Sleep Apnea

Obstructive sleep apnea occurs when a child struggles and pauses to breathe during periods of sleep. This usually occurs because of a blockage in the airway, such as enlarged tonsils and adenoids, enlarged tongues, or obesity, among others.

At the CHOC Sleep Center, we specialize in diagnosing children with sleep apnea. Our comprehensive sleep studies evaluate breathing, brain activity, heart activity, oxygen content in the blood, chest and abdominal wall movement, muscle activity and the amount of air flowing through the nose and mouth. A technologist will intervene anytime an issue arises, including episodes of apnea. Sleep apnea is generally considered significant in children if two or more episodes occur per hour, in an overnight sleep.

What causes sleep apnea?

Sleep can occur in children with large tonsils and adenoids, which can make it difficult to breathe during sleep. It also occurs in children with congenital conditions affecting the upper airway (for example, conditions causing large tongue or small jaw) and in children whose brain doesn’t send proper signals to the muscles that control breathing. Obesity may also cause obstructive sleep apnea. Certain syndromes or birth defects, such as Down syndrome and Pierre Robin syndrome, can also cause obstructive sleep apnea.

What are the symptoms of sleep apnea?

The following are the most common symptoms of obstructive sleep apnea. However, each child may experience symptoms differently. Symptoms may include:

  • Loud snoring or noisy breathing during sleep.
  • Periods of not breathing or choking while breathing.
  • Mouth breathing. No air is moving from the nose to the throat, requiring a child to breathe through the mouth.
  • Restlessness during sleep, tossing and turning. This occurs with or without periods of being awake.
  • Hyperactivity during the day.
  • Excessive daytime sleepiness or irritability.
  • Excessive sweat during sleep or bedwetting.

How is sleep apnea diagnosed?

Often times, sleep apnea is diagnosed by our specialist based on a thorough history, as well as a detailed examination of your child. Occasionally, an overnight sleep study (polysomnogram), is needed to establish the diagnosis, or assess the severity of your child’s problem.

In certain patients, an endoscopic evaluation of the airway, also known as Drug Induced Sleep Endoscopy (DISE), is needed to evaluate the source of the issue. Your child’s care team uses the endoscopic evaluation to make decisions regarding the best steps in management of a child’s sleep apnea. These quick, outpatient endoscopic procedures are performed by members of our world-class otolaryngology team.

How is sleep apnea treated?

It is important to treat sleep apnea as soon as possible. Sometimes, sleep apnea can cause lowered blood oxygen levels, or increase carbon dioxide, which could lead to long-term effects.
The treatment for sleep apnea is based on the cause. Commonly, these include:

Tonsil and/or Adenoids Removal – Since enlarged tonsils and adenoids are the most common cause of airway blockage in children, treatment may include evaluation by a pediatric ear, nose and throat physician and possible surgery to remove the tonsils and/or adenoids.

CPAP or BIPAP – If surgery is not an option or elected, less invasive treatments may be appropriate, including weight loss with obesity and wearing a CPAP or BIPAP mask while sleeping to keep the airway open. This mask uses air pressure to force the airway open, acting like a splint. Our pulmonary team (including a pulmonologist, sleep psychologist, respiratory and sleep therapist, and case managers) will work closely with you and your child to learn how to properly use a mask and adapt your lifestyle to it.

Adjunct Surgeries – For certain patients, additional causes of sleep apnea may be identified during the diagnosis process, and may necessitate further surgical treatment. These include turbinate reduction, lingual tonsillectomy, tongue base reduction, epiglottopexy, and more. Our highly experienced sleep surgery team, led by Dr. Jay Bhatt, is available should additional surgical needs arise.

Inspire Therapy – CHOC is the first pediatric hospital in the state of California to offer Inspire therapy, which works inside the body with a patient’s natural breathing process to treat sleep apnea. Our multidisciplinary team consists of otolaryngologists (Dr. Jay Bhatt and Dr. Qiu Zhong) and pulmonologists (Dr. Chana Chin, Dr. Hanna Hong and Dr. Neal Nakra).

    • How does Inspire therapy work? Inspire sends stimulation to the tongue and ensures the airway remains open without interrupting sleep. Patients activate the device with a remote control before bedtime and deactivates it when they wake up. Patients can also use the remote to change the strength of stimulation. The stimulation is not painful or uncomfortable.
    • What is the procedure like? Inspire is implanted under the skin in the upper right chest and under the chin in an outpatient procedure. Most patients are able to go home the same day of the surgery.

  • Will Inspire limit my child’s activities? Inspire does not limit physical activity in children. Most patients get better sleep at night and experience improved moods, energy and focus.

Children and Snoring

In this segment of American Health Journal, Dr. Paul Lubinsky, associate director of the PICU at CHOC, explains the reasons why children snore and the treatments that are available.