What is sleep apnoea?

Obstructive sleep apnoea is a condition that is characterised by the inability to keep the upper respiratory tract open during sleep.¹ 

The loosening of respiratory muscles becomes evident while sleeping,which causes inhaling and exhaling to become more difficult. This causes a decrease in oxygen levels in the blood, which means that there is an increased risk of insufficient oxygen uptake in body tissues. This oxygen deficiency causes the person to wake up. Oxygen levels usually return to normal shortly after. 

The rise and drop in blood oxygen levels can have negative impacts over time, especially for young children.¹ 

It is important to recognise the signs and seek medical advice if you have any concerns about the quality of your family’s sleep.

Symptoms of sleep apnoea in children

The following are potential nighttime indicators of paediatric sleep apnea:^1,2

• Snoring
• Long pauses between breaths
• Restlessness
• Mouth breathing
• Sweating
• Bedwetting

Whilst snoring could indicate that a child is suffering from obstructive sleep apnoea, it could be the consequence of a sleepless night if it does not happen often.

Children with sleep apnoea might also face issues during the day, such as:¹

• Poor performance in school
• Difficulty concentrating
• Struggle to put on weight
• Unpredictable behaviour, such as hyperactivity, lethargy, and aggression

Causes 

We can categorise the causes of sleep apnoea in children into three distinctive categories: enlargement of tonsils, muscle tone, and bone structure anomalies.¹ 

Enlarged tonsils

Larger adenoids or tonsils can cause paediatric sleep apnoea. Tonsils are glands that are located in the back of your throat. Adenoids are located behind your nasal cavity. 

If your child gets an infection or inflammation, these glands can become larger than usual. Genetics can also affect the size and growth of your glands.³

Muscle tone

Some genetic disorders, such as cerebral palsy or Down Syndrome, can alter the tone of the muscles in your child's head and neck.¹ 

While your child's muscle tone may be normal during the day, it lowers at night. This makes the tissue more likely to relax and obstruct the airway. 

Bone abnormalities

An overbite or small jaw are examples of narrow facial bone structures that can influence your child's air intake.¹

Risk factors

Some children are more prone to facing sleep apnoea than others. This includes children who are:¹ 

• Of African American descent
• Between 2 to 8 years old
• Born prematurely
• Assigned male at birth and have started puberty

Some factors can increase the severity of sleep apnoea:^1,3

• Having asthma or allergies
• Being in the vicinity of tobacco smoke
• A biological family history of sleep apnoea
• Being overweight
• Acid reflux issues
• Upper respiratory tract ailments

ADHD and its link to sleep-related conditions

Sleep apnoea, as well as other sleep-related conditions like restless legs syndrome and insomnia, appear to be more common in people with attention-deficit hyperactivity disorder (ADHD).⁴ 

Daytime symptoms of inattention and hyperactivity are common in children with sleep apnoea. People with ADHD also report a high frequency of sleep disturbances. An infrequent or disrupted sleep pattern is commonly associated with both conditions.

This overlap of symptoms suggests that regular screening for sleep problems could help with ADHD diagnosis and management in children.⁵ 

There are complex and varied relationships between ADHD and side effects from medications, problems sleeping, and mental health conditions.⁶ Therefore, it is important to monitor the signs of both sleep apnoea and ADHD in children.

Treatment options for paediatric sleep apnoea

Surgery

Surgery is the initial course of treatment for most children with obstructive sleep apnoea. Tonsillectomy and adenoidectomy are the most common treatments for children with sleep apnoea since adenotonsillar hypertrophy is the primary cause of blockages in most cases.¹

Medication

Certain nasal steroid sprays, antihistamine sprays, and oral drugs like montelukast are available for treating mild cases of sleep apnoea caused by allergies, enlarged tonsils, and/or enlarged adenoids.^7,8

Continuous positive airway pressure (CPAP)

Continuous positive airway pressure, which is abbreviated as CPAP, is an effective treatment option.It is a device that uses air pressure to keep your respiratory airways open while you sleep. 

CPAP is used for moderate to severe obstructive sleep apnea. It is more common for treating adult sleep apnoea, however, with a physician’s advice, children can use CPAP as a treatment via the use of a mask during sleep. 

Lifestyle management

Having a balanced diet is important for children to maintain a healthy body weight.

Overweight individuals are more likely to have severe sleep apnoea, whether they are adults or children. Numerous biological, psychological, and societal factors contribute to the childhood obesity epidemic.⁹

Weight loss can be useful for overweight and obese obstructive sleep apnoea patients.

Regular exercise is also recommended. Active movement can help to open the airway naturally. 

Stopping or reducing smoking can also be beneficial.³

Positional therapy

Positional therapy is used for people who experience sleep apnoea symptoms exclusively when lying on their backs. The therapy's effectiveness is particularly high for mild cases of sleep apnoea.

Even though the compliance of this therapy option is high, more data is needed for long-term use, thus more research should be conducted.¹⁰

FAQs

Do I have sleep apnoea?

If you snore everyday on a regular basis, and you feel down and crushed under the sense of weariness, you may have sleep apnoea. Although sleep apnoea is as common as diabetes or asthma, it can remain hidden due to the lack of prognosis procedures.

When should I see a doctor?

Make an appointment with your child's healthcare professional if your child wakes up in the morning feeling tired with sense of weariness and has behavioural problems on a regular basis.

Does adenotonsillectomy always cure obstructive sleep apnoea?

Surgery is the initial course of treatment for most children with obstructive sleep apnoea. This is because adenotonsillar hypertrophy is the primary cause of blockages in most cases. 

However, obese children may not be completely cured from this surgery alone, as other factors may be influencing their symptoms. 

Since there are advantages and disadvantages to each of these treatments, it's critical to evaluate each child to ensure that their airway will keep getting better as they sleep.

Summary

Obstructive sleep apnoea in children is a condition where the upper airway becomes partially or completely blocked during sleep, leading to disrupted breathing and reduced oxygen levels in the blood. This can cause both nighttime symptoms, such as snoring and restlessness, and daytime challenges, including poor concentration and behavioral issues. 

Enlarged tonsils, muscle tone variations, and bone structure abnormalities are common causes, with risk factors ranging from age and genetics to environmental influences like exposure to tobacco smoke. Treatment options include surgery, medications, CPAP devices, and lifestyle changes, with a focus on addressing the underlying causes and managing symptoms effectively. Early recognition and intervention are essential to improve outcomes and support children’s overall health and development.