Obstructive sleep apnea, or OSA, is a well-recognized and not uncommon condition in adults. It also occurs in children, though less frequently, and has quite different symptoms, causes and treatments than the adult form. Widely publicized as a cause of poor growth in children, childhood OSA remains largely unknown and misunderstood.
Recommendations
In 2002, the American Academy of Pediatrics released recommendations on the diagnosis and management of obstructive sleep apnea, or OSA, in children. Studies available at that time revealed that about 15 percent of preschool-aged children snore habitually and about 2 percent suffer from OSA. Many media outlets announced the recommendations, citing the link of OSA in children with poor growth, but more information has become available to give us a much better picture of childhood OSA.
Definition and Presentation
OSA is a condition in which the airway becomes blocked during sleep, with little or no air movement. It results in increased respiratory effort, pronounced snoring and disturbed sleep. Sleep-deprived children generally do not experience the same daytime symptoms as adults, such as yawning or sleepiness, but are irritable, hyperactive and have difficulty with learning and with impulse control. Many are evaluated or diagnosed with Attention Deficit/Hyperactivity Disorder, and so, it is poor school performance rather than poor growth that is the most common symptom of OSA in children. Concerns about these symptoms should be brought ot the attention of your pediatrician.
Children vs. Adults
There is a dividing line between childhood OSA and the adult form around the age of ten. Unlike in adults, the largest risk for OSA in children is enlarged tonsils and adenoids, which are part of your child's immune system, catching germs and allowing certain white blood cells to process antibodies against them. The tonsils and adenoids grow with children up to the age of ten and then shrink to adult size. Large adenoids can obstruct the nasal airway and result in mouth breathing. Surgical removal of the tonsils and adenoids may be recommended and is the most common and most effective treatment for children with OSA, as noted most recently by a multi-center review led by Dr. Rakesh Bhattacharjee of the University of Louisville.
Results
Surgery has been shown to improve school performance in children with OSA, and these children also grow faster than expected for a while, evidence that their growth had been suppressed somewhat. However, children with OSA are not unusually small and cannot be identified based on their poor growth.
Other Risk Factors
Actually, obese children are more likely to suffer from OSA. As in adults, an increase in fat deposits in the neck around the airway and in the abdomen, which presses against the diaphragm and chest cavity, is a risk for OSA. Beyond the age of ten, OSA in pediatric patients resembles that of adults, and the most effective treatment is weight loss and nighttime use of a continuous positive airway pressure, or CPAP, machine.
Complications
Adults with long-standing OSA are more likely to suffer from high blood pressure, heart failure and strokes. Although these long-term complications are not seen in pediatric populations, it stands to reason that those who develop OSA earlier in life are more likely to experience these complications. To provide for the most favorable outcome in individual cases, consult with your doctor.
References
- American Academy of Pediatrics: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
- Growth and Growth Biomarker Changes After Adenotonsillectomy: Systematic Review and Meta-Analysis
- "American Journal of Respiratory and Critical Care Medicine"; Adenotonsillectomy Outcomes in Treatment of OSA in Children: A Multicenter Retrospective Study; Bhattacharjee, Rakesh, Kheirandish, Leila, et al.; September 2010
- "Journal of the American Board of Family Medicine"; Obstructive Sleep Apnea (OSA) in Primary Care: Evidence Based Practice; Pagel, J.F., MS, MD; 2007
