Over the last decade, there’s been increasing awareness of obstructive sleep apnea (OSA), a condition that can cause people to stop breathing for short periods of time during sleep. According to the Mayo Clinic, anyone can develop OSA, although it is more common in people who are overweight or middle-aged or older. What many parents don’t realize, though, is that another age group can also develop OSA: children and adolescents.
“OSA occurs in about 1 to 3 percent of children,” says J. Brian Kang, M.D., who specializes in pediatric pulmonary medicine and sleep medicine. “The peak age at which OSA initially manifests in kids is between 2 and 6. This is the time that coincides with rapid growth of tonsils and adenoids.”
According to the American Academy of Pediatrics (AAP), childhood OSA is often caused by enlarged tonsils, although there can be other causes, including childhood obesity. If not diagnosed and treated, OSA can lead to a variety of health and behavioral problems.
A Range of Symptoms
Although snoring is the symptom most often associated with sleep apnea, snoring by itself doesn’t always mean a child has sleep apnea—and snoring can be hard to pinpoint in children.
“Snoring is one of the hallmarks of OSA,” says Dr. Kang. “But it can occur sporadically and be overlooked by the parent.” Because of this, the AAP advises pediatricians to always ask parents specifically about any snoring during a routine check-ups.
Children with OSA can also have other symptoms.
“With a lot of these kids, you have very poor sleep quality,” says Dr. Kang. “They may have a high frequency of awakenings or abnormal behaviors in sleep—like sleep walking, sleep terrors, bedwetting and teeth grinding. These are clues to the possibility of OSA.”
Another common problem? Daytime sleepiness, although the AAP cautions that this isn’t always the case in very young children. But the lack of quality sleep can impact a child’s health and learning.
Attention-Deficit/Hyperactivity Disorder?
“Children with OSA may be at three times the risk for behavior and attention problems,” says Dr. Kang. “That may include hyperactivity, inattentiveness and impulsivity.”
According to Dr. Kang, the symptoms of OSA can mimic ADHD. “Children with OSA may have ADHD—or they may just be exhibiting symptoms of their OSA that are similar to ADHD.”
In either case, the impact on school performance can be about the same—and cause ongoing problems in the classroom.
Getting an Accurate Diagnosis
Because OSA can mimic other conditions, and because some symptoms can be hard to spot, it’s important for a child with suspected sleep apnea to have a thorough evaluation.
According to the Mayo Clinic, a sleep study is the gold standard for diagnosing OSA. During a sleep study, special equipment monitors heart, lung and brain activity as well as breathing patterns. Arm and leg movements are also monitored, as is the blood oxygen level.
Treating Sleep Apnea
According to the AAP, treatment for OSA can range from surgery to Continuous Positive Airway Pressure (CPAP) to weight loss and nasal sprays for the milder forms of OSA.
“Removing the tonsils usually solves the problem—that’s in about 80 to 85 percent of the cases,” says Dr. Kang. “Other options may include CPAP therapy.”
CPAP therapy uses a mask connected to a small bedside unit by a flexible hose that sends a constant stream of air down the throat to keep breathing regular throughout the night.
“You can use CPAP with children, but there are more steps, as you have to desensitize them to using the mask,” explains Dr. Kang.
Children with mild sleep apnea may be able to use corticosteroid nasal sprays to reduce inflammation and alleviate any obstruction, adds Dr. Kang.
Future Health
Although convincing your child to sleep using a mask may not sound like something you’d volunteer for, sleep apnea is a serious problem and can lead to other problems if left untreated.
“There can be other underlying medical conditions that make [untreated OSA] worse,” says Dr. Kang. “For example, children with underlying cardiac disease may develop pulmonary hypertension. Or if children have asthma, it may make the asthma more difficult to control.”
Dr. Kang cautions that because the treatment for sleep apnea can be somewhat complicated, it’s important for parents to have an accurate diagnosis.
“Although sleep apnea is considered the main sleep disorder, there are other sleep disorders that make for poor sleep quality and daytime behavioral concerns,” says Dr. Kang. “Kids can have things like restless leg syndrome and periodic limb movement during sleep—both of which can cause sleep-related issues and behavioral problems during the day. We have to look at all the possibilities. No one wants a child to have a tonsillectomy unnecessarily.”
Sara Rider is a native Austinite who has worked with physicians and hospitals throughout Texas. She frequently writes freelance articles on health topics for newspapers and magazines.
