructive sleep apnea is based on its cause. Since enlarged tonsils and adenoids are the most common cause of obstructive sleep apnea in children, surgical removal of the tonsils (tonsillectomy) and adenoids (adenoidectomy) is usually the recommended treatment. An ear, nose, and throat specialist will make the evaluation for such surgery. Other types of surgery are occasionally needed in children with craniofacial abnormalities. Weight loss and treatment of other medical problems may also be helpful in the management of obstructive sleep apnea.

In cases where surgery is not helpful, another effective treatment is continuous positive airway pressure (CPAP). CPAP involves wearing a mask over the nose during sleep attached to a machine that blows air through the nasal passages and into the airway. This air pressure keeps the airway open and allows the child to breathe normally during sleep.

If left untreated, OSA can cause poor growth ("failure to thrive"), high blood pressure, and heart problems. OSA can also affect behavior and cognition. Therefore, it is important to get it evaluated early.

In all cases, the specific treatment for obstructive sleep apnea depends on many factors and is tailored for each child. Please discuss your child's condition, treatment options and your preferences with your child's physician or health care provider.

Reviewed by: Steven D. Handler, MD, MBE
Carole L. Marcus, M.B.B.Ch.
Date: April 2009

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