Respiratory disorders and apneas in children

It’s very common for children with respiratory disorders to suffer from snoring and apneas (pauses in breathing) during sleep, some studies reveal that between a 4% and 10% of the population suffer from sleep apnea.

Symptoms

Nocturnal

Snoring is the most common symptom. Parents are not always aware that their child snores and sometimes the snoring is interrupted by apneas. Usually these alterations happen during the REM phase of sleep and can go unnoticed. Some other symptoms are difficulty breathing, intercostal retraction and profuse sweating during sleep.

Diurnal

Some diurnal symptoms are excessive daytime sleepiness, alterations in behavior like extreme shyness, social isolation, hyperactivity, aggression, difficulty in staying focused, etc. In more severe cases, the child may have an important tendency to fatigue quickly, dyspnea on exertion, and even heart failure.

Respiratory disturbances during sleep can also influence the development of certain structures. For instance, there may be problems of dental malocclusion due to negative changes in the development of the lower jaw because of the continuous increase in respiratory effort during sleep. This is important, because some orthodontic treatments, aimed at correcting malocclusion, actually worsen respiratory related sleep disorders, creating a vicious circle.

Risk Factors

There are a number of situations that predispose children to respiratory related sleep disorders that should alert parents and pediatricians. Some of these factors are:

  • Obesity: it’s an important risk factor, although there are many non-obese children with respiratory disorders in sleep.

  • Nasal, oropharyngeal or laryngeal abnormalities.

  • Genetic malformations such as down syndrome, Arnold Chiari syndrome and myelomeningocele.

  • Neurological disorders like cerebral palsy.

Diagnosis

If the pediatrician or the child’s parents suspect the presence of obstructive sleep apnea syndrome (OSAS), they should refer them to a sleep specialist to confirm the diagnosis and assess the severity of the disorder.

Video recording prolonged sleep (more than four hours) can be very useful, both in the child’s home and in the sleep clinic.

Treatment

In children with hypertrophy of the adenoids or tonsils and OSAS, the treatment of choice is surgical intervention to remove them. However, sometimes the problem is not completely resolved and new interventions are necessary. In mild cases, or when nasal obstruction is the most important factor, improvements can be achieved by eliminating nasal congestion by using intranasal corticosteroids.

You can also use a CPAP or BiPAP machine. A CPAP (Continuous Positive Airway Pressure) machine maintains constant positive pressure, while a BiPAP (Bi-level Positive Airway Pressure does not offer continuous airway pressure. Rather, pressure from a BiPAP machine oscillates with the respiratory cycle, so that it is higher with inspiration and lower during expiration. Although the adjustment period is more delicate than in adults, a CPAP machine is usually well tolerated and effective in children.

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