Childhood Snoring and Sleep Apnoea
What you need to know about snoring and sleep apnoea in children.
The link between snoring and obstructive sleep apnoea:
A child with sleep apnoea most often snores, but not all children that snore will have sleep apnoea.
Other signs that may be present with obstructive sleep apnoea include
pauses in breathing which may end with a gasping or choiking nose
brief awakenings as the child struggles to breathe
sleeping in strange positions or with their neck extended
nocturnal tooth grinding
sweating a lot during sleep
dry mouth, headache or confusion on waking
being unrefreshed or slow to rouse in the morning
Sleep Apnoea explained
Obstructive sleep apnoea is a condition where a child stops breathing for a short period on a regular basis during sleep. Episodes last from 10 seconds to a minute. These apnoeas are caused by the airway being blocked. The most common cause for this in children is a combination of enlarged tonsils and adenoids in a smaller anatomic airway.
Another related condition is Upper Airway Respiratory Syndrome (UARS). Children with this condition have identical symptoms and health risks requiring similar management. Instead of the airway completely collapsing, in UARS there is increased work of breathing to maintain airflow through the narrowed airway. This also results in fragmented, unrestorative sleep. Although this page is about sleep apnoea, any of this information can also apply to Upper Airways Respiratory Syndrome, which is actually the more common condition.
Daytime symptoms of sleep apnoea
Due to sleep being quite fragmented due to the repetitive awakenings and effort to breathe, the child with sleep apnoea may exhibit a number of problems.
Infants may feed poorly, fail to gain to weight and experience developmental delays.
Older children may have problems with their behaviour, such as being hyperactive, aggressive, having trouble learning or not being able to focus well.
Sleepiness can cause personality changes, poor school performance and interpersonal relationship problems. A child may lag behind in many areas of development and become frustrated and depressed.
If untreated, it can also cause heart problems and high blood pressure in a subset of children.
Causes of sleep apnoea
There are many factors that contribute to sleep apnoea, but the biggest predisposing factor is an anatomically small airway. The airway is small through a combination of enlarged adenoids and tonsils in many children, and the relatively small size of the jaw structures that form the boundaries of the airway. Studies have linked narrow palates and retruded lower jaws as the craniofacial characteristics that are most strongly associated with risk of sleep apnoea.
Obesity can play a part as well because fat deposits in the neck can also narrow the airway via gravity during sleep.
How is sleep apnoea managed?
The front line management option for sleep apnoea in children is removal of the adenoids and tonsils. This will normally result in an improvement in symptoms and sleep quality, however research studies that have followed up these children with sleep testing have demonstrated that up to 80% of children do not have complete resolution of sleep apnoea after this procedure.
Removing these inflammed tissues can be likened to removing furniture from a small apartment. The apartment will still be remain small.
Studies show that despite the initial cure of obstructive sleep apnoea following adenotonsillectomy, it does tend to recur later in childhood and the latest research links this to the impact of obstructed nasal breathing on limiting proper jaw and facial development.
This supports the importance of a return to nasal breathing following adenotonsillectomy. Mouth breathing or "nasal disuse" is a habit that may need retraining to break. This is the reason for the increasing field of myofunctional therapy.
There is also some long term evidence to support treatment to widen or expand the upper jaw in selected children. The upper jaw also forms the floor of the nose and it has been well established that expansion will improve nasal volume and airflow. Expansion is not considered a mainstream option for sleep apnoea, but Dr Shereen Lim has a special interest and knowledge in this area. It is something that she may review with parents when making informed decisions whether early orthodontic intervention may be of benefit.
Continuous Positive Airway Pressure (CPAP) may also be reccomended as it considered the gold standard option or most predictable way to reduce obstructive events. Compliance can be an issue for young children. From a dental perspective, worn over the midface during sleep, it does have the potential to limit forward development of the upper jaw structure if used for prolonged periods.
Encouraging good sleep habits
Good sleep habits are important to a child with sleep apnoea.
setting a regular time to sleep and wake
stay away from electronic devices or TV before bed
having a quiet and dark bedroom
avoidance of caffeine (including cola and hot chocolate) in the afternoon and evening
Dr Lim Shereen and our dental Therapist Rachel Harvey have advanced training in the field of dental sleep medicine and are both involved in delivering presentations to dental professionals on identifying and screening for children at risk of obstructive sleep apnoea and other sleep disturbed breathing.
They can assist with a direct referral to a paediatric Ear, Nose and Throat specialist if you have any concerns, and/or liase with your GP doctor to keep them informed with any positive findings.
In addition, several clinicians in our practice are trained in myofunctional therapy. If you would like a conusultation to discuss further options after removal of adenoids and tonsils, please contact us.
Watch this video if you would like further information.