Sleep Apnea
What is Sleep Apnea?
Sleep apnea is a sleep disorder characterized by pauses in breathing during sleep. These episodes (literally) “without breathing”, each last long enough to be one or more breaths missed, and occur repeatedly throughout sleep.
Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram. Regardless of the type of sleep apnea, the child with this disorder is rarely aware of having difficulty breathing, even upon wakening. It is recognized as a problem by others witnessing the individual during the episodes, or it is suspected because of its effects on the body.
Obstructive sleep apnea (OSA) is not only much more frequent than the other type of sleep apnea called central sleep apnea, it is a common condition in many parts of the world.
What population of patients are at risk?
Individuals with decreased muscle tone, increased soft tissue around their airway and those with structural abnormalities that give rise to a narrowed airway are at risk.
How is sleep apnea different in children compared to adults?
In children, sleep apnea does not usually present with excessive sleepiness. Children with obstructive sleep apnea instead behave as if they are “over-tired” or “hyper.” Children with severe obstructive sleep apnea also differ in their body habiturs compared to adults. Adults are generally heavy with short and heavy necks, while children on the other hand are generally thin and may have “failure to thrive.”
Poor growth associated with obstructive sleep apnea in children is usually due to their poor appetite due to the nose and throat obstruction. Obstructive sleep apnea in children, unlike adults, is almost always caused by obstructive tonsils and adenoids and is usually cured with tonsillectomy and adenoidectomy (T&A).
Never forget that this problem may also be caused by excessive weight. The symptoms are more like adult symptoms, such as restlessness and exhaustion.
What are the common symptoms and signs of sleep apnea?
The signs and symptoms that follow apply to both adults and children and include:
• Restless sleep
• Loud snoring
• Morning headaches
• Trouble concentrating
• Irritability
• Mood and behavior changes
• Increased heartrate
• Anxiety
• Depression
• Bedwetting
• Esophageal reflux
• Heavy sweating at night
The most serious consequences of obstructive sleep apnea is the effect on the heart.
What cranio facial abnormalities are associated with sleep apnea?
There are several patterns of unusual facial features that occur in recognizable syndromes. Some of the cranio facial syndromes are genetic, others are from unknown causes. Down Syndrome (“Trisomy 21”) is one of such syndromes. In this abnormality of the chromosome, several features of the syndrome combine to create obstructive apnea.
How is the diagnosis made?
The diagnosis is made through the history and physical, as well as various lab testings. These tests include EKG, arterial blood gas and polysomnogram.
What are the treatments for sleep apnea?
There are a variety of treatments for obstructive sleep apnea. Treatment is usually individualized based on a specific course or etiology. Treatments include the use of respiratory stimulants such as caffeine in newborn infants. Surgical treatment is also a common option. Tonsillectomy and adenoidectomy is offered to children with enlarged tonsils or adenoids. Nasal C-PAP (NCPAP) is another modality that is used to provide therapeutic relief for patients with sleep apnea.