Duke Medicine: Obstructive sleep apnea in children

As parents, we consider nothing more important than the health and well-being of our children. We make sure they eat well, get their checkups, are immunized to prevent serious illnesses, and see a doctor when they are sick. Yet many parents are unaware that problems may occur at a time they least expect -- while their children are asleep.

Obstructive sleep apnea (OSA), a condition in which the airway becomes partially or completely blocked during sleep, occurs in 1 to 3 percent of otherwise healthy children.

While long recognized in adults, OSA has only recently been recognized as a significant problem for children. Children frequently have symptoms that are different from those experienced by adults, and as a result, a potentially serious problem may go unrecognized and untreated.

OSA is most commonly seen in children ages two to seven, but it can affect infants and adolescents as well. The most common cause of OSA in children is enlarged adenoids and tonsils, though we are seeing an increasing number of cases caused by childhood obesity.

Children with OSA frequently snore and may have difficulty breathing while asleep. They may have pauses in their breathing (called apneas), which can be followed by a sudden gasping for air. Their sleep can be restless, with tossing and turning, and they may sleep in unusual or contorted positions in an attempt to open up their blocked airway.

If left untreated, children are at risk for many physical as well as behavioral problems. These can include: daytime sleepiness (after snoring, the most common symptom seen in adults); excessive napping; changes in behavior; hyperactivity (especially troublesome in school); trouble concentrating in school with a decline in school performance; poor growth; the reappearance of bedwetting; and high blood pressure and other cardiac-related problems.

While observing your child when he or she sleeps is an important way of identifying a potential problem, the presence of some or all of the above listed symptoms is usually not enough to be certain that OSA is occurring.

For example, snoring, a relatively common problem seen in 10 percent of otherwise healthy children, does not always mean OSA. Also, when sleep apnea is present, its severity does not always correlate with the number and degree of symptoms present -- some children with mild snoring have severe OSA, while others with heavy snoring do not have OSA at all.

Currently, the only way to definitively determine whether or not OSA is present is by physiologic monitoring of the child while asleep with a sleep study (also known as polysomnography).