Louise M. O'Brien, Ph.D
Did you know that about 10-12% of children regularly snore? Snoring 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. Snoring is abnormal in otherwise healthy children. Sometimes it can be a sign of a respiratory infection, a stuffy nose or allergy; other times it may be a symptom of obstructive sleep apnea (OSA).
About two percent of young children have OSA which is when the airway collapses and blocks the throat. This causes frequent pauses in breathing which can last from several seconds to a minute and oxygen levels subsequently fall. The brain briefly wakes up and alerts the body to breathe. This effort results in the child gasping or snorting, waking up and starting to breathe again. This can happen hundreds of times in a night. Because of these repeated arousals to breathe the child may not get enough quality sleep and is likely to be sleepy or overtired during the day. Sleepiness in children often manifests as hyperactive behaviors.
Undiagnosed and untreated OSA may contribute to daytime sleepiness, morning headaches, bed wetting, mouth breathing, and behavioral problems including difficulties at school. Following a night of poor sleep, children are more likely to be hyperactive and have difficulty paying attention. These are also signs of attention-deficit hyperactivity disorder (ADHD). Many studies show that OSA and learning and behavioral problems are linked even in very young children. A large survey also found that children who snored between the ages of two to six years were three times more likely to have behavioral and intellectual problems in middle school. Furthermore, research also suggests that children with OSA are at risk of developing heart and lung problems which may lead to serious problems when the children get older.
It was previously thought that primary snoring was normal (i.e., snoring which does not cause pauses in breathing, frequent arousals, or drops in oxygen levels). However, new research now shows that even children with primary snoring are still more likely to perform below their pees in school, particularly in language tests, spelling, and tests of IQ. They are also more likely to have behavioral problems.
Enlarged tonsils and adenoids are usually the cause of snoring in children since tonsils are quite large in comparison to the size of the throat especially between the ages of about five and seven years. Removing the tonsils and adenoids often stops the snoring. In fact taking out the tonsils and adenoids also improves academic performance as well as behavior. Obesity increases the risk of OSA. Fat deposits around the throat can cause it to constrict, and fat in the stomach can prevent the diaphragm from functioning properly. Approximately 20-40% of obese children suffer from OSA so it is important for children to maintain an appropriate weight.
Children with allergies are more likely to have blocked nasal passages and this can explain why some children only snore during allergy season or when they have a cold. In these cases taking allergy medication can help stop the snoring. In a small group of children poor muscle tone in the airway or abnormalities of facial development (including a small jaw) rather than enlarged tonsils and adenoids can be the problem. In these cases a breathing machine which blows air into the lungs may be required.
During the night, children with OSA may:
• Snore loudly and on a regular basis.
• Have pauses, gasps, and snorts and actually stop breathing. The snorts or gasps may waken them and disrupt their sleep.
• Be restless or sleep in abnormal positions.
• Sleep in an elevated position or with their neck extended.
• Sweat heavily during sleep.
• Wet the bed.
During the day, children with OSA may:
• Have behavioral problems such as hyperactivity (mimicking ADHD).
• Have schooling difficulties.
• Be difficult to wake up.
• Have headaches during the day, especially in the morning.
• Be irritable, agitated, aggressive, and cranky.
• Be so sleepy during the day that they actually fall asleep.
• Speak with a nasal voice and breathe regularly through the mouth.
If you suspect your child may have symptoms of OSA, talk to your child's doctor instead of trying to ignore the snoring. A recent guideline from the American Academy of Pediatrics, Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome, should help doctors more readily recognize, diagnose, and treat children with OSA. Your doctor may refer your child to a sleep specialist who may order an overnight sleep study. This study will record the child's sleep, brain waves, body movements, heartbeat, breathing, oxygen levels, and snoring to determine a diagnosis. Sleep specialists have special training in sleep medicine and can offer you the most appropriate treatment.
Remember to be especially suspicious that your child may have OSA if he/she regularly snores and has daytime sleepiness, and/or school and behavioral problems. If caught early these problems may be reversible.
Dr. O'Brien is a Senior Fellow in Pediatric Sleep Medicine at the University of Louisville, KY. She has written a number of articles on the consequences of snoring and sleep apnea in children and has also contributed to several book chapters.
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