Sleep Apnea in Children

by Dr. Raymond Tan Suan-Kuo

Sleep apnea, generally considered a problem among middle-aged men, can be a problem for youngsters, too. The third Malaysian National Health and Morbidity Survey 2006 tells us that 20% of Malaysian children are obese. With the increasing rates of obesity in children, it is likely there will also be an increase in sleep apnea. It is estimated that 5 to 10% of Malaysian children suffer from sleep apnea.

Sleep apnea is characterised by brief but numerous involuntary breathing pauses during sleep. These breathing pauses cause awakenings throughout the night, making it impossible for sleep apnea sufferers to enjoy a night of deep, restorative sleep.


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Sleepy Day

People with sleep apnea often feel sleepy during the day and their concentration and daytime performance suffer. While being overweight or obese are risk factors for sleep apnea, being thin does not preclude a diagnosis.

The repercussions of sleep apnea and poor sleep for children are vast. When children do not get the sleep they need, they are at risk for health, performance, and safety problems; difficulties in school are often the result. However, sleep deprivation in children is often overlooked or attributed to attention-deficit or behaviour disorders.


Aware of Symptoms

Parents should be aware of night time and daytime symptoms of sleep apnea.

Night time symptoms include snoring, breathing pauses during sleep, restless sleep, mouth breathing, difficulty getting up in the morning, even after getting the proper amount of sleep.

Daytime symptoms include hyperactivity, inattention, behaviour problems, e.g. aggressive behaviour, problems at school, sleepiness and headaches.


Good Night Tips

To help your child get a good night's sleep, follow these tips :

*Establish a regular bedtime and wake up time. Parents and children should plan a daily schedule that includes the basic daily sleep requirements for particular age groups. This schedule should be maintained on the weekends, though students can be permitted to sleep in one or 2 hours on weekend mornings if necessary.


While individual sleep needs can vary, the amount of sleep suggested by sleep experts for particular age groups is:

18 months to 3 years : 12-14 hours
3 to 5 years : 11-13 hours
5 to 12 years : 10-11 hours
Teens : 9.25 hours

* Create a bedtime routine. Bedtime routines are important, regardless of a child's age. It should include at least 15 to 30 minutes of calm, soothing activities. Discourage television, exercise, computer and telephone use, and avoid caffeine (found in beverages, chocolate and other products).

* Achieve a balanced schedule. Identify and prioritise activities that allow for downtime and sufficient sleep time. Help students avoid an overloaded schedule that can lead to stress and difficulty coping, which contribute to poor health and sleep problems.


Healthy Body Weight Tips

To help children maintain a healthy body weight, follow these tips :

* Be supportive. Children know if they are overweight and don't need to be reminded or singled out.

* Plan family activities that involve exercise. Instead of watching TV, go hiking or biking, wash the car, or walk around the mall. Offer choices and let your children decide.

* Eat meals together as a family and eat at the table, not in front of the television. Eat slowly and enjoy the food.

* Don't use food as a reward or punishment. Children should not be placed on restrictive diets unless done so by a doctor (for medical reasons). Children need food for growth, development and energy.


Diagnose

# Seek treatment from an ENT specialist

# Look for large tonsils and adenoids

# Child may have an 'adenoids face' – a long face with flat cheeks, open-mouthed look with thick lower-lips, caused by years of mouthy breathing and little air entering the maxillary (cheeks) sinuses.

# Look for high blood pressure

# Look for poor growth (failure to thrive) and also, paradoxically, obesity

# Look for heart problems, e.g. heart failure and lung problems

# May need a sleep study

Treatment

1. Main treatment in children is surgery - remove the enlarged tonsils and adenoids

2. Lose weight – help children maintain a healthy body weight

3. Nasal steroid sprays for nasal allergies


4. CPAP (Continuous Positive Airway Pressure) mask at night for children who still have OSA and are very symptomatic after surgery.

Other High Risk Children

* Down’s Syndrome

* Children with craniofacial abnormalities e.g. Pierre Robin sequence, Treacher Collins Syndrome, Crouzon Syndrome.


More info on SLEEP APNEA here.

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