Snoring And Sleep Apnea In Children
Most children snore on occasion, and about 10 per cent snore most nights. Snoring is a noise that occurs during sleep when the child is breathing in and there is some blockage of air passing through the back of the mouth. The opening and closing of the air passage causes a vibration of the tissues in the throat. The loudness is affected by how much air is passing through and how fast the throat tissue is vibrating. Children aged three years or older tend to snore during the deeper stages of sleep. Primary snoring is defined as snoring that is not associated with more serious problems such as obstructive sleep apnea syndrome (OSAS), frequent arousals from sleep, or inability of the lungs to breathe in sufficient oxygen.
Loud and regular nightly snoring is often abnormal in otherwise healthy children. Sometimes it is a sign of a respiratory infection, a stuffy nose or allergy; at others it may be a symptom of sleep apnea.
About one to three per cent of children not only snore but also suffer from breathing problems during their sleep. When snoring is accompanied by gasps or pauses in breathing, the child may have OSAS. Children's muscles normally relax during sleep, but they can become so relaxed that the airway is narrowed or obstructed and sufficient air cannot pass through.
This interferes with breathing, causing a pause in breathing that can last only a few seconds or as long as a minute. The brain is then alerted and signals the body to make an effort to start breathing again. This effort results in the child gasping or snorting, waking up and starting to breathe again. Because of these repeated arousals to breathe, the child may not get enough quality sleep and is likely to be sleepy or tired during the day.
Contributing factors to sleep apnea include obesity, allergies, asthma, GERD (gastroenterological reflux disorder), an abnormality in the physical structure of the face or jaw as well as medical and neurological conditions. In children, the most common physical problem associated with sleep apnea is large tonsils.
Young children's tonsils are quite large in comparison to the throat, peaking at five to seven years of age. Swollen tonsils can block the airway, making it difficult to breathe and could signify apnea.
Undiagnosed and untreated sleep apnea may contribute to daytime sleepiness and behavioural problems including difficulties at school. Following a night of poor sleep, children are also more likely to be hyperactive and have difficulty paying attention. These are also signs of attention-deficit/hyperactivity disorder (ADHD). Apnea may also be associated with delayed growth and cardiovascular problems.
Night-time symptoms include snoring loudly and on a regular basis; pauses, gasps, and snorts that may waken them and disrupt their sleep, restlessness of sleeping in abnormal positions with their head in unusual positions; and sweating heavily during sleep.
Daytime symptoms to watch for are: Behavioural, school and social problems; difficult to wake up; headaches during the day, and especially in the morning; irritability, agitation, aggression and crankiness; sleepiness, daydreaming or actually falling asleep; speaking with a nasal voice and regularly breathing through the mouth.
If you suspect your child has symptoms of sleep apnea, talk to your doctor who may refer you to a sleep specialist and/or an overnight sleep study. This study will record the child's sleep, brain waves, body movements, heartbeat, breathing, arousals and noises to determine a diagnosis. Sleep specialists have special training in sleep medicine and can help to determine if your child has primary snoring, sleep apnea or another problem. They can then offer you the most appropriate treatment.
Samitivej Sukhumvit Hospital's Child Health Institute can be contacted at
(02) 711-8236-7 or (02) 711 8181.