My 4 year old snores: Is it sleep apnea?
Mother called in for a question regarding her 4 year old son snores nightly. Her Concern was whether it is just snoring or sleep apnea.
Answer: Sleep apnea possible, let us discuss how.
In pediatric age group, breathing difficulty while sleeping is common which is known as Pediatric sleep-disordered breathing (SDB).This condition ranges from loud snoring to obstructive sleep apnea (OSA). It has been observed that 2 to 4% of pediatric population suffers form of OSA, and 10% snore regularly and possibly susceptible to similar health consequences that occur in adults with OSA.
What is sleep apnea?
Sleep apnea is a medical disorder when one has cessation of airflow for 10 seconds or more while sleeping. This may occur several times while sleeping depending on severity of disorder. It is important to know that everyone who snores does have sleep apnea; however snoring is one of the major indicators and should be evaluated.
Further explanation to your question:
If you have observed your child is gasping, experiencing breath hold, waking up with chocking while sleep probably child may have sleep apnea.
Child may experience addition symptoms such as:
- Mouth breathing
- Poor school performance
- Daytime drowsiness/sleepiness
- Lack of concentration/Poor attention
- Behavioral problems
Risk factors and Causes:
- Hypertrophy or over growth of soft tissue in upper airway such as enlarged tonsils and adenoids
- Abnormality of jaw and tongue
- Neuromuscular disorders such as cerebral palsy
- Concurrent nasal allergy and lung disorders may worsen the condition
Potential risks of sleep apnea if not managed in time:
- Learning deficits/cognitive problems:
- Poor academic performance can result from sleep deprivation.
- Compromised physical growth:
- Children with OSA may have growth hormone secretion impairment.
- Insulin resistance:
- Intermittent oxygen deprivation in blood due to oxygen deprivation in blood
- Cardiovascular problems:
- Includes at higher risk of high blood pressure and coronary artery disease
- Fatigue, lethargy and reduced activities secondary to sleep deprivation and insulin resistance.
How is it diagnosed:
- Clinical presentation (witnessed SDB by parents) and physical examination is mainstay.
- Occasionally require fiberoptic nasal endoscopy if child co-operates which facilitate direct visualization of lesion such as enlarged adenoids in nasal air way.
- Sleep study also known as polysomnography (PSG) is most reliable way to confirm OSA. However, PSG may not be required in evident enlargement of tonsils and adenoids.
- X ray soft tissue neck helps showing size of possible adenoid enlargement/nasal obstruction.
How OSA managed in pediatric age group:
- Enlarged tonsils or adenoids are very common cause of OSA in children. Surgical removal of tonsils and adenoids generally considered first line of treatment. Every patient does not need surgical intervention especially when SBD is intermittent or mild, however, needs close follow-up. As child grows to puberty tonsils and adenoids may reduce in size. If symptoms do not resolve may need surgery.
- Regular follow-up after surgery is important for a while. For persistent symptoms after surgery needs repeat sleep study. Positive sleep study indicates other possibilities required to be addressed such as:
- Weight management in obese children.
- Correction of craniofacial abnormality.
- Use of continuous positive airway pressure (CPAP) in neuromuscular disorders and patients not responding to optional management.
- Nasal allergy and lung disorders should be addressed because they may worsen severity of OSA.
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Anil P. Patel
MBBS MS (ENT)