Snoring and Obstructive Sleep Apnea

September 06, 2008

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Snoring and Obstructive Sleep Apnea

by Robert Needlman, M.D., F.A.A.P.
reviewed by Laura Jana, M.D., F.A.A.P.

Whenever I hear about a child who is getting into trouble in school, not concentrating, or acting irritable, one of the first questions I ask is, "Does he snore?" While this may seem like an odd question at first, the connection between snoring and all of these problems is simple and important: Sometimes--but not always--snoring is a sign of a serious sleep problem called Obstructive Sleep Apnea (OSA). Key symptoms of OSA are--you guessed it--difficulty paying attention and poor behavior.

What is Obstructive Sleep Apnea?
While most children who snore are simply noisy breathers, a few have OSA. With OSA, even though the child stays in bed, linapparently asleep, for a long time, he doesn't ever sleep well. As a result, he is chronically overtired, and so may have trouble learning and controlling his behavior.

Don't let the long name put you off. Apnea simply means "not breathing." Obstructive refers to the fact that the child's airway is blocked off, or obstructed. With OSA, the child's airway gets blocked off when he's deeply asleep. With the airway blocked, the child can't breathe. After a while, what doctors refer to as "air hunger" (the feeling you get when you hold your breath a long, long time) wakes up the child. But as soon as he's deep asleep again, his airway blocks, and he wakes once more. You can see how a child with this problem would never really enjoy a long stretch of deep, restful sleep.

What causes OSA?
Normally, the airway, or windpipe, is held open by a large number of muscles. These muscles are controlled by a portion of the brain that works, night and day, without our ever having to think about it. In some people, however, deep sleep causes these muscles to relax abnormally, and as a result, the airway walls become floppy and collapse together, blocking off the windpipe. This problem tends to run in families and is fairly common in adults as well as children. Two factors that make OSA particularly likely are:

Large adenoids. Children who have very large adenoids are more prone to OSA. The adenoids are little lumps of tissue that sit in the very back of the nose, where you can't see them (they show up clearly on x-rays of the face and neck, however). Children who have very large adenoids can't breathe through their noses well, and therefore habitually hold their mouths open, a look that often gets confused for "dumbness." When adenoids chronically block breathing, surgeons may have to remove them, an operation called adenoidectomy. Since their airways are already partially obstructed, children with large adenoids often have problems with OSA.

Obesity. Children who are obese also are at risk for OSA. One explanation is that the weight of their overly heavy chests presses down on their windpipes, making it easier for their airways to become obstructed. (Obese adults often have the same problem.) Because obesity is associated with an increased risk of OSA, an overweight child who snores and has problems paying attention in school should always be considered to have OSA until proven otherwise!

How is OSA diagnosed?
Certain signs make OSA more likely. Look for these by watching while your child sleeps. For example, you might notice that he snores loudly, then suddenly stops snoring, although his chest is still moving up and down (that is, he is trying to breathe, but no air is going in or out). If your child then startles suddenly and takes a large gasping breath before falling back asleep, it's a sign that he might have had air hunger. Other things to look for include:

very restless sleep, with the blankets and sheets all over the place in the morning

sleeping with his head at a funny angle or on several pillows (these may be an unconscious attempt to keep his windpipe open)

sleeping a long time, but waking up tired, or frequently becoming tired during the day (Keep in mind, however, that young children often become "wired" when tired, rather than sleepy.)

someone else in the family who snores loudly or has other OSA symptoms

Once your child's doctor has asked you about these matters, he might call for an x-ray to see if your child has very large adenoids. To confirm the diagnosis, there is a special test called a "sleep study," which involves the child staying overnight in the hospital and being monitored during sleep.

Treatment options
OSA can be mild, moderate, or severe. Moderate or severe OSA can lead to heart problems. If the OSA is severe enough to interfere with school or daily life, it should be treated. If the adenoids are large, having them taken out is sometimes all that's needed. Otherwise, your child's doctor can discuss with you a treatment called Continuous Positive Airway Pressure (or CPAP), which proves useful in many cases. If your child is obese, weight loss also can help.

Err on the side of caution
If your child does not snore, it is very unlikely that he has OSA. If your child does snore but doesn't have any learning or behavior problems (or any of the other concerning signs mentioned above), it's also probable that he doesn't have this condition. But if you have even the slightest suspicion that your child might have OSA, definitely talk about it with your pediatrician. Infants and very young children who snore loudly on a regular basis need to be evaluated even if there are no other signs of OSA. OSA is one of those problems that you can do something about, and the proper treatment can make a big difference for your child.


RELATED INFORMATION

			Sleep: Specific Problems

Created July 11, 2001
Reviewed July 25, 2001

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