Sleep apnea in children
Nate Tritle, MD, specializes in Ear, Nose, & Throat and provides care in Page through the Page Hospital Visiting Specialist Program.
Question: I've heard of sleep apnea in adults but do children also have sleep apnea?
Answer: One of the most common reasons for a child to be referred to an otolaryngologist (Ear, Nose, and Throat specialist) is to evaluate the child’s enlarged tonsils.
About five percent of children under the age of twelve have obstructive sleep apnea and the vast majority of these children are found to have enlarged tonsils as the leading cause.
Obstructive sleep apnea is defined as intermittent complete airway obstruction leading to decreased oxygen saturation in the blood while sleeping. It has been found that pauses in breathing, apneas, of five to six seconds in children are enough to cause decreased oxygen levels leading to increased strain on the heart and lungs. When oxygen levels decrease, heart rate and blood pressure increase in order to deliver enough oxygen to the brain and other organs. In other words, having sleep apnea is like taking your heart on brisk jog when it should be resting. This can lead to significant problems with blood pressure and breathing if left untreated. Sleep apnea also leads to poor quality sleep resulting in problems when awake such as inattention, poor performance in school, and hyperactivity.
Children with obstructive sleep apnea who are found to have enlarged tonsils will usually be cured by tonsillectomy and adenoidectomy. This is a thirty minute outpatient procedure with reasonably low risk in most children. It, however, has a notably difficult, albeit brief, period of healing afterwards requiring seven to ten days of care at home (out of school).
Tonsils and adenoids are lymph nodes which begin enlarging in children’s throats at around eighteen months of age. They usually peak in size around five years of age and then often begin to shrink. Enlarged tonsils are hereditary and children in families with a tendency toward large tonsils often do not see them decrease in size after five years of age.
Obstructive sleep apnea can be definitively diagnosed in a sleep laboratory; however, it is challenging to get children to cooperate with sleeping in a laboratory setting. Labs specializing in pediatric sleep disorders are frequently unavailable in local communities.
Otolaryngologists believe that parents can adequately evaluate their child’s sleep and reliably identify obstructive sleep apnea if they know what to look for. Children with obstructive sleep apnea will snore loudly and pauses in breathing, lasting five to six seconds, will be followed by a gasp for breath. It is often quite alarming to parents when they witness such breathing disorders and concerns should be raised with the child’s doctor if apnea is noted. If the doctor finds enlarged tonsils in the child, referral should be made to an otolaryngologist to consider tonsillectomy and adenoidectomy.
Reviewed December 2010