I’d like to continue on the topic of obstructive sleep apnea (OSA) in children.
As we mentioned OSA is the repetitive stopping of breathing due to an obstruction in the child’s airway. OSA can occur in children of all ages, but is probably more common in pre-school children. As we explained, in most children the main reason for their OSA is not obesity, which is the main risk factor in the adult population, it is actually the size of their airway, especially the tonsils and adenoids (lymph nodes that are located at the very back of the nose, where the nose meets the mouth). In younger children the tonsils and adenoids are largest in relation to the size of the airway.
Untreated OSA in children can lead to serious health consequences. In the past, due to poor recognition of the disease, OSA was associated with heart failure (especially the right heart, whose job it is to pump blood to the lungs) and poor growth, known medically as failure to thrive. Fortunately, these complications are rare nowadays. OSA has been associated with poor learning, behavioral problems, and attention-deficit/hyperactivity disorder. It is interesting to note, that some research studies showed that when the OSA was treated with adenotonsillectomy (surgical removal of the adenoids and tonsils-more on this later), children may have a growth spurt, improved school work, and less behavioral problems.
OSA is unlikely in the absence of almost nightly snoring so the American Academy of Pediatrics recommends that every pediatrician ask about snoring on routine health visits to help screen for the possibility of OSA. If a child has nightly snoring then the doctor might ask more questions about other breathing problems during sleep, such as labored breathing, witnessed apneas (stoppage of breathing), restless sleep, bedwetting, daytime sleepiness, or learning problems. Other signs that a physician (or an observant parent) might note is mouth breathing, stuffy nose, nasal sounding speech, which might all be signs of enlarged adenoids and tonsils. Of course, a doctor would note enlarged tonsils on the physical exam.
Despite all the emphasis that I have been putting on the adenoids and tonsils (AT), it is actually controversial in the medical literature if the size of the AT are actually related to an increased risk of OSA. This is because OSA is probably caused by a combination of AT enlargement and the muscle tone of the back of the nose/throat area (referred to as the naso-, oro-, hypo- pharynx).
Even though the symptoms and physical exam can be helpful to determine if further testing is necessary, the only way to make a firm diagnosis is with polysomnography. However, as pointed it in my last blog, the number of actual respiratory events needed to make a diagnosis in children is less than in the adult (please refer to my last blog).
In my next blog we will review the treatment for sleep apnea in children, as well as cover how the growing obesity problem is altering the approach to treatment in some kids.
Published On: July 30, 2008