What is Sleep-Disordered Breathing?
Does your child snore? Do they breathe through their mouth when they're sleeping? Are there times where their breathing appears to stop when they are asleep?
If any of this sounds familiar, than your child may be suffering from Sleep-Disordered Breathing. SDB in children is disruptive to their nightly rest, and can result in numerous health problems.
SDB is where there are repeated episodes of airway obstruction during sleep. The lack of oxygen entering our lungs and bloodstream is detected by our brains, which wake us up just enough to breathe.
The consequences of childhood OSA
Quality sleep is essential to everyone, but especially to children and teenagers, as this is where the majority of normal growth and development takes place.
While we are sleeping, our brain is forming new pathways to help us learn and remember new information. Proper sleeping patterns improve our ability to absorb and retain new information.
Difficulties with breathing prevent a child from achieving a good quality of sleep. This can make a child irritable, sleepy during the day, or have poor concentration in school. They might display busy or hyperactive behavior, and it is not uncommon to experience frequent issues with bed-wetting.
The most obvious symptom of sleep disordered breathing is loud snoring when a child is sleeping. The snoring can be interrupted by complete stoppages of breathing, with gasping and snorting noises, and arousals from sleep.
Approximately 10 percent of children snore regularly and about 2-4 % of the pediatric population has OSA. Children with abnormalities involving the lower jaw or tongue have a higher risk of developing sleep disordered breathing.
Potential consequences of untreated pediatric sleep disordered breathing
Social: Loud snoring can become a significant social problem if a child shares a room with siblings or at sleepovers and summer camp.
Behavior and learning: Children with SDB may become moody, inattentive, and disruptive both at home and at school. Sleep disordered breathing can also be a contributing factor to attention deficit disorders in some children.
Enuresis: SDB can cause increased nighttime urine production, which may lead to bedwetting.
Growth: Children with SDB may not produce enough growth hormone, resulting in abnormally slow growth and development.
Obesity: SBD may cause the body to have increased resistance to insulin or daytime fatigue with decreases in physical activity. These factors can contribute to obesity.
Cardiovascular: OSA can be associated with an increased risk of high blood pressure or other heart and lung problems.
Sleep disordered breathing in children should be considered if frequent loud snoring, gasping, snorting, and thrashing in bed, or if unexplained bedwetting is observed. Behavioral symptoms can include changes in mood, misbehavior, and poor school performance.
Not every child with academic or behavioral issues will have SDB, but if a child snores loudly on a regular basis and is experiencing mood, behaviour, or school performance problems, sleep disordered breathing should be considered.
How is childhood OSA detected?
Snoring is commonplace during childhood, but it should never be regarded as normal. Snoring does not mean that a child has OSA, but it is the number one sign they should be assessed for the condition.
Nighttime signs of OSA
Children with OSA almost always snore, struggle to breathe, and have restless sleep. There may be frequent stoppages to breathing or snoring, lasting anywhere from a few seconds to over a minute. These may end with a gasping or choking noise, with the child waking briefly as they struggle to breathe.
In young children, their chest may be sucked in during a breathing stoppage, and you may find they adopt unusual sleeping positions to free up their airway. They may sweat profusely, and return to a habit of bedwetting. They may wake in the morning with a dry mouth, headache, or confusion.
Daytime symptoms of OSA
Infants may feed poorly and have difficulty gaining weight. Older children may have behavioural problems such as hyperactivity, aggression, learning difficulties, and poor concentration. There can be personality changes, poor school performance, and issues interacting with other children.
They may lag behind in areas of development, become frustrated and depressed. In the long term and left untreated, OSA can cause heart problems and high blood pressure, increasing the risk of heart attack or stroke.
OSA in children is caused by anatomical obstruction to the airway that prevents normal breathing. Obstruction is created by abnormal upper jaw growth, lower jaw development, or a combination of the two.
An airway free of obstruction allows for a smooth flow of air when breathing. Air passing through a narrowing or constriction point becomes turbulent, like water out of a tap that is partially turned off. Turbulent airflow irritates the surface of the airway, producing symptoms similar to upper airway infection.
There can be inflammation of the tonsils and the adenoids, which increase in size as a result. Their enlargement makes OSA more severe, but this inflammation is a symptom of OSA and not the cause. Surgical removal of the adenoids and tonsils provides short term improvement, but not a cure of the primary issue.
A small, narrow upper jaw obstruct the flow of air though the nasal passage and behind the soft palate. A short lower jaw narrows the airway space between the tongue and the back of the throat. The treatment of OSA should target these anatomical points of constriction by correcting normal jaw growth.
A cure for childhood OSA
To successfully cure a child of OSA, it is critical to identify the underlying cause, and the exact points of airway obstruction. It is only then that the most appropriate treatment can be determined.