Obstructive sleep apnea syndrome (OSA) in children means that the child has a respiratory delay due to narrow airways. This means that the child has a car sound when inhaled, usually snoring sounds, and sleeps anxiously. The lack of good sleep allows the child to become tired or hyperactive during the days. It can also be difficult to gain weight. If your child has a respiratory break or strained breathing while sleeping, contact a health care center.

Symptoms of obstructive sleep apnea syndrome in children

It is normal for children to receive occasional breathing breaks, especially during colds. However, if the child has more than one breathing break per sleep hour, it may have OSA. Some children have a more severe form of OSA with more than ten breathing pauses per day of sleep. Breathing pauses should be at least two breaths long, or about 10 seconds. Both short and long breathing breaks interfere with sleep. In addition, long periods of breathing may cause oxygen deficiency. It is usually heard when the child begins to breathe again after a break. Then the breathing sound is higher and the breathing movement is more powerful.

OSA occurs in children of all ages but is most common in preschool-age 2-6 years. At that age, the tonsils and the gland behind the nose are the biggest. But all children do not have breathing problems. Most children who have developed OSA need treatment because the problems usually do not grow away by themselves.

Central sleep apnea

There are children with central respiratory arrest, so-called central sleep apnea, CSA. The child then has no breathing movements but is completely still. This may be because the brain has not matured, that the lungs are sick or so-called gastroesophageal reflux. Stomach acid leaks from the stomach into the throat and can affect breathing. If your child shows signs of central apnea, contact your health care center.

Seek care

If your child has repeated breathing pauses, strained to breathe when sleeping or has difficulty gaining weight, contact a health care center. There you can then get a referral to an ear-nose-throat doctor.

You can seek care at any medical center or open specialist clinic you want throughout the country. You also have the opportunity to establish regular medical contact at the health center.

What happens in the body?

OSA in children is usually because the tonsils, tonsils, are large and take up too much space in the throat. Often, the gland behind the nose, the adenoid, is enlarged. Then it gets very crowded in the nasal and pharynx. This means that the child cannot breathe through the nose and instead breathe through the mouth, even during the day. The child snores and can take a breather during sleep.

A child who snores and has a respiratory break is asleep. The child can also sweat a lot. This means that the child can become tired during the days and not cope with activities at preschool or school. Some slightly smaller children may instead become hyperactive and difficult to concentrate.

The child’s natural development in the brain is disturbed if it does not sleep well. This can lead to impaired learning ability. Some children pee at night because of OSA. In addition, young children who have OSA may have difficulty gaining weight. In rare, very severe cases of OSA, the baby’s heart can be damaged. When treating OSA, the child’s body, with brain and heart, usually recovers well.

It is more common with OSA in certain risk groups and certain things can contribute to getting OSA. Some of these are: 

  • Being overweight can contribute to OSA. It is more common in teenagers. 
  • If the child has abnormalities in the facial skeleton, such as a small lower jaw or crossbite, the risk of OSA increases. The risk also increases for children with muscle weakness or Down syndrome.
  • Children with Prader-Willi syndrome may have OSA that can be exacerbated by growth hormone therapy.
  • In gastroesophageal reflux, gastric acid leaks from the stomach up to the throat. The acid is strong and can cause the upper airways to swell and make the throat even narrower. It can cause the child to have more breathing breaks and worsen OSA.

Treatment for obstructive sleep apnea syndrome in children

For mild problems, a nasal spray with cortisone can help. It reduces the swelling behind the nose. If the baby has reflux from the stomach, it is treated with antacids for the evening. It is almost always necessary to remove the tonsils at OSA. Most often, the gland is removed behind the nose at the same time. Sometimes it is enough just to remove the gland behind the nose. In some parts of the country, some of the tonsils are removed, so-called tonsillotomy. This method is considered easier for the child as it causes less pain after surgery. 

Operation

The three most common operations are:

  • Tonsillectomy the tonsils are completely removed
  • Tonsillotomy – parts of the tonsils are removed by laser, heat or radio waves to reduce the narrowing of the throat
  • Abrasion the gland behind the nose is removed by scraping.

Then the operation goes on

The child is anesthetized with anesthesia before the operation. In some hospitals, children 0-3 years, as a rule, stay overnight. On others, the child may go home the same day as the operation. Before the child is allowed to go home it should be able to eat and drink.

Aftercare

When the tonsils are removed, the child should be home for ten days. The pain after an operation of the tonsils can be troublesome for some children, even though they are given pain tablets. It may be good to take painkillers regularly.

The results of the operation at OSA in children are good. Almost all children get better and most become completely free of hassles. Some children may be followed up after surgery because they have less chance of being completely free from OSA.

There is no evidence that there would be any downside to the tonsils being operated on.

Investigation

An ear-nose-throat doctor examines the pharynx by pressing down the tongue with a spatula. If the gland behind the nose or trachea is to be examined, a so-called fibrous copy of the nose and throat is made. Then a thin tube, with a camera, is inserted through the nose. The examination may be a little unpleasant, but it usually does not hurt. In some cases, you need to record the breathing during sleep, either at a sleep lab or at home. In a sleep lab, especially young children with sleep and breathing problems are examined. There breathing is measured at the same time as sleep during one night. A parent is allowed to accompany and sleep with the child.   

If you have the opportunity, you can video film your child during sleep, where the sound of breathing can also be heard. It is important that the movements of the chest appear in the film so it can be good to avoid pajamas.

All children with Down syndrome are screened for OSA, preferably before the age of 4.

Complications

In young children, the tonsils grow back after an operation when parts of the tonsils are removed, tonsillotomy. Then the child should be operated again. It may also happen that the gland behind the nose, the adenoid, grows out again after surgery. Even then, the child should be re-operated.

Muhammad Nadeem

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