Sleep Apnea

Sleep apnea is a disorder in which a child has one or more pauses in breathing or shallow breaths during sleep.

Pauses in breathing can last from a few seconds to minutes. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Sleep apnea usually is a chronic (ongoing) condition that disrupts sleep. As a result, the quality of sleep is poor, which can make a child tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness.

It is estimated that 1% - 4% of children suffer from sleep apnea, many of them between the ages of 2 and 8. But it can occur at any age.

Patients can be seen by Texas Children's experts in Ear Nose and Throat (Otolaryngology).

Causes & Risk Factors

Causes:

The most common cause in children is enlarged tonsils and adenoids. Enlarged tonsils and adenoids block the airway during sleep.

The muscles in the back of the throat also relax during sleep. When these muscles relax, the airway narrows or closes as the child breathes in. This narrowing makes it hard to take in an adequate breath.

Most children with obstructive sleep apnea do not have problems breathing when awake.

Risk factors:

• Being overweight
• Family history
• Having small airways
• Enlarged tonsils and adenoids
• Craniofacial syndromes
• Neuromuscular disorders

Symptoms & Types

Symptoms:

• Hyperactivity
• Excessive daytime sleepiness
• Poor school performance
• Angry or hostile behavior
• Memory problems
• Bedwetting
• Loud snoring
• Breathing through the mouth rather than through the nose
• Dry mouth or sore throat when your child wakes up
• Restless sleep
• Difficulty awakening in the morning

Diagnosis & Tests

All that might be needed to diagnose sleep apnea is a physical exam and medical history.

Your child's doctor will perform a physical exam and ask questions about sleep patterns. The doctor will check your child's mouth, nose and throat for extra or large tissue.

You child may need to have tests that observe breathing during sleep and how often wakefulness happens.

Tests include:

• Having your child sleep in a specialized lab to be observed during sleep. Ideally, this test should be done during your child's regular bedtime. This is commonly referred to as a sleep study.

Treatment & Care

Treatment includes:

• Possible removal of the adenoids (adenoidectomy) and the tonsils (tonsillectomy) as a first-line of treatment.
• Possible use of continuous airway pressure mask (CPAP). It may take your child a while to get used to this, but if tolerated, it will cure the obstructive sleep apnea. CPAP is also sometimes needed after tonsil and adenoid removal if symptoms persist.
• If your child is overweight, losing weight helps.

Living & Managing

To help manage apnea:

• If your child is overweight, losing the excess weight helps reduce symptoms. Your doctor may recommend that your child meet with a registered dietitian to discuss dietary changes.   
• Your child should also not eat large amounts of food immediately before bedtime.
• Encourage your child to choose a sleep position of being on his side or stomach rather than on his back.
• Be sure to put your child to bed early to ensure adequate sleep time.