Children and Sleep Apnea

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. Common

. Serious

. . Children

. Treatable

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Children and Sleep Apnea

This page discusses uncomplicated childhood sleep apnea. The American Academy of Pediatrics defines uncomplicated sleep apnea as obstructive sleep apnea in an otherwise healthy child, caused by any or all of:

enlarged tonsils
enlarged adenoids
obesity

Snoring is an important sign of uncomplicated childhood sleep apnea. The American Academy of Pediatrics recommends that all children be routinely screened for snoring. Asking parents is the usual method of screening. Children who snore should be evaluated further.

It is important to diagnose sleep apnea in children because the disease is common, serious, and treatable. The effects of treatment can be dramatic.

Common

About 2% of children have sleep apnea, or 1 in 50. Snoring occurs in 3% to 12% of children of pre-school age.

Serious

Sleep apnea in children can cause:

Behavioral and mental effects, including:

excessive sleepiness during the day
hyperactive behavior
other behavioral disturbances
decreased school performance
mental retardation (in severe, untreated cases)

Cardiovascular effects, including:

High blood pressure
High blood pressure in the lungs ("pulmonary hypertension")
Abnormal heart function

Diminished growth
Re-shaping of the ribs
Bed wetting
Worsening of co-existing medical conditions, including

Asthma
Epilepsy

One or more of these consequences of sleep apnea may be absent in some children, mild in some, and severe in others. Death from sleep apnea has occurred.
The behavioral effects of sleep apnea in children can be different from those in adults. Some children with sleep apnea have behaviors that are indistinguishable from attention deficit/hyperactivity disorder.

Treatable

Surgical removal of the tonsils and adenoids is the first-line treatment for most children. The success rate is 75% to 100%, even if the child is obese. Children who undergo surgery should be evaluated afterwards, to determine the effectiveness of the operation.
When surgery fails or is inadequate, it is possible to use breathing masks of the type used to treat adults.

Effects of Treatment

The American Academy of Pediatrics notes that childhood sleep apnea "can result in severe complications if left untreated.".
For most, if not all, of the sleep apnea consequences listed above, there is at least some evidence that treating sleep apnea leads to improvement.
For example, a remarkable study from New Orleans showed that treating sleep apnea in academically poor first graders leads to improved grades in school the next year.
Improvement is thought to be more likely the earlier the disease is diagnosed and treated.

References and Notes