Understanding treatment options for sleep-disordered breathing

Children with sleep-disordered breathing will commonly snore and have repeated episodes of under-breathing (hypopnea) and not breathing at all (apnea) during sleep. Parents might notice gasping or snorting, restless sleep, frequent nighttime awakenings, teeth grinding, bedwetting and abnormal sleep positions. These disturbances can lead to hyperactivity or increased feeling of being tired during the day (hypersomnolence). Untreated sleep-disordered breathing can have long term consequences including poor academic performance, behavioral issues, growth retardation and high blood pressure.

If you’re not sure your child is obstructing during sleep, a sleep study is recommended. This can help determine the degree of obstruction. Removing enlarged tonsils and adenoids (adenotonsillectomy) is a frequently suggested surgical procedure known to improve obstruction.

Following this procedure, up to 40 percent of children may continue to exhibit sleep obstruction. Obesity is the most common reason for this, and other children at risk include those with genetic disorders like Down syndrome, neuromuscular disorders, small/recessed jaw bones, asthma and also those with severe sleep obstruction observed on their sleep study.

If a child continues to have difficulty with sleep, both nonsurgical and surgical options are available to help treat the obstruction. Weight loss and evaluation by a dietitian is recommended for overweight and obese children. A nonsurgical option is continuous positive airway pressure (CPAP) where the sleeping child is connected to a pump through a face mask, forcing air into the nasal passages at pressures high enough to overcome the obstruction. Certain medications, including intranasal corticosteroid sprays and leukotriene inhibitors, have been shown to improve mild sleep obstruction in select cases.

A sleep endoscopy can be performed by an otolaryngologist (ENT) to evaluate where the obstruction is. The procedure involves passing a small flexible telescope into the nose and down through the throat to the airway while the child is sleeping. Photos are taken to look for anatomical obstruction sites. Depending on where the obstruction is found, the child might benefit from other surgical procedures including nasal septoplasty, nasal turbinate reduction, revision adenoidectomy, palatoplasty, lingual tonsillectomy and supraglottoplasty. For cases involving severe sleep obstruction, patients usually need both nonsurgical and surgical treatment options.

Children typically do not outgrow sleep obstruction and it may worsen with age. If you’re concerned your child is not sleeping well, you should consult with your pediatrician to determine if a sleep study or evaluation from an otolaryngologist is recommended.