Sleep disordered breathing (SDB) is a common problem for adults leading to hypertension, heart attack, stroke, and early death. Other consequences are bedroom disharmony, excessive daytime sleepiness, and weight gain, poor performance at work, failing personal relationships and increased risk for accidents, including motor vehicle accidents.
Sleep disordered breathing in children, from infancy through puberty, is in some ways a similar condition but has different causes, consequences and treatments. A child with SDB does not necessarily have this condition as an adult.
The premiere symptom of sleep disordered breathing is snoring that is loud, present every night regardless of sleep position and is ultimately interrupted by complete obstruction of breathing with gasping and snorting noises. Approximately 10% of children snore. 10% of these children (1% of the total pediatric population) have obstructive sleep apnea.
When an individual, young or old, obstructs breathing during sleep, the body perceives this as a choking phenomenon. The heart rate slows, the sympathetic nervous system is stimulated, blood pressure rises, the brain is aroused and sleep is disrupted. In most cases a child’s vascular system can tolerate the changes in blood pressure and heart rate. However, a child’s brain does not tolerate the repeated interruptions to sleep, leading to a child that is sleep deprived, cranky and ill behaved.
The first diagnosis of sleep disordered breathing in children is made by the parent’s observation of snoring. Other observations may include obstructions to breathing, gasping, snorting and thrashing in bed as well as unexplained bedwetting. Social symptoms are difficult to diagnose but include alteration in mood, misbehavior and poor school performance.
A child with suspected SDB should be evaluated by an otolaryngologist – head and neck surgeon. If the symptoms are significant and the tonsils are enlarged, the child is strongly recommended for tonsillectomy and adenoidectomy (removal of the tonsils and adenoids). Conversely, if the symptoms are mild, academic performance remains excellent, the tonsils are small, and puberty is eminent (tonsils and adenoids shrink at puberty), it may be recommended that SDB be treated only if matters worsen. The majority of cases fall somewhere in between and physicians must evaluate each child on a case-by-case basis.
There are other pediatric sleep disorder diagnoses. Sudden infant death syndrome (SIDS) and apparent life threatening episode (ALTE) are considered forms of sleep disordered breathing. Children with these conditions warrant thorough evaluation by a pediatric sleep specialist. Children with craniofacial abnormalities, primarily abnormalities of the jaw bones, tongue and associated structures, often have sleep disordered breathing. This must be managed and the deformities treated as the child grows.
The sleep test is the standard diagnostic test for sleep disordered breathing. This test can be performed in a sleep laboratory or at home. Sleep tests can produce inaccurate results, especially in children. Borderline or normal sleep test results may still result in a diagnosis of SDB based on parental observation and clinical evaluation.
Enlarged tonsils are the most common cause for SDB, thus tonsillectomy and adenoidectomy is the most effective treatment for pediatric sleep disordered breathing. T & A achieves a 90% success rate for childhood SDB. Of the nearly 400,000 T & As performed in the United States each year, 75% are performed to treat sleep disordered breathing.
Not every child with snoring should undergo T & A. The procedure does have risks and possible complications. Aside from the mental anguish experienced by the parent and child, potential problems include: anesthesia risks, bleeding and infection.