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Understanding Sleep Apnea In Children

Child with sleep problemsSleep never seems as interesting as when you are a new parent and your bundle of joy isn't sleeping through the night — but sleep is an important issue throughout childhood. Sleep disturbances have become a focus for national attention due to the high number of children involved and the significant problems associated with sleep issues. The study of sleep has proven the adage attributed to Benjamin Franklin “Early to bed and early to rise, makes a man healthy, wealthy and wise” holds a great deal of scientific truth!

How can you tell if your child has a sleep problem? This isn't as easy as one might suspect. There is a full spectrum of sleep-related problems, and there are medical specialists trained to help families with sleep problems. In general, we divide sleep problems into primary snoring which is just noisy breathing without arousals, sleep-disturbed breathing which is snoring with partial airway obstruction and minor arousals and sleep apnea. Sleep apnea can be central, which means that it is a brain regulation issue, or it can be obstructive, which is snoring in conjunction with decreased oxygen saturation, arousals and disruption of sleep. It can be very difficult to distinguish between routine primary snoring and significant sleep apnea. This spectrum goes from needing no intervention to conditions which can lead to heart enlargement, congestive heart failure and other significant problems if untreated. The precise diagnosis of sleep apnea usually relies on formalized testing. Texas Children's Hospital has outstanding pediatric sleep labs which use state-of-the-art testing to assess a number of parameters during sleep. The computer records the oxygen level and several other important physiologic parameters while the patient is asleep. Then the results are calculated and assessed by a physician with specialized training in sleep medicine to determine if the patient has mild, moderate or severe central or obstructive sleep apnea. I would like to focus on obstructive sleep apnea (OSA) because these patients are often referred to otolaryngologists for care. Obstructive sleep apnea in children is quite different from adults. One of the biggest differences is that in children, boys and girls are equally affected. Certain syndromes increase the likelihood to develop sleep apnea, such as Down syndrome or certain craniofacial conditions. Obesity is becoming another important factor in childhood obstructive sleep apnea. In fact, an excellent but challenging treatment for OSA is weight reduction. Children with OSA have nighttime and daytime symptoms. At night, the children are usually restless with loud snoring, frequent awakening and at times bed wetting. During the daytime, children may be difficult to awaken, likely to take naps and sometimes display hyperactivity or aggressive behavior. More and more studies are indicating that children with poor sleep have learning problems with concentration issues and poor school performance. One study performed here at Texas Children's revealed that obese children with obstructive sleep apnea had problems with memory, learning and vocabulary mastery. The increasing incidence of sleep problems and the deepened understanding of the results of abnormal sleep on behavior and learning and increased physician’s interest in helping these children. There are medical and surgical options that need to be considered. If you feel that your child may have any of the signs or symptoms of obstructive sleep apnea, I suggest you discuss these findings with your primary caregiver. At Texas Children's, we have many ways to help you help your child to be as healthy as possible.
Dr. Ellen Friedman, Chief of Otolaryngology