Childhood obstructive sleep apnoea
Significance of quality sleep in children
Quality sleep is fundamental for children as it contributes to their physical growth, cognitive development and overall health. A restful night’s sleep allows them to wake up feeling refreshed, alert and ready to embrace the challenges of a new day. However, when the quality of sleep is compromised, it can lead to a range of short-term and long-term issues.
Children who don’t get adequate sleep may experience difficulties concentrating, learning and maintaining a healthy emotional balance. Poor sleep can significantly affect your child’s performance in school or daily activities. As parents, it is essential to recognise the signs of sleep disorders and take action to address them.
What is childhood obstructive sleep apnoea?
Obstructive sleep apnoea, commonly known as OSA, is a sleep disorder that disrupts a child’s breathing during the night. It occurs when the muscles around the upper airway relax, causing the throat and airway to narrow. This narrowing leads to a range of nighttime symptoms, including snoring and, more alarmingly, partial or complete blockage of the airway.
Consequently, oxygen levels drop while carbon dioxide levels rise. These blockages are intermittent, as the brain responds with brief awakenings or movements to reopen the airway. These frequent disruptions significantly disturb a child’s sleep.
Causes of childhood obstructive sleep apnoea
The most common cause of OSA in children is the enlargement of the tonsils and adenoids. These tissues grow most rapidly during the preschool years, occasionally outpacing the growth of the bony pharynx, leading to airway obstruction. Additionally, other risk factors for childhood OSA include obesity, allergies, medical conditions that result in low muscle tone and structural abnormalities of the airway or face, such as Down Syndrome or achondroplasia.
Symptoms of childhood obstructive sleep apnoea
Children with OSA may exhibit the following indicators:
Nighttime symptoms:
- Loud snoring: This is a common symptom, but it should not be dismissed as normal.
- Breathing pauses: Children may have trouble breathing while they sleep.
- Choking, gasping and snorting: These sounds during sleep are alarming.
- Restlessness: Children may appear agitated and sweat during sleep
- Mouth breathing: Breathing through the mouth instead of the nose at night.
- Morning headaches: Headaches upon waking.
- Poor appetite: Children might have a reduced appetite.
- Swallowing difficulties: Particularly related to enlarged tonsils.
Daytime symptoms:
- Excessive daytime sleepiness: Children may appear tired during the day.
- Behavioural issues: Difficulty in paying attention, mood changes and behaviour problems.
- Learning difficulties: OSA can affect cognitive functioning, potentially leading to learning difficulties and concentration issues.
Recognising these signs early and seeking medical attention is critical for addressing OSA effectively.
How is childhood obstructive sleep apnoea diagnosed?
The gold standard for diagnosing childhood OSA is through an overnight sleep study known as polysomnography. During this non-invasive test, various physiological parameters are measured, including breathing, oxygen levels, heart rate, brain activity, eye movement and muscle activity. This study is typically conducted in a sleep unit, and both the child and a parent spend the night there. However, not all children with symptoms require a sleep study. Your doctor will determine the need for one based on the child’s specific situation.
Treating childhood obstructive sleep apnoea
The treatment approach for childhood OSA depends on the cause and severity of the condition:
Tonsillectomy and adenoidectomy: In children with enlarged adenoids and tonsils, this surgical procedure is the primary treatment and successfully treats OSA in nearly 83% of cases. It is essential to have the surgery in centres with expertise in paediatric anaesthesia and paediatric intensive care facilities for children at high risk of postoperative respiratory complications.
Weight management: Children who are very overweight (obese) may benefit from an exercise and weight management program.
Anti-inflammatory medications: Children with chronic nasal allergies may try a combination of medical treatments, including topical steroid sprays. This can be particularly helpful in controlling allergic rhinitis and potentially reducing adenoid size.
Continuous positive airway pressure (CPAP): A small number of children with severe sleep apnoea or specific conditions may require a CPAP machine to help them breathe while sleeping.
Reevaluation: Some children may need to return to the sleep clinic if they have severe sleep apnoea or if their condition does not improve 6–8 weeks after surgery. Parents should also inform the doctor if their child continues to snore or experiences difficulty breathing after surgery.
How dentists can help manage childhood obstructive sleep apnoea
Dentists play a significant role in the holistic care of children with obstructive sleep apnoea (OSA) by addressing potential oral factors contributing to the condition. In addition to examining the effects of mouth breathing, dentists can identify dental problems like malocclusion and abnormalities in jaw structure that could block the airway.
They are often part of a multidisciplinary team that collaborates with otolaryngologists and sleep specialists to provide comprehensive care for children with OSA. Additionally, dentists can create customised orthodontic treatments and oral appliances to improve the alignment of teeth and jaws. This can potentially expand the airway space and subsequently alleviate the symptoms of OSA in some cases.
Ensure healthy sleep for your child
Childhood obstructive sleep apnoea is a condition that demands attention. Be vigilant for signs like snoring or daytime sleepiness. Recognise the signs early, seek prompt medical advice and follow the recommended treatments to ensure your child gets the good sleep they need for a healthy future.