From the April 2019 issue

Sleep Apnea in Kids is Underdiagnosed, Study Says

The Journal of the American Osteopathic Association notes sleep apnea in kids is often untreated. Why – and what signs should you look for in your child?

A sleeping boy asleep under a bedspread with a sawing logs theme
Illustration by Jay Hollaay

My brother spent most of his life sleeping on the couch. He had the largest bedroom among us siblings, yet he preferred the comfort of the basement couch.

And because he slept on a different level of the house than everyone else, no one realized he was showing signs of sleep apnea.

In fact, it wasn’t until he was married and sharing his sleep space that he was diagnosed with the disorder.

It’s not uncommon for this issue to be missed – primarily sleep apnea in kids. In fact, according to a study published in the Journal of the American Osteopathic Association, 90 percent of kids with sleep apnea go undiagnosed. In these cases, sleep apnea can lead to a variety of problems depending on the severity of this sleep disorder.

“Some evidence shows that significant sleep apnea may interfere with daytime behavior, daytime aggressiveness – and (kids) may have some hyperactivity symptoms,” says Dr. Ibrahim Abdulhamid, the chief of pulmonary medicine and director of the Pediatric Sleep Lab at Children’s Hospital of Michigan in Detroit. “It can affect their cognitive functioning and academic functioning.”

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While snoring is the No. 1 indicator of sleep apnea, there are other signs to look for. Here, Abdulhamid breaks down this sleep issue.

Common causes of sleep apnea in kids

Enlarged tonsils and adenoids are the most common culprits of sleep apnea.

“What happens with sleep apnea is that the airway closes down, so if you have big tonsils and big adenoids, the airway is already compromised when you’re awake,” Abdulhamid says. “When you sleep, the airway closes down even more.”

Obesity, which impacts 1 in 5 school-age children and youth, according to the Centers for Disease Control and Prevention, is the second most common cause of this sleep disorder.

Children born with congenital or genetic diseases, low muscle tone or small jaws, are among those who are more likely to develop sleep apnea.

Signs of sleep apnea in kids

Is your child a restless sleeper? This is something Abdulhamid asks parents, because oftentimes kids with sleep apnea will stop breathing and move around a lot to keep their airways open. They might be sleeping on their back, but they stop breathing so they move to their side, for example.

“They might keep their neck extended to keep the airways open,” he says. “A lot of kids want to sleep elevated to keep the airway open.”

That’s why your child might sleep with two or three pillows under his or her head. Children who sleep with their mouths open or wake up with a dry mouth – a result of sleeping with an open mouth – could also have sleep apnea.

If you’ve noticed any of these signs in your child, Abdulhamid suggests talking to your child’s pediatrician, who can guide you from there.

“The best way to diagnose sleep apnea is to do a sleep study,” he says. “That’s the gold standard.”

This test, which is done in a sleep lab, involves hooking a child up to various sensors on the head, chest and abdomen – along with an oxygen saturation censor around the finger and a censor on the leg to check for kicking. The doctors monitor the child while he or she sleeps to determine whether or not the child has obstructive sleep apnea, which is the most common form of sleep apnea among children.

“If a child stops breathing for more than two breaths, we consider that an obstructive sleep apnea,” he says.

Doctors count the number of times a child stops breathing and divide that number by the number of hours of sleep. This is known as an obstructive hypopnea episode. For example, 30 episodes in six hours of sleep is an index of 5. Any index above 1 is considered abnormal, he adds.

Treating sleep apnea in kids

Intervention is based on the index count, he says. Since the most common cause of obstructive sleep apnea is enlarged tonsils and adenoids, therefore the first line of treatment is adenotonsillectomy, which is the removal of the tonsils and adenoids.

“The most common and the most effective and curable intervention is to take the tonsils and adenoids out,” Abdulhamid explains.

Nasal steroids can be used to treat very mild apnea, he adds, especially when parents refuse surgery or if mild apnea persists after surgery.

For children with more severe cases, or those with underlying disorders such as Down syndrome, another suggested treatment could be the use of a CPAP (continuous positive airway pressure) machine worn at night to deliver steady air pressure.

Keep an eye out for any changes in your child, he suggests. If your child is struggling in school or having issues focusing, you might want to pay attention to him when he’s sleeping.

“It’s important for the most part when you notice the child is snoring, you should bring this up to the pediatrician and mention the symptoms to the pediatrician.”

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