SLEEP APNEA IN CHILDREN

What is the most common type of sleep apnea observed in children?
The most common type of sleep apnea which children suffer from is Obstructive Sleep Apnea Syndrome. This type of sleep Apnoea is usually characterized by repetitive episodes of upper airway obstruction that occurs during their sleep.  The majority of the children outgrow this problem if it is a minor problem. However it has been recognized as a cause of daytime attention and behavioral problems. It is also very difficult to diagnose this type of sleep apnea in children.

What can be the Causes of sleep apnea?
1. Obstructive sleep apnea in children is almost always caused by obstructive tonsils and adenoids.
2. Down syndromes: It is a chromosomal abnormality. Low muscle tone, narrow nasopharynx, large tongue, enlarged tonsils and adenoids are the conditions that occur in the cases of down syndromes and predisposes to apnea.
3. Craniofacial Syndromes: They are caused due to unusual facial features; especially nose, mouth, jaws. This puts them at a higher risk of obstructive sleep apnea.

Are there any conditions associated with sleep apnea?
There are three conditions associated with sleep apnea.
1. Apparent Life-Threatening Events:  It is a combination of apnea, change in color (mostly blue), change in muscle tone, choking, and / or gagging.
2. Apnea of Prematurity: This can be obstructive, central or mixed apnea. It is caused due to under-developed brain and respiratory conditions prevalent in premature babies.
3. Apnea of Infancy: This refers to apnea which occurs in children before 1 year and applies to infants who were born after full-term pregnancy.

What are the symptoms?
The common symptoms found in children with sleep apnea are:
* Excessive daytime sleepiness,
* snoring,
* mouth breathing, gasping / choking during sleep,
* restless sleep,
* sleeping in a strange position,
* developing high blood pressure, 
* failure to grow and thrive,
* frequent upper respiratory infection,
* enlarged tonsils and adenoids, 
* hyperactive behavior,
* personality changes,
* low productivity in school,
* interpersonal relationship problems,
* learning problems,
* irritability, difficulty in concentration,
* daytime cognitive and behavioral problems,
* Problems paying attention and aggressive behavior which could lead to problems at school.
* In more severe cases congestive heart failure can occur.

The symptoms vary with the age of the child. In some cases this problem can be seen as early as infancy.  Due to obstructive apnea their nose and throat gets blocked.  The result is restricted eating, as they find it tasteless, uncomfortable and painful. But the calorie requirements at this age are very high.  Thereby it leads to underdevelopment in children.

How is Sleep Apnea treated?

Treatment through devices: 
1. C-PAP (Continuous positive airway pressure) - This method is used for both obstructive and central sleep apnea.  In this method the patient's nose is covered by a mask.  Through that mask the air is supplied into the throat at a predetermined pressure level.  The pressure level can be controlled based on the individual. The controlled level of air pressure that is sent into the body keeps the airways from closing up or obstructing throughout the night.
2. Bi-Level positive airway pressure - This Expensive method provides two different pressure levels; a higher pressure level during inhalation and a lower pressure level during exhalation.  An electronic circuit continuously monitors the patient's breathing.

Treatment through Surgery:
1. In children, removing their tonsils, adenoids or polyps may solve the problem.
2. Tracheostomy - In this surgery a small incision is made in the neck and a tube with a valve is inserted.  During day time the valve is kept closed and opened up in the night to ensure free flow of the air thereby by-passing the blocked pathway.
3. Mandibular advancement surgery - A surgical correction of certain facial abnormalities is performed, where the upper and lower part of the jaw is moved forward from the rest of the facial bones. This enlarges the space between the tongue and the soft palate and helps in free movement of air.  
4. Uvulopalatoplasty - This surgery removes soft tissues at the back of the throat and palate, increasing the width of the airway at the throat opening. This method helps in reducing snoring but not very effective against apnea as the tissues deep inside the throat is not removed.

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