We have already discussed obstructive sleep apnea (OSA) in the adult, but have not spent much time on OSA in the pediatric age group, which despite also causing breathing to stop during sleep, can have different consequences, is often treated differently, and consequently is a very different disease. Unfortunately pediatric OSA is often overlooked as a problem, and can lead to serious health problems.
As is the case in an adult, childhood OSA is an occasional upper airway obstruction during sleep and is often associated with snoring. However as opposed to snoring, OSA can cause drops in the blood oxygen level, increase in the carbon dioxide level (which is waste product of our body’s metabolism), and sleep fragmentation, which can cause high levels of “stress” in the body These elevated stress levels should not occur during “restful” sleep. Sleep disruption can cause the child to be sleepy, but interestingly often causes the opposite- some kids may become hyperactive and even get a diagnosis of attention deficit hyperactivity disorder (ADHD).
In the US adult population, OSA is estimated to affect about 4 % of men and 2 % of women. In children it is believed to be present in about 2% of the population, compared to 7-9% of kids who snore frequently. OSA is more common among African American and Hispanic individuals, with African Americans under 18 being 3.5 times more likely to have OSA than whites.
Common symptoms include restless sleep, loud snoring, sometimes with breathing pauses followed by gasping or snorting. Other complaints can be bedwetting, nightmares morning headaches. Unfortunately these signs are overlooked by parents and doctors and ultimately lead to failure to thrive, behavioral problems, and possibly even heart dysfunction.
Apneas (total stopping of breathing) or hypopneas (decreased levels of breathing) are calculated differently in children than in adults. In adults these breathing changes need to last 10 seconds to be counted, but in children who breathe more rapidly than adults and have smaller lungs even shorter spans can cause a significant decrease in blood oxygen level and increases in carbon dioxide. It is therefore felt that fewer events (called the apnea hypopnea index or AHI) should be considered pathological in children, compared to adults, because even fewer numbers of breathing dysfunction can lead to symptoms.
In adults the most common risk factor associated with OSA is obesity. While this may be a problem in children as well, and likely will increase with the growing problem of childhood obesity, the most common causes of airway obstruction in pediatric OSA is enlarged tonsils and adenoids and bone deformities of the face and mouth.
In my next blog we will continue on the topic of childhood sleep apnea.