Do you have a child who sleeps as peacefully as a Boeing 737 jet taking off? Does your child seem to snore and stop breathing just long enough to make YOUR heartrate skyrocket, only to restart snoring loudly enough to ensure you don’t get to sleep for the rest of the night?  Well then this might be just the article for you.

Sleep apnoea is a condition that affects about 3% of children in the general population.¹

The term “apnoea” literally means “without breath” and we use it clinically to describe when someone temporarily stops breathing for 10 seconds or more.²  Sleep apnoea therefore, is when this happens whilst a person is asleep.  There are two main types of sleep apnoea, “obstructive sleep apnoea (OSA),” and “central sleep apnoea” (CSA).

By far the most common in both adults and children is obstructive sleep apnoea (comprising 90 to 96% of apnoeas) and in children, the most common cause is hypertrophy (or overgrowth) of the adenoids and/or tonsils, with obesity, cranio-facial abnormalities (anatomical abnormalities of the face or skull) and neuromuscular diseases all being major risk factors.¹  Central sleep apnoea is due to decreased output from breathing control centres in the brain.²

Why do we get so worried about sleep apnoea?

The reason why your paediatrician will take a sleep history and ask you about your child snoring is because the quality and quantity of a child’s sleep can literally affect every aspect of their life!

In OSA, the upper part of the airway partially collapses (or obstructs) meaning that air is not as easily moved in and out of the lungs.  The result of this is that the air sacs (or alveoli) in the lungs do not fill completely and the child does not effectively exchange oxygen and into the blood and carbon dioxide OUT of the blood as they would if they were awake.  Being in this relative hypoxic (low oxygen) state all night, can make a child wake up tired and poorly rested in the morning.  It can cause daytime somnolence (sleepiness), poor concentration and learning difficulties, behavioural problems³ and even medical issues long term (like hypertension, and pathological structural cardiac changes).⁴

In fact, studies have shown that even sleep disturbance in the absence of hypoxia can cause impairments in cognitive functioning (that is, intelligence and problem solving abilities).^5,6,7,8

Effects of sleep apnoea in children

• Cardiovascular
  • Hypertension (increased blood pressure) during sleep
  • Structural cardiac changes (increased right and left ventricular wall thickness)
• Neurocognitive/behavioural
  • Impairment in memory, attention
  • Learning difficulties
  • Challenging behaviours

So what will your doctor do about your child’s snoring or OSA?

Well it depends really on your child’s specific symptoms, but your doctor will likely ask you questions about things like:

• Snoring/noisy breathing
• Problematic night-time waking
• Nasal obstruction/congestion
• Recurrent tonsillitis
• Swallowing difficulties
• Daytime sleepiness or difficulty in getting out of bed in the morning

If they have cause of suspicion of OSA, the doctor will likely refer you to an Ear Nose and Throat specialist and/or a Sleep/Respiratory Physician, +/- ordering a sleep study.

Possible treatment pathways may include (but are not limited to) surgical removal of the tonsils/adenoids, topical anti-inflammatory treatments (eg steroid nasal spray), oral antihistamines (if allergy is suspected) and continuous positive airway pressure (CPAP).

So if you have concerns about your child and their sleep/snoring, make sure to see your friendly GP and/or paediatrician to rule out sleep apnoea as a cause.

REFERENCES:

1. Chang S, Chae K.  Obstructive sleep apnea syndrome in children.  Epidemiology, pathophysiology, diagnosis and sequelae.  Korean J Pediatr. 2010 Oct; 53(10): 863–871.
2. Australasian Sleep Association factsheet.  Obstructive Sleep Apnoea.  Accessed online at https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0006/212919/Obstructive_Sleep_Apnoea_Guidelines.pdf
3. https://www.rch.org.au/kidsinfo/fact_sheets/Childhood_obstructive_sleep_apnoea_OSA/
4. Nixon G, Davey M. Sleep apnoea in the child. Aust Fam Physician 2015; 44(6):352-355. Accessed at https://www.racgp.org.au/afp/2015/june/sleep-apnoea-in-the-child/

5. Gozal D. Sleep-disordered breathing and school performance in children. Pediatrics 1998;102:616–20.
6. Beebe DW. Neurobehavioral morbidity associated with disordered breathing during sleep in children: a comprehensive review. Sleep 2006;29:1115–34.
7. Biggs SN, Nixon GM, Horne RS. The conundrum of primary snoring in children: what are we missing in regards to cognitive and behavioural morbidity? Sleep Med Rev 2014;18:463–75.
8. Blunden S, Lushington K, Lorenzen B, Ooi T, Fung F, Kennedy D. Are sleep problems under-recognised in general practice? Arch Dis Child 2004;89:708–12.