Snoring occurs during sleep when the child is breathing in and there is some blockage of air passing through the back of the mouth. Snoring in children can result from three causes:
-First, there is an anatomical component, such as a small jaw or a small airway that the child was born with.
-Secondly, there’s the possibility that the muscles and the nerves controlling those muscles are not well integrated during sleep and therefore do not open the airway enough.
-But the most common reason children snore is enlarged tonsils and adenoids.
Obstructive Sleep apnea in Children
In sleep apnea, the airway sometimes collapses and doesn’t open, and the child struggles to breathe and can’t get any air in. Children with upper airway resistance syndrome sometimes wake up because of the resistance in the airway, or because their snoring is loud, or because the snoring requires so much effort. But there are no changes in the oxygen levels or the carbon dioxide levels within the blood or in the tissues in the child.
As a result, the carbon dioxide goes up, the oxygen goes down, and then finally the child has to wake himself or herself up in order to catch his or her breath. We’ve seen children with 500 and 600 awakenings in the night just to be able to catch their breath and go back to sleep.
Approximately 20-40% of obese children suffer from OSA so it is important for children to maintain an appropriate weight.
• Snore loudly and on a regular basis.
• Have pauses, gasps, and snorts and actually stop breathing. The snorts or gasps may waken them and disrupt their sleep.
• Be restless or sleep in abnormal positions.
• Sleep in an elevated position or with their neck extended.
• Sweat heavily during sleep.
• Bed wetting
During the day, children with OSA may:
• Have behavioral problems such as hyperactivity.
• Have schooling difficulties.
• Be difficult to wake up.
• Have headaches during the day, especially in the morning.
• Be irritable, agitated, aggressive, and cranky.
• Be so sleepy during the day that they actually fall asleep.
• Speak with a nasal voice and breathe regularly through the mouth.
By Full History, ENT Examination, Lateral Skull X-Ray and CT Imaging of Nose and Naso pharynx.
Sleep study will record the child’s sleep, brain waves, body movements, heartbeat, breathing, oxygen levels, and snoring to determine a diagnosis. Sleep specialists have special training in sleep medicine and can offer you the most appropriate treatment.
What are treatments for sleep apnea?
Tonsillectomy and Adenoidectomy
Enlarged tonsils and adenoids are usually the cause of snoring in children since tonsils are quite large in comparison to the size of the throat especially between the ages of about five and seven years. Removing the tonsils and adenoids often stops the snoring. In fact taking out the tonsils and adenoids also improves academic performance as well as behavior. There are some groups of children, including the very young, children with severe apnea, or those with other disorders that may be contributing to the sleep apnea, who we usually retain for at least 24 hours’ monitoring in the hospital after surgery, instead of doing the procedure as an outpatient procedure. In about 85 percent to 90 percent of the cases, we’ll see complete resolution, at least for a few years, of that problem.
CPAP in Children?
In children, it’s a little bit different than it is for adults. In general, adults, because the major cause is obesity, will require a machine that is called CPAP (continuous positive airway pressure). Obesity increases the risk of OSA. Fat deposits around the throat can cause it to constrict, and fat in the stomach can prevent the diaphragm from functioning properly.
If surgery is not effective, which is true in about 5-10 percent of the cases, such as in the more obese children or in those with more severe or complicated conditions, then CPAP and/or BIPAP (bi-level positive airway pressure) are the techniques that we use.
Advice to Parents
First of all, they should recognize that snoring is not something that we would call a benign condition. They should be concerned if their child is tired in the morning, has very restless sleep, has difficulty performing at school or has behavioral issues. Other issues are having a lot of nightmares, morning headaches, or, in older children, having a lot of bedwetting that is unexplained.
Following a night of poor sleep, children are more likely to be hyperactive and have difficulty paying attention. These are also signs of attention-deficit hyperactivity disorder (ADHD).
All of these characteristics, in addition to snoring, should raise the suspicion in the parents that they should pay more attention and have their child seen by a specialist and evaluated for potential sleep disorder breathing.