Obstructive Sleep Apnea

WHAT IS OBSTRUCTIVE SLEEP APNEA?

Obstructive sleep apnea occurs when a child stops breathing during periods of sleep. The cessation of breathing usually occurs because of a blockage (obstruction) in the airway. Tonsils and adenoids may grow to be large relative to the size of a child’s airway (passages through the nose and mouth to the windpipe and lungs). Inflamed and infected glands may grow to be larger than normal, thus, causing more blockage. The enlarged tonsils and adenoids block the airway during sleep. The tonsils and adenoids are made of lymph tissue and are located at the back of the nose and to the sides of the throat. During episodes of blockage, the child may look as if he/she is trying to breath (the chest is moving up and down), but no air is being exchanged within the lungs. Often these episodes conclude with a period of awakening and compensation for lack of breathing. Periods of blockage occur regularly throughout the night and result in a poor, interrupted sleep pattern. Sometimes, the inability to circulate air and oxygen in and out of the lungs results in lowered blood oxygen levels. If this pattern continues, the lungs and heart may suffer permanent damage. Obstructive sleep apnea is most commonly found in children between 3 to 6 years of age. It occurs more commonly in children with Down syndrome and obesity.

 

WHAT CAUSES OBSTRUCTIVE SLEEP APNEA?

In children, the most common cause of obstructive sleep apnea is enlarged tonsils and adenoids in the upper airway. Infections may cause these glands to enlarge. Large adenoids may completely block the nasal passages and make breathing through the nose difficult or impossible. 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 glands) while awake, falling asleep may result in a completely closed passage. 

 

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:

• Loud snoring or noisy breathing during sleep
• Periods of not breathing (apnea) - although the chest wall is moving, no air or oxygen 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)
• Hyperactivity during the day

The symptoms of obstructive sleep apnea may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

 

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

 

The sleep study (also called polysomnography) - is the best test available for diagnosing obstructive sleep apnea. The child will sleep in a specialized sleep laboratory, multiple leads will be attached to the child while he/she is sleeping 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, respiratory events, or episodes of obstruction are recorded:

• Apnea - complete airway obstruction
• Hypopnea - the partial airway obstruction combined with a significant decrease in the oxygen content of the blood. The number of apneas and hyppheas per hour will help to determine if your child has sleep apnea. An apnea hyponea index of greater than 5 indicates sleep apnea and typically requires treatment.
• 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:

• Our 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 typically surgery to remove 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. Other treatments include wearing a special mask while sleeping to keep the airway open, (continuous positive airway pressure CPAP). Medications may also be used to treat sleep apnea especially if the disease is mild. 

 

WHAT HAPPENS DURING TONSILLECTOMY AND ADENOIDECTOMY?

Tonsillectomy and adenoidectomy (T&A) surgery is the most common major surgery performed on children in the US. About 400,000 surgeries are performed each year. The need for a T&A will be determined by your child's ear, nose, and throat surgeon and discussed with you. Most T & A surgeries are done on an outpatient basis. This means that your child will have surgery and then go home the same day.