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Monday, January 30, 2023

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Sleep Apnea in Kids

When the kids have issues sleeping, it can affect other parts of their lives in a big way. Dr. John Prpich, a pediatric pulmonologist at St. Joseph’s Children’s Hospital took the time to answer one of our biggest questions about kids and sleep: could it be sleep apnea?

What exactly is sleep apnea and why is it dangerous?

Sleep apnea is a broad term, but the word apnea means a pause in breathing. So it means that while sleeping, the child is not able or is having a hard time breathing like they’re supposed to.

The two big types of sleep apnea that children can have are either obstructive sleep apnea, or what we call central sleep apnea. That is important because obstructive means that their airway is actually closing or being obstructed, whereas central type of apnea is because the brain is just not telling the body to breathe like it is supposed to. So there is no obstruction but the breathing just pauses and picks back up. Those are two pretty big distinctions in terms of apnea, but when we talk about sleep apnea we are talking about a pause in breathing.

By far and away, especially in children, most people mean obstructive sleep apnea. The reason that this is so important is because often the symptoms may be very subtle. You might not even know that your child is doing it very often or at all, and when it is happening it can do several things. The important thing is that it is going to hinder the quality of sleep, so the child will not sleep nearly as well or go through the different stages of sleep. During the day the following day they will be sleepy or they will be hyperactive. So sometimes the symptoms can be hard to determine because you may be expecting a sleepy child when often they are actually a hyperactive child or a child who is having a hard time focusing because they’re overtired.

From a medical standpoint, when there is repetitive obstruction of the airway and when oxygen level are dropping and the job of the lungs is not occurring, it is a big strain on the body. So this can be a reason for there to be cardiac issues, you can develop high blood pressure in the lungs which we call pulmonary hypertension, so it really can trigger a multitude of medical issues as well as impacting their ability to learn and their neurocognitive development. It will impact their day to day lives and their ability to perform in school in the short term.

Is sleep apnea very common in kids?

Sleep apnea is common and the obstructive sleep apnea tends to be quite common in younger kids between 4-6. In younger children it is most common due to enlarged tonsils or adenoids so it is more common to be caused by soft tissue.

Unfortunately as we get older, we begin to see more of the obstructive sleep apnea that we see in adults which is due to obesity. Childhood obesity is a growing problem in adolescents and younger kids but it is fairly common of a problem. A lot of people will minimize those symptoms because they will think: “Timmy snores because his dad snores and his uncle snores so snoring must just run in the family” so they think this is normal, when in reality, snoring in children is a problem and should be a red flag.

They may not be snoring right when you put them to bed, though. A lot of times children’s symptoms will come during what we call REM sleep which happens much later in the night. So they are having all of their problems at 3 or 4 in the morning when everyone else is asleep as well. So really they may only present with symptoms of ADHD, focus issues, or problems in school and may not even be aware that it is related to a breathing problem at night.

Do kids grow out of sleep apnea?

Some children will have snoring and breathing problems that are very mild and as they get older, especially in younger kids where it is related to tonsils and adenoidal tissue, their skull and the back of their throat will grow and they grow out of it. So if the obstruction is very mild then yes, it will get better over time. You can observe and watch and may not need intervention.

If it is more moderate or severe than those children may not grow out of it and the impact that it has on their body may be too dangerous that you wouldn’t want to wait. There have been some reason studies, one very important one called the CHAT study particularly, which did look at mild forms and showed that under the supervision of a physician and with close follow up, that some kids did grow out of their obstructive sleep apnea in mild cases.

It is going to take sleep studies to determine if it is sleep apnea. Really the best way that we have to determine the severity is with a sleep study. That is why we do sleep studies in children at St. Joseph’s, so that we can really understand what is going on. Because unfortunately from other studies we have learned that it is very difficult to determine the severity of sleep apnea from the symptoms reported. I have had many cases where the families don’t report very significant snoring or symptoms but when you actually put them in a sleep lab it is very severe and needs to be addressed very quickly. And other times they may talk about or report very severe symptoms and when you measure them in the sleep lab they’re not as bad as you thought which means that you can watch them and allow them to outgrow it or attend medical management and avoid surgery.

The help of a sleep physician is important and helpful to make the right decisions. You can suspect that your child has sleep apnea, but really you can’t make a diagnosis without a sleep study.

Is there anything else you’d like to add?

The symptoms tend to be underappreciate and I see it so often because families lump in their experience with the adult population. But people will extrapolate their feelings about snoring or breathing problems from the family and it can be important– especially when they are young like 3, 4, or 5 year-olds– that they have success in school. Their ability to learn and focus and their self-confidence at school is so important. So if they are able to be successful at school it will follow them for the rest of their lives. If they feel like school is just something they can’t do, through no fault of their own, and because of the quality of sleep that they are getting, it can hurt their confidence. Sleep is a huge part of the day for children and it impacts so much of how they function, so we really need to be on the lookout for our kids. Pediatricians may not have the training that they need to notice a sleep issue so as the parent you really need to notice the symptoms and be aware that sleep is important make sure the child is getting enough sleep. If the child is sleepy during the day, taking naps when they shouldn’t be, they need to talk to the pediatrician about it.


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