The most common cause of obstructive sleep apnea in children is enlargement of the adenoids and tonsils. During sleep there is a considerable drop in muscle tone, which affects the airway and breathing. Many of these children have little difficulty breathing when awake; however, with decreased muscle tone during sleep, the airway becomes smaller, making the flow of air more difficult and the work of breathing harder.

An analogy can be made to breathing through a small, flimsy straw with the straw occasionally collapsing and obstructing airflow. These obstructions result in frequent brief arousal from sleep. Many of the short pauses (lasting only a few to twenty seconds or so) cause a brief arousal that increases muscle tone, opens the airway, and allows the child to resume breathing. Although the actual number of minutes of arousal during the night may be small, the repeated, chronic, but brief disruptions in sleep can lead to significant daytime symptoms in children.

A comparable image is being poked in the arm every few minutes throughout the night. The child is usually unaware of waking up, and the parent often describes the child as having very restless sleep but not necessarily waking up completely.

Daytime Symptoms Often Associated With Sleep Apnea In Children

• Appearing sleepy during the day. Children with sleep apnea are not getting enough sleep because their nighttime sleep is interrupted so frequently. Thus, your child may be sleepy during the day. He may be difficult to get up in the morning and may fall asleep in school or at other unusual times (such as during meals). Younger children may nap longer or take more naps than others their age.
• Appearing hyperactive during the day. Many children who do not get enough sleep do not look and act sleepy. Instead, they become wired and hyperactive. This is common. Don’t fool yourself by saying that your child is never tired because he is in constant motion. This may actually be a sign that he is overtired.
  Daytime behavior problems. Some children may have daytime behavior problems. For example, some children with sleep apnea are irritable, cranky, or easily frustrated. Others may have difficulty focusing their attention.
• Behavior has changed significantly. If your child’s behavior has changed significantly during the day, such as appearing more cranky, irritable, or sleepy, and if he also has other symptoms that are discussed above, the problem may be associated with sleep apnea.
• Falling asleep at inappropriate times or at times other than naptime. Your child may not be getting enough sleep if he is falling asleep at inappropriate times. For ex-ample, does he always fall asleep while riding in the car, whether for a two-minute or twenty-minute drive? Does he fall asleep at mealtimes?
• Health problems. Many children with sleep apnea have a history of chronic problems with tonsils, adenoids, and/or ear infections.
• Difficulty eating. Some children with sleep apnea are noisy eaters, probably because they have difficulty breathing solely through their nose while chewing. Other children with sleep apnea are slow eaters, and some even have problems swallowing, especially if they have very large tonsils.
• Slow growth. Sleep apnea may cause growth impairment, as growth hormone gets released during sleep. Children with growth impairment are usually impaired because of sleep apnea, she may have a sudden growth spurt when the sleep apnea is treated and catch up to other children her age.

Additional Symptoms Associated With Sleep Apnea In Older Children (Ages Six and Up)

• Bed-wetting. Older children with sleep apnea often continue to wet their beds beyond when you would expect them to stay dry all night. If your older child is continuing to wet his bed, check to make sure that he doesn’t have any of the symptoms listed above.
• Morning headache. Some children with sleep apnea will complain of having a headache in the morning. The headache is caused by the decrease in oxygen to the brain during the night. This diminished oxygen is unlikely to be harmful, although it sounds scary. This symptom may also occur in infants and toddlers, although it is difficult to know whether they have a headache.
• Difficulty in school. In older children the effects of sleep apnea may result in poor performance in school. These children may be labeled slow or lazy and may have difficulty focusing their attention on their schoolwork.

This entry was posted on Monday, April 20th, 2009 at 8:31 am and is filed under Sleep Apnea. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.