Apnea is a brief pause in one’s breathing pattern. When it occurs for extended periods or frequently during sleep, it may be a cause for concern. Pauses of 20 seconds five or more times per hour in adults indicate the presence of sleep apnea syndrome, whereas the syndrome is diagnosed when pauses of 10 seconds one or more times per hour occur in children 1 to 12 years of age.
There are three types of apnea: obstructive, central, and mixed. Obstructive sleep apnea (OSA) is the most common type of apnea in both children and adults. Estimates of OSA in children range from 1% to 10%. Most have mild symptoms, and many outgrow the condition. Caused by an obstruction of the airway, childhood OSA is associated with enlarged tonsils and adenoids. Problems related to allergies, neuromuscular disease, and craniofacial abnormalities also may be involved. Although obesity is the most common cause of OSA in adults, it is not as frequently associated with childhood OSA. The most common symptom is snoring, although not all children who snore have OSA. Other symptoms are labored breathing while sleeping, gasping for air, sleeping in unusual positions, bedwetting, and changes in color.
Central apnea occurs when the part of the brain that controls breathing does not start or maintain the breathing process properly. This form is very rare in older children and adults. In very premature infants, it is common because the respiratory center in the brain is immature. Even with premature infants, a few short central apneas are normal. Only when these pauses are frequent or prolonged do they become cause for concern.
Mixed apnea is a combination of central and obstructive apnea. It usually begins with a central episode followed by collapse of the muscles in the throat. This obstruction causes the child to struggle to resume breathing Treatment for OSA related to enlarged tonsils and adenoids involves surgical removal. Facial reconstructive surgery is required for the small number of patients with craniofacial abnormalities. Weight loss is indicated for overweight children. For those whose conditions do not indicate the above approaches, a continuous positive airway pressure (CPAP) device, used to keep the airway opened, is recommended. Treatment for central or mixed apnea involves the use of a bilevel positive airway pressure device (Bi-PAP). With the Bi-PAP device, the pressure varies during each breath cycle. If the user does not breathe independently, the machine will initiate a breath.
Although children often outgrow mild forms of sleep apnea, particularly central sleep apnea, OSA has serious consequences for development. Infants and children with OSA are more likely to have elevated diastolic blood pressure, abnormal cardiac function, and decreased muscle tone than are those with no sleep disorders. They are also more likely to be diagnosed with the general condition of failure to thrive. Infants with sleep disorders have reduced levels of alertness, intensity, and activity as well as deficits in reflexes, motor movements, motor symmetry, visual and auditory functioning, balance, and tactile functioning. This suggests that neurological problems may be associated with sleep disorders. Perhaps because of the sleep deprivation associated with all forms of apnea, school age children with OSA have poor attention spans, intermittent hyperactivity, sleep “spells,” and overall decreases in academic performance. Children with mild hyperactivity behaviors are more likely to have sleep disorders than those with significant symptoms of attention deficit hyperactivity disorder (ADHD), suggesting that some behaviors that result from apnea and other sleep disorders are misattributed.
Current medical thinking suggests that the damage from lack of oxygen that occurs with OSA may be permanent. In addition, apnea of childhood and infancy may progress at faster rates than for adults. Thus, the early and accurate diagnosis and treatment of this disorder are imperative in order to prevent possible extensive and permanent developmental impairments.
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