Who Is At Risk For Sleep Apnea?
A number of factors put children at risk for sleep apnea. These include:
- Tonsils and adenoids. As mentioned earlier, most children with sleep apnea have enlarged tonsils and/or adenoids. Once the muscles in the neck relax during sleep, the big tonsils or adenoids block the airway and impede breathing.
- Illness. Children with frequent ear infections, sore throats, and tonsillitis are more likely to have sleep apnea. Allergies and asthma also can contribute to sleep apnea.
- Weight. Sleep apnea is more common in children who are overweight, as the extra weight around their necks can make their airways smaller. Not all children with sleep apnea are overweight, however. Many children of normal weight have sleep apnea, and children with sleep apnea can even be underweight.
- Physical structure. Other children who are at high risk for sleep apnea include those with abnormal bone structure in the jaw area. For instance, children who have a receding chin may have a smaller airway. Another potential cause may be a cleft palate, particularly if it has been repaired.
- Decreased muscle tone. Children with decreased muscle tone, as a result of such conditions as cerebral palsy or muscular dystrophy, are at risk for sleep apnea.
- Down syndrome. Children with Down syndrome are at risk for sleep apnea because they are often slightly overweight and because they often have an enlarged tongue that can block the airway during sleep. Studies have shown that almost half of all children with Down syndrome have sleep apnea.
Causes of Sleep Apnea In Children
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 arousals 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.
