Pediatric sleep-disordered breathing (SDB) is a general term for breathing difficulties occurring during sleep. Sleep disordered breathing can range from frequent loud snoring to obstructive sleep apnea (OSA), a condition where part, or all, of the airway is blocked repeatedly during sleep. When a child’s breathing is disrupted during sleep, the body thinks the child is choking. The heart rate increases, blood pressure rises, the brain is aroused, and sleep is disrupted. Oxygen levels in the blood can also drop.
Approximately 10 percent of children snore regularly, and about two to four percent of children experience OSA. Recent studies indicate that mild sleep disordered breathing or snoring may cause many of the same problems as OSA in children.
Potential symptoms and consequences of untreated pediatric sleep disordered breathing may include:
A common physical cause of airway narrowing contributing to sleep disordered breathing is enlarged tonsils and adenoids. Overweight children are at increased risk for sleep disordered breathing because fat deposits around the neck and throat can also narrow the airway. Children with abnormalities involving the lower jaw or tongue, or neuromuscular deficits such as cerebral palsy, have a higher risk of developing sleep disordered breathing.
If you notice any of the symptoms described in this article, have your child checked by an ENT (ear, nose, and throat) specialist, or otolaryngologist. Sometimes physicians will make a diagnosis of pediatric sleep disordered breathing based on history and physical examination. In other cases, like children suspected of having severe OSA due to craniofacial syndromes, morbid obesity, neuromuscular disorders, or for children less than three-years-old, additional testing such as a sleep test may be recommended.
The sleep study, or polysomnography (PSG), is an objective test for sleep disordered breathing. Wires are attached to the head and body to monitor brain waves, muscle tension, eye movement, breathing, and the level of oxygen in the blood. The test is not painful and is generally performed in a sleep laboratory or hospital. Sleep tests occasionally produce inaccurate results, especially in children. Borderline or normal sleep test results may still result in a diagnosis of sleep disordered breathing based on parental observations and clinical evaluation.
Enlarged tonsils and adenoids are a common cause for sleep disordered breathing. Surgical removal of the tonsils and adenoids, called tonsillectomy and adenoidectomy (T&A), is generally considered the first line treatment for pediatric sleep disordered breathing if the symptoms are significant, and the tonsils and adenoids are enlarged. Of the more than 500,000 pediatric T&A procedures performed in the United States each year, the majority treat sleep disordered breathing. Many children with OSA show both short- and long-term improvement in their sleep and behavior after T&A.
Not every child with snoring needs to undergo T&A. If the sleep disordered breathing symptoms are mild or intermittent, academic performance and behavior is not an issue, the tonsils are small, or the child is near puberty (because tonsils and adenoids often shrink at puberty), it may be recommended that a child with sleep disordered breathing be watched conservatively and treated surgically only if symptoms worsen.
Recent studies have shown that some children have persistent sleep disordered breathing after T&A. A post-operative sleep study may be necessary, especially in children with persistent symptoms or increased risk factors for persistent apnea after T&A such as obesity, craniofacial anomalies or neuromuscular problems. Additional pediatric sleep disordered breathing treatments such as weight loss, the use of continuous positive airway pressure (CPAP), or additional surgical procedures may sometimes be required.
Copyright 2021. American Academy of Otolaryngology–Head and Neck Surgery Foundation. Last reviewed April 2020.
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