What Causes Obstructive Sleep Apnea?

In children, the most common cause of OSA is enlarged tonsils and adenoids.  The path that air takes from the nose through the throat down towards the lungs is called the oropharyngeal airway.  The tonsils and adenoids form part of the ring of lymphoid tissue in the back of the throat.  If the tonsils and adenoids are large, they narrow the oropharyngeal airway and make breathing more difficult.  While awake they may cause symptoms such as a continuous stuffy nose, "nasal" speech or chronic mouth breathing.  During sleep, however, the muscles of the throat relax.  The combination of relaxed muscles and low pressure causes collapse of the throat and the child will be unable to breathe (apnea).  After a few seconds of struggling, the child is partially aroused from sleep (although he or she will not completely wake up), the muscle tone returns, and the throat opens-often with a gasp.  A child may go through many of these cycles in an hour, resuling in a disturbance of the normal sleep patterns.  Obesity may also cause obstructive sleep apnea.  It is less common than for adults. 

What are Tonsils?

The tonsils are two lumps of tissue on each side of the throat and can be seen through the mouth. When they are small (as in young babies and many adults) they are barely visible.  Children often have larger tonsils, and they can be big enough to touch each other ("kissing" tonsils).  The tonsils are lymphoid tissue, that is, the type of tissue that the body uses to fight infections.

What are Adenoids?

Adenoids are the name given to another group of lymphoid tissue that sits between the tonsils, higher up in the back of the mouth.  This tissue cannot be seen without special instruments or x-rays, since it is hidden behind the roof of the mouth.  It is located right behind the nose (in an area called the nasopharynx).

What is the Difference between Snoring, Sleep Disordered Breathing and Obstructive Sleep Apnea?

When it is severe, obstructive sleep apnea can result in serious conditions such as heart and lung strain, abnormalities in heart rhythm, growth disturbance, behavioral problems and concentration difficulties. Lesser degrees of sleep disturbance can cause bedwetting, or daytime sleepiness (since the sleep that htey are getting is not as restful as it could be), or hyperactivity in some children.  Sleep disturbance can also occur even without complete apnea, if the child is struggling to breathe against resistance and airflow is reduced.  The term Sleep Disordered Breathing (SBD) refers to the whole spectrum of these breathing problems, including OSA.  The spectrum ranges from mild snoring to severe life-threatening, obstuctive sleep apnea.  It is important to realize that whle mose children with sleep-disordered breathing have enlarged tonsils and adenoids, there are other casues of SDB, which will result in persistent symptoms even if the tonsils and adenoids are removed.  These include obesity, a small jaw, a big tongue, a variety of congential skull abnormalities, or neurological problems causing porr muscle tone.  Snoring is the sound of vibrating soft tissue in the back of the throat, caused by partical airway blockage.  Childhood snoring (like SDB) is often the result of enlargement of the tonsils and adenoids. Adults who snore usually have a long soft palate (extra tissue in the roof of the mouth) or nasal obstruction (such as allergies or a deviated septeum).  Obesity can also cause snoring.  While the sound can be disturbing to others sleeping in the same household, snoring by itself is not harmful if there is good air movement. 

Symptoms of OSA in Children

The following are the most common symptoms of obstuctive sleep apnea in children:

*Loud snoring or noisy breathing during sleep

*Pauses in breathing while sleeping-although the chest wall is moving, no air is moving through the nose or mouth into the lungs

*Chronic mouth breathing

*Restlessness during sleep

*Excessive daytime sleepiness or irritablity

*Bedwetting

*Hyperactivity of disruptive behavior in school

How is OSA Diagnosed?

If you suspect your child has obstructive sleep apnea, you should consult with your child's pediatrician, family practioner, or an ear, nose and throat physician (Otolaryngologist) for further evaluation.

A complete medical history and physical exam should be performed.  In addition, diagnostic procedures for OSA inlcude:

*Sleep history

*Evaluation of upper airway

*Sleep study.  This is commonly used in adults but rarely in children.  A sleep study is performed in a specialized sleep laboratory and the patient is monitored while he/she sleeps.  The sleep lab monitors brain activity to evaluate the quality of sleep, the electrical activity of the heart, the oxygen content of the blood, chest and abdominal wall movement, muscle activity, and the amount of air flowing through the nose and mouth.

Treatment of Obstructive Sleep Apena

The specific treatment for OSA will be determined by your child's physician based on your child's age, overall health, and medical history as well as the underlying cause of the condition.  Since enlarged tonsils and/or adenoids are usually the cause of OSA in children, the most common treatment is surgical removal of the tonsils and/or adenoids.  In the case of an otherwise normal child with enlarged tonsils, the cure rate of sleep disordered breathing and sleep apnea is greater than 90%.  If the cause of the disorder is obestiy, less invasive treatments may be approporiate, including weight loss and/or wearing a special mask while sleeping to keep the airway open. This mask delivers continouous positive airway pressure (CPAP).

If you suspect your child may be suffering from Obstructive Sleep Anea, you should arrange for an evaluation by the child's pediatrician, family practioner, or an Otolaryngologist (an Ear, Nose, and Throat physician).