Obstructive sleep apnea (OSA) is often seen as a disorder in elderly or obese individuals, but is quite prevalent in children according to Dr Anoop Karippot, who is board certified in Pediatric & Adult Sleep Medicine as well as Child & Adolescent Psychiatry. OSA is estimated to occur in 1-3 percent of otherwise healthy preschool children. Children in the range of 2 to 9 years of age are most affected. These children are sometimes misdiagnosed with attention deficit hyperactivity disorder (ADHD) or assessed as having behavioral problems in school.

OSA in children is most commonly due to enlarged adenoids and tonsils. The size of the airway and muscle tone may also play a role. Nasal congestion from allergies and gastroesophageal reflux can be other contributing factors.

Snoring is seen in 20 percent of normal children. However, loud snoring is one of the main symptoms of OSA. Other symptoms include mouth breathing, sweating or bedwetting at night, sleep talking/walking, night terrors, difficulty waking up in the morning, and being tired and sleepy during the daytime. These children can be irritable, moody, and inattentive to the point of having significant academic difficulties and school absences.

The presence of OSA cannot be determined by history and physical examination alone. An overnight sleep study is the gold standard for diagnosis. Children with family members who snore and have OSA need to be carefully evaluated. X-ray of the head and neck may show the narrowing or obstruction of the airway.

The management depends on the severity of the disease and other associated risk factors. In most cases, removing the tonsils and adenoids resolves the breathing- related sleep disorder. Children show a dramatic resolution of their symptoms following the successful management of OSA. They show significant improvement in attention, academic function, and behavior at home and school. They also sleep peacefully at night and awaken refreshed.

Recommendations

All children should be screened for snoring.

Loud snoring, attention and behavioral problems, weight gain and disturbed sleep at night warrant a sleep evaluation.

If parents witness apnea (stopping breathing/gasping/choking) at night, the child should be referred for a sleep study which is the gold standard for diagnosis of OSA.