Obstructive sleep apnea in children is a condition in which a child stops breathing during sleep. This usually occurs as a result of an obstruction in the airway. You might be surprised, but this condition is very common in children and can occur at any age.

Obstructive sleep apnea usually occurs as a result of enlarged tonsils and adenoids. When children sleep, the muscle tone decreases which has a huge impact on the airway and breathing. Children who have OSA don’t usually experience difficulty breathing when awake. However, the airway decreases during sleep and the tonsils and adenoids block the airway. Consequently, the breathing process becomes deteriorated. The breathing pauses usually last only a few seconds. They trigger brief arousal that increases muscle tone, opens the airway, and allows the child to resume breathing. Hence, children can deal with a poor night’s sleep, which might have a negative impact on everyday life. The child is usually unaware of these instances and they might also face a very restless sleep.

Children who are overweight and who have enlarged tonsils and/or adenoids are prone to developing obstructive sleep apnea. Additionally, other risk factors for OSA in children include muscle weakness, craniofacial syndrome, a small jaw, or Down syndrome.

The symptoms of this sleep disorder in children may vary. Nevertheless, some of the most common symptoms might include:

• Loud snoring and noisy breathing;
• Mouth breathing or periods of not breathing;
• Restlessness during sleep;
• Sleeping in odd positions;
• Bed wetting;
• Frequent infections;
• Sleepiness, school and behavior problems;

Diagnosing Obstructive Sleep Apnea in Children 

If you notice some breathing difficulties during your child’s sleep or you recognized some of the symptoms of OSA we mentioned, you should talk to a physician. Your child’s physician will probably refer you to a sleep specialist, a pulmonary doctor, or an otolaryngology physician for additional tests. Likewise, you might be even suggested an overnight sleep study or an evaluation of the upper airway by visualization and/or X-rays. One of the most common and most effective ways of diagnosing OSA is home sleep testing. Home sleep testing is an affordable and convenient way which will determine whether your child has OSA.

Additionally, your child might need to undergo a thorough physical examination, such as evaluation of the child's general appearance. So, your child will be examined for signs of nasal obstruction, choanal atresia, septal deviation, nasolacrimal cysts, nasal aperture stenosis, oral cavity, and tonsillar hypertrophy. Likewise, the physical examination will include a neurologic survey for hypotonia and an assessment for obesity.

When it comes for polysomnography as a way of diagnosing OSA in children, we must point out that it’s a bit of a controversial topic. There is a lack of reliable sleep laboratories for children and the parameters are based on adult values.

Other examination methods for children include video photography, lateral neck radiography, and pulse oximetry. Video photography is used to record apneic events and night time arousals in children and it provides information on the degree of obstruction and the dynamics of the child's airway. On the other hand, lateral neck radiography provides useful information about the size of the adenoids and their relationship to the upper airway and it’s a great alternative to nasopharyngoscopy. Last but not least, pulse oximetry is often recommended for children, but it isn’t an accurate predictor of OSA because large numbers of children have sleep disturbance without desaturations.

The treatment of obstructive sleep apnea in children depends on the cause. So, if the cause for this sleep disorder are enlarged tonsils and adenoids, surgical removal of the tonsils (tonsillectomy) and adenoids (adenoidectomy) is usually recommended. Likewise, your child might be required to lose some weight as a possible way to manage obstructive sleep apnea.

Nevertheless, if a surgery doesn’t help, your child might need to start using continuous positive airway pressure therapy. CPAP therapy usually involves wearing a mask during sleep which will keep the airway open and allow the child to breathe normally.

Diagnosing obstructive sleep apnea in children is crucial as if the condition occurs and it’s left untreated, it can cause high blood pressure, poor growth, heart issues, and can have a negative impact on cognition and behavior.