Obstructive Sleep Apnea (OSA) in Children

Obstruction of the airway during sleep may be much more subtle in a child. Although the term sleep apnea may still be used, true apnea commonly does not occur. Instead, the obstruction will lead to a disruption of sleep or “arousal.” Snoring is a sign that disruption is occurring. Reoccurrence of these events throughout the night prohibits the child from obtaining a restful sleep. However, young children may not manifest signs of sleepiness or fatigue from fitful sleep. Rather, symptoms such as irritability, poor attention span, lack of concentration, and even poor physical growth may be seen. In some cases, the normal secretion of growth hormone which occurs during sleep may be disturbed. Over a prolonged period of time alteration of the growth of the midface leading to orthodontic concerns and even cardiac and pulmonary side effects may occur.

Recent reports in the pediatric literature have stressed that because signs of this process are perhaps less obvious in children, any child with snoring deserves evaluation. This evaluation will include a thorough examination of the upper airway and a detailed history of the child’s social and intellectual development. A sleep study called a polysomnogram may then be used to confirm the diagnosis and establish the real severity of the problem.

Treatment

Reduction of the turbinates can be accomplished by a non-surgical method called radiofrequency, which uses a small electrode to shrink the turbinate without damaging its function.

Treatment may include non-surgical options such as continuous positive airway pressure (CPAP), in which a mask is worn while sleeping, and the airway is kept open by a constant pressure of air. This may be difficult for the pediatric patient to tolerate.

Surgical treatment is aimed at eliminating the obstruction. Most commonly the tonsils and adenoids are addressed first. It is important to note that these structures should be evaluated based on their size relative to the individual patient’s airway. As shown below, suturing techniques are used to further increase the size of the airway after tonsillectomy.

In addition, the interior of the nose should be examined. Inflammation of normal structures known as turbinates can contribute to the obstruction. Tonsillectomy with adenoidectomy is very effective in relieving snoring and improving the airway. Reduction of the turbinates can be accomplished by a non-surgical method called radiofrequency, which uses a small electrode to shrink the turbinate without damaging its function. It is important to document whether or not the sleep issues have been completely resolved after any procedure. In some cases, further treatment may include surgery to shorten the palate or orthodontic procedures to widen and open the airway further.

If you have questions about your child’s sleep health please contact our center through the website, or call us at (650) 328-0511 and we will respond promptly.

Jerome E. Hester, MD

Specializing in the diagnosis & treatment of children and adults with snoring and/or sleep apnea.

References

Since a child’s growth, development and overall health are important, you may wish more information regarding these issues:

• Hester JE, Powell NB, Riley RW. Hypopharyngeal airway surgery in the pediatric patient with obstructive sleep apnea syndrome. Operative Techniques in Otolaryngology Head and Neck Surgery 16:264-269, 2005
• Hester JE, Powell NB, Riley RW. Advanced Surgical Treatment of Obstructive Sleep Apnea Syndrome in the Pediatric Patient. In: Pediatric Sleep Disorders, Norman Friedman, ed. London: Egerton
• Wei JL, Mayo MS, Smith HJ, et al. Improved behavior and sleep after adenotonsellectomy in children with sleep disordered breathing. Arch Otolaryngology Head and Neck Surgery 133: 974-979, 2007
• Beebe DW. Neurobehavioral morbidity associated with disordered breathing during sleep in children: a comprehensive review. Sleep 29: 1115-1134, 2006
• Chervin RD, Ruzicka DL, Giordani BJ, et al. Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pedriatics 117:e769-e778, 2006
• Chervin RD, Ruzicka DL, Archbold KH, et al. Snoring predicts hyperactivity four years later. Sleep 28:885-890, 2005
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• Hester JE, Troell RJ, Riley RR, Powell NB, Li KK: Reconstructive surgery for sleep disordered breathing. In: Anesthesiologist’s Manual of Surgical Procedures. Jaffe RA, Samuels SI, eds. Lippincott Williams & Wilkins 2004, 193-198.
• Mitchell RB, Kelly J, Call E, et al. Long-term changes in quality of life after surgery for pediatric obstructive sleep apnea. Arch Otolaryngology Head and Neck Surgery 130:409-412, 2004
• Avior G, Fishman G, Leor A, et al. The effect of tonsillectomy and adenoidectomy on inattention and impulsivity as measured by the Test of Variables of Attention (TOVA) in children with obstructive sleep apnea. Otolaryngology Head and Neck Surgery 131:367-370
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