What is Obstructive Sleep Apnea?
Obstructive sleep apnea (OSA) is a characterization of sleep patterns in children which include; snoring, restless sleeping, awakening at night, obstructive events (apnea), behavioral changes during the day (hyperactivity, lethargy, increased daytime fatigue) as well as difficulty in arousal and difficulty in getting a child to sleep.
The most common cause of Sleep Disordered Breathing in children is an enlarged adenoid and/or tonsils. It is a disorder, which if left untreated, results in difficulty in cognitive function during the day, behavioral changes and significantly decreased quality of life for children.
How can I tell if my child has Obstructive Sleep Apnea?
Snoring is very common in children, and in fact, it is prevalent in about 12% of children in the general population. However, 1-3% percent of children will exhibit not only snoring, but Sleep Disordered Breathing. Parents will usually notice this when families are together on vacation and the child is sleeping in the same room. Frequently, the child will exhibit signs of restless sleep, tossing and turning throughout the night, awakening in the middle of the night (usually after midnight), sleep walking, bed wetting and tiredness during the day. Other children who have to sleep in the same bedroom will usually complain about not being able to sleep well because of the noise of snoring, pauses in breathing or their bedmate sleeping restlessly and pushing them out of bed.
Why is it important to determine if my child has Obstructive Sleep Apnea?
Children who have prolonged Sleep Disordered Breathing (greater than 4-months) that is not due to an acute illness, may suffer from significant decrease in their quality of life. Behavioral changes such as hyperactivity, loss of concentration and cognitive function have led to the diagnosis of Attention Deficit Disorder in children. In addition, children who have prolonged Sleep Disordered Breathing can have cognitive and learning disabilities which can extend into the teenage years. More importantly, the benefits of diagnosis and treatment Sleep Disordered Breathing leads to a significant improvement in quality of life. Greater than 80% of children who have documented and treated Sleep Disordered Breathing will benefit from long term increases in cognitive ability, behavioral stabilization and more even temperament. Prolonged bedwetting has also been associated with problems with sleeping and Sleep Disordered Breathing is no exception.
What should I do if I suspect my child has Obstructive Sleep Apnea?
If your child exhibits signs not only of snoring, but of restless sleep, awakening at night, daytime sleepiness, change in behavior, bedwetting or daytime hyperactivity, it may be best to talk with your pediatrician about a referral to a pediatric ear, nose and throat specialist. Once there, your doctor will ask you several questions about symptoms and examine your child. If the physical exam matches the medical history then further studies or treatment may be offered at that time. For some small children, adenoidectomy alone may be sufficient to alleviate the symptoms. However, in most cases, tonsillectomy and adenoidectomy is the treatment of choice. There are several methods under which this is done. Your doctor will choose the method best suited for your child to make the best recovery possible.
I thought they were not removing Tonsils any longer?
Although many parents will hear from friends and physicians alike that tonsils are no longer being removed, it is still one of the most common procedures in children in the U.S.. According to the recent government numbers available, 300-400,000 tonsillectomies are performed every year in children and adolescents. The tonsils produce antibodies that are helpful to fighting infection in the first two years of life. However, after 2 years, they serve as part of the larger lymph system and are only 2 of 300 lymph nodes in the head and neck area. That is why studies have proven removal of the tonsils and/or adenoid presents no long term detriment to the child.
What To Expect During Your Child’s Sleep Test
Polysomnogram (Overnight Sleep Study)
During the sleep study, your child will have some stickers and wires placed on his/her scalp, face and legs. Thin elastic belts will encircle the chest and abdomen to detect breathing. Small plastic tubing will be placed on the upper lip to measure air moving in the nose. We will record your child’s brainwaves, breathing, eye movements, heart rate, snoring, oxygen and carbon dioxide levels, body movements and limb movements using a computer program. Placing the equipment on your child takes 45 minutes to an hour. The process is painless, and there are no needles, etc. Glue and tape are used to secure the equipment. Yes, kids do fall asleep despite the wires! After the study, the sites are cleaned with acetone, and rinsed off the following day.
Your child and you will share a private room with an attached bathroom. An experienced technologist will be available to assist you. You can expect to be in the lab from approximately 6:30 p.m. till 6 a.m. the following morning.
Once the test is done, the study is scored by the technologist and sent to a sleep physician for interpretation. A final report is available after 5-7 days. The report will be sent to the physician that ordered the test. For test reports, please contact the office of the doctor that ordered your child’s study one week after the test is completed. Your doctor can then suggest the most appropriate treatment for your child.
MSLT (Multiple Sleep Latency Testing)
Sometimes we monitor your child’s sleep during a series of 4 or 5 naps following overnight sleep testing. If this test is done, expect to arrive at the lab at 6:30 p.m. and leave at 5 p.m. the NEXT DAY (total 23 hours in the lab). Your child will receive breakfast and lunch during the MSLT. Please bring appropriate doses of his/her daily medications for the following day.
Therapeutic Sleep Study (Titration)
This study will be performed exactly like the polysomnogram. In addition, your child will be fitted with a small mask covering his/her nose (rarely nose and mouth) to receive mildly pressurized air delivered via a Positive Pressure Device called a CPAP or BiPAP to support your child’s breathing.