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, for a period of time. (The tonsils and adenoids are made of lymph tissue and are located at the back 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 three–six years of age. It occurs more commonly in children with Down syndrome.

What causes it?

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.

Obesity may cause obstructive sleep apnea. While a common cause in adults, obesity is a far less common reason for obstructive sleep apnea in children. A rare cause of obstructive sleep apnea in children is a tumor or growth in the airway.

Symptoms

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 - 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)

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