Can Your Child Breathe While Asleep?

Obstructive sleep apnea in kids should be identified and treated

(RxWiki News) Snoring in small children can mean more than a noisy bedroom. It also might mean a child has obstructive sleep apnea — a big problem for little kids.

Obstructive sleep apnea can lead to many health problems if it's not treated.

The American Academy of Pediatrics recently published a list of recommendations related to obstructive sleep apnea in kids.

"Tell your pediatrician if your kid snores."

Carole L. Marcus, MBBCh, the director of the sleep center at the Children's Hospital of Philadelphia, led the committee that wrote the Clinical Practice Guideline.

Doctors use this guideline paper when diagnosing and treating obstructive sleep apnea in kids.

The guideline paper focused exclusively on obstructive sleep apnea that results from obesity or from enlarged tonsils or adenoids. Adenoids are lumps of tissue similar to tonsils that are behind the nose.

The researchers review 3,166 articles from 1999 through 2010 to come up with 350 studies with data that they could use for their recommendations.

The statement included eight recommendations that primary care doctors should follow, and these recommendations are useful for patients to know as well.

The first is that all children and teens should be screened for snoring. If your child snores, it's important to tell their pediatrician about it.

The next recommendation is to test children with snoring or other symptoms of obstructive sleep apnea using a sleep study.

Sleep studies are usually covered by insurance when they are required by a doctor. Without insurance, they can cost anywhere from about $2,000 to $6,000.

They involve a child sleeping overnight at a center while hooked up to electrodes that monitor their sleep, and there are no side effects to a sleep study.

The third recommendation is that children who have obstructive sleep apnea receive a type of surgery called an adenotonsillectomy.

This surgery removes a child's tonsils and adenoids since these tissues, when enlarged, are usually what cause the breathing obstructions when a child is sleeping.

Adenotonsillectomies, also usually covered by insurance, costs about $2,000 to $4,000. The most common complication is bleeding, which occur in 2 to 5 percent of children.

Other risks involve a reaction to the anesthesia or swelling in the tongue or the roof of the mouth. Infection can occur, but it is very rare.

Children who are high-risk patients who undergo the surgery should be monitored closely afterward in the hospital, the authors wrote.

After an adenotonsillectomy, children should be evaluated to see if they still have obstructive sleep apnea. The surgery is successful in 75 to 100 percent of patients, according to research conducted by the American Academy of Pediatrics.

If the child does still have symptoms of obstructive sleep apnea, a prescription of continuous positive airway pressure (CPAP) is recommended.

CPAP therapy involves wearing a mask while asleep that forces air into a person's air passageways. CPAP is also recommended if a child does not undergo an adenotonsillectomy.

CPAP masks can cost between approximately $30 and $200, and CPAP machines range from about $150 to over $5,500. Most insurance plans will cover some or all of CPAP therapy hardware.

The authors' also recommended that a child with obstructive sleep apnea lose weight if obesity is contributing to their condition.

Finally, children with mild obstructive sleep apnea who cannot or do not undergo an adenotonsillectomy, or who still have it after the surgery, can take intranasal corticosteroids to treat the condition.

William Kohler, MD, director of Pediatric Sleep Services at Florida Hospital Tampa, said it's important that parents and pediatricians realize how important it is to know if a child has sleep apnea.

"Obstructive sleep apnea can be a problem medically and psychologically to children if the sleep apnea goes undetected," Dr. Kohler said. "Being able to diagnose and treat it early will make a big difference in children's long-term cognitive, emotional development."

He said the AAP statement offers excellent recommendations.

"We need to have more education in the public about sleep apnea and its serious consequences," he said. "The public needs to know that treatment is available and makes a difference."

Dr. Kohler added that other symptoms of obstructive sleep apnea besides snoring include behavioral changes in the child, complaints of dryness in the mouth or a morning headache.

The clinical practice guideline statement was published August 27 in the journal Pediatrics.

Review Date: 
August 28, 2012