Sleep Apnoea in Children
Table of Contents
Sleep Apnoea is a condition when there are repeated episodes of interrupted breathing during a night of sleep. According to the journal, Australian Family Physician, the condition affects 1%-5% of children.
What causes Obstructive Sleep Apnoea in Children
The most common cause of OSA in children is enlarged tonsils and adenoids. Obesity is a contributing factor.
Lack of good sleep in children is a particular concern as it will affect their growth and cognitive performance.
Disproportionate jaws and poor bite are often seen in children with chronic OSA
Allergic rhinitis or other causes of nasal obstruction may also cause Obstructive Sleep Apnoea (OSA). Children with certain medical conditions are also more likely to have OSA, particularly those associated with muscle weakness, small jaw, previous airway surgery including repair of cleft palate, and syndromes such as Down syndrome.
What are the signs of Obstructive Sleep Apnoea (OSA) in children?
Snoring or noisy breathing is one of the chief signs of obstructive sleep apnoea. Children with persistent snoring or noisy breathing during sleep, in the absence of an upper respiratory tract infection, are at risk of OSA.
Unlike adults*, children with lack of sleep may not present with daytime sleepiness but with hyperactivity, and disruptive behaviour, even aggression. Other symptoms of sleep apnea in children include frequent arm and leg movements while asleep, sleeping in unusual positions, bed-wetting and nightmares. * See article on Obstructive Sleep Apnea – What it is & How it is treated
The relationship of OSA with impairments in memory, attention, learning and behaviour has been recognized for many years.
Chronic congestion of the airway with enlarged tonsils or other nasal obstruction will lead to mouth-breathing and subsequently, poor development of the face and jaws.
Mouth-breathing means that the tongue is habitually kept in a low position with the mouth open. For healthy growth and proper development of the jaws, the tongue needs to be against the palate, with the lips closed and breathing through the nose. Poor development of the jaws may result in crooked or protruded teeth.
Long-term mouth-breathing may lead to an open-mouthed “droopy face” and even affect the posture.
The roof of the mouth is the floor of the nose.
What affects one will affect the other.
How is Obstructive Sleep Apnoea (OSA) diagnosed?
The Dentist can identify impairments in the development of the jaws and teeth that might be the consequence of mouth-breathing. Mouth-breathing is often associated with OSA. The suspicion of OSA would trigger a referral to an ENT or respiratory physician.
The diagnosis of Obstructive Sleep Apnoea (OSA) must be made by a medical doctor. A sleep test may be ordered to determine the presence and severity of OSA.
What is the treatment for Obstructive Sleep Apnoea (OSA) in children?
- In very mild cases, there is the chance that the child may outgrow the condition. Certainly, anything that may trigger an allergy should be avoided e.g., airway irritants or pollutants like tobacco smoke.
- Management of any allergies that cause nasal congestion. This often involves anti-inflammatory medication.
- Weight reduction if obesity is an issue.
- Removal of enlarged tonsils and adenoids.
- Positive airway pressure therapy may be recommended if anti-allergy treatment or removal of tonsils & adenoids do not work.
- Orthodontic treatment to widen the palate (rapid maxillary expansion*) would also widen the base of the nose. This will help to enlarge the nasal passages and reduce congestion. This treatment is useful in actively growing children. Another benefit of this procedure is that it will help to reduce crowding of the teeth as more space would be created for the teeth to grow into.
- Myofunctional treatment to train the child to keep the lips closed and breathe through the nose.
Obstructive Sleep Apnea (OSA) has many physical and cognitive consequences.
Thus, it is essential that it is identified and treated in a timely manner.