Obstructive Sleep Apnea in Children

According to studies conducted by SingHealth, 3-12% of children in Singapore snore habitually, and 1-3% of children with obstructive sleep apnea (OSA). Untreated obstructive sleep apnea among children may include attention deficit disorder, behavioral problems, and poor academic performance. Therefore, parents should pay more care to these children with proper awareness by providing treatment.

Symptoms

While OSA is a common condition, it is often overlooked. It causes the airways to be partially blocked resulting in brief periods of time where your child stops breathing. This is coupled by oxygen desaturation where your child may not get enough oxygen to the brain and other vital organs at night. This sleep disorder can result in daytime sleepiness and behavior problems.
Your child may also sleep in unusual positions, such as on their side, or even sitting up. Symptoms may include behavioral and learning problems. A sleep study is recommended if your child shows any of the abovementioned symptoms so that a primary care giver can guide you towards an appropriate treatment plan.

Diagnosis

The diagnosis of pediatric obstructive sleep apnea may begin with a physical examination. This will be followed by a polysomnogram, a type of overnight sleep study, in which the child wears sensors to monitor brain wave activity, breathing patterns, and oxygen levels. During this procedure, the child's heart rate will also be monitored. In some cases, an electrocardiogram is also necessary, to monitor the heart rhythm.

Surgical Treatment


Treatment for OSA in children may include surgical removal of large tonsils or adenoids. These surgeries can alleviate the symptoms of obstructive sleep apnea in children. This surgery is relatively successful in some cases, but the success rate depends on several factors. Healthy children under seven are more likely to experience a cure with surgery than those who are obese. An alternative to surgery would be CPAP therapy where children can use a nocturnal medical device that will help them sleep better.



Adenotonsillectomy Treatment


Adenotonsillectomy is an effective treatment for most patients with severe OSA. If the tonsils are enlarged and do not occupy 50% of the pharyngeal diameter, adenotonsillectomy is a possible treatment option. Although the procedure has limitations, it improves daytime behavior, sleepiness, and quality of life. Children who underwent this procedure should be closely monitored especially if their symptoms worsen or found to have other anatomic abnormalities.

CPAP Treatment

CPAP, also known as continuous positive airway pressure, is an alternative to invasive surgical approaches to alleviate OSA in both adults and children. It helps keep the upper airways open by applying extra pressure through a mask that covers the nose and/or mouth. Oral appliances can also help correct certain anatomical abnormalities that causes OSA by bringing the tongue and jaw forward. Children with obstructive sleep apnea often tolerate oral appliances better than CPAP.
CPAP is considered a gold standard treatment for patients with OSA. Positive airway pressure therapy can help to eliminate snoring in children. The CPAP machine can be worn at night to prevent your child from abnormal breathing patters during their sleep.

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